The paper titled “Comparison of Factors Associated With 30-Day and 90-Day Readmission Among a Global Cohort of Patients Hospitalised With Cirrhosis” is a large international prospective study examining what predicts 30-day versus 90-day hospital readmissions after discharge for patients hospitalized with cirrhosis.
Citation
Idilman R, et al. Comparison of Factors Associated With 30-Day and 90-Day Readmission Among a Global Cohort of Patients Hospitalised With Cirrhosis. Liver International. 2026. PMID: 42522657.
Study design
- 4,208 adults with cirrhosis
- 125 hospitals
- 37 countries
- Prospectively enrolled after non-elective hospitalization
- Outcomes tracked through 90 days after discharge
Key findings
1. Cirrhosis remains extraordinarily high risk after hospitalization
Within 90 days after discharge:
- 47% were readmitted
- 8% underwent liver transplantation
- 23% died
Those numbers emphasize how dangerous the post-discharge period is for decompensated cirrhosis.
2. Country income mattered enormously
Perhaps the most interesting finding was that country income independently predicted outcomes, including:
- 30-day readmission
- 90-day readmission
- likelihood of receiving a liver transplant
- 30-day mortality
- 90-day mortality
Patients in high-income countries had:
- higher readmission rates
- higher transplant rates
- lower mortality
This suggests that greater access to healthcare leads to more rehospitalization and transplantation but ultimately better survival.
3. The same clinical factors predicted both 30- and 90-day readmission
Independent predictors included:
- greater liver disease severity
- previous ascites
- prior hospitalization
- hyponatremia (low sodium)
- vasopressor use during hospitalization
In other words, the sickest patients continue to be at high risk well beyond the traditional 30-day quality window.
4. Some factors uniquely predicted later readmissions
Prior variceal bleeding was particularly associated with 90-day readmission rather than just 30-day readmission.
5. Predictors of death
Higher mortality after discharge was associated with:
- older age
- more severe liver disease
- mechanical ventilation during admission
- vasopressor use
- admission infections
- hospital-acquired (nosocomial) infections
These remained important predictors through 90 days.
Why this matters
The study suggests that healthcare systems should not focus solely on reducing 30-day readmissions. Patients with cirrhosis remain at very high risk for at least 90 days, so transitional care, hepatology follow-up, medication management, nutrition, and surveillance need to extend beyond the first month after discharge.
