The multifaceted spectrum of liver cirrhosis in older hospitalised patients: analysis of the REPOSI registry
Author:
De Vincentis Antonio1, Vespasiani-Gentilucci Umberto2, Costanzo Luisa1, Novella Alessio3, Cortesi Laura3, Nobili Alessandro3, Mannucci Pier Mannuccio4, Incalzi Raffaele Antonelli1, Mannucci Pier Mannuccio, Nobili Alessandro, Pietrangelo Antonello, Perticone Francesco, Licata Giuseppe, Violi Francesco, Corazza Gino Roberto, Corrao Salvatore, Marengoni Alessandra, Salerno Francesco, Cesari Matteo, Tettamanti Mauro, Pasina Luca, Franchi Carlotta, Franchi Carlotta, Cortesi Laura, Tettamanti Mauro, Miglio Gabriella, Tettamanti Mauro, Cortesi Laura, Ardoino Ilaria, Novella Alessio, Prisco Domenico, Silvestri Elena, Emmi Giacomo, Bettiol Alessandra, Mattioli Irene, Biolo Gianni, Zanetti Michela, Bartelloni Giacomo, Vanoli Massimo, Grignani Giulia, Pulixi Edoardo Alessandro, Lupattelli Graziana, Bianconi Vanessa, Alcidi Riccardo, Girelli Domenico, Busti Fabiana, Marchi Giacomo, Barbagallo Mario, Dominguez Ligia, Beneduce Vincenza, Cacioppo Federica, Corrao Salvatore, Natoli Giuseppe, Mularo Salvatore, Raspanti Massimo, Zoli Marco, Matacena Maria Laura, Orio Giuseppe, Magnolfi Eleonora, Serafini Giovanni, Simili Angelo, Palasciano Giuseppe, Modeo Maria Ester, Gennaro Carla Di, Cappellini Maria Domenica, Fabio Giovanna, De Amicis Margherita Migone, De Luca Giacomo, Scaramellini Natalia, Cesari Matteo, Rossi Paolo Dionigi, Damanti Sarah, Clerici Marta, Leoni Simona, Di Mauro Alessandra Danuta, Di Sabatino Antonio, Miceli Emanuela, Lenti Marco Vincenzo, Pisati Martina, Dominioni Costanza Caccia, Pontremoli Roberto, Beccati Valentina, Nobili Giulia, Leoncini Giovanna, Anastasio Luigi, Carbone Maria, Cipollone Francesco, Guagnano Maria Teresa, Rossi Ilaria, Mancuso Gerardo, Calipari Daniela, Bartone Mosè, Delitala Giuseppe, Berria Maria, Delitala Alessandro, Muscaritoli Maurizio, Molfino Alessio, Petrillo Enrico, Giorgi Antonella, Gracin Christian, Zuccalà Giuseppe, D'Aurizio Gabriella, Romanelli Giuseppe, Marengoni Alessandra, Volpini Andrea, Lucente Daniela, Picardi Antonio, Gentilucci Umberto Vespasiani, Bellelli Giuseppe, Corsi Maurizio, Antonucci Cesare, Sidoli Chiara, Principato Giulia, Arturi Franco, Succurro Elena, Tassone Bruno, Giofrè Federica, Serra Maria Grazia, Bleve Maria Antonietta, Brucato Antonio, De Falco Teresa, Fabris Fabrizio, Bertozzi Irene, Bogoni Giulia, Rabuini Maria Victoria, Prandini Tancredi, Manfredini Roberto, Fabbian Fabio, Boari Benedetta, De Giorgi Alfredo, Tiseo Ruana, Paolisso Giuseppe, Rizzo Maria Rosaria, Catalano Claudia, Borghi Claudio, Strocchi Enrico, Ianniello Eugenia, Soldati Mario, Schiavone Silvia, Bragagni Alessio, Sabbà Carlo, Vella Francesco Saverio, Suppressa Patrizia, De Vincenzo Giovanni Michele, Comitangelo Alessio, Amoruso Emanuele, Custodero Carlo, Fenoglio Luigi, Falcetta Andrea, Fracanzani Anna L, Tiraboschi Silvia, Cespiati Annalisa, Oberti Giovanna, Sigon Giordano, Peyvandi Flora, Rossio Raffaella, Colombo Giulia, Agosti Pasquale, Monzani Valter, Savojardo Valeria, Ceriani Giuliana, Salerno Francesco, Pallini Giada, Montecucco Fabrizio, Ottonello Luciano, Caserza Lara, Vischi Giulia, Liberato Nicola Lucio, Tognin Tiziana, Purrello Francesco, Di Pino Antonino, Piro Salvatore, Rozzini Renzo, Falanga Lina, Pisciotta Maria Stella, Bellucci Francesco Baffa, Buffelli Stefano, Montrucchio Giuseppe, Peasso Paolo, Favale Edoardo, Poletto Cesare, Margaria Carl, Sanino Maura, Violi Francesco, Perri Ludovica, Guasti Luigina, Castiglioni Luana, Maresca Andrea, Squizzato Alessandro, Campiotti Leonardo, Grossi Alessandra, Diprizio Roberto Davide, Bertolotti Marco, Mussi Chiara, Lancellotti Giulia, Libbra Maria Vittoria, Galassi Matteo, Grassi Yasmine, Greco Alessio, Sciacqua Angela, Perticone Maria, Battaglia Rosa, Maio Raffaele, Stanghellini Vincenzo, Ruggeri Eugenio, del Vecchio Sara, Salvi Andrea, Leonardi Roberto, Damiani Giampaolo, Capeci William, Mattioli Massimo, Martino Giuseppe Pio, Biondi Lorenzo, Pettinari Pietro, Ghio Riccardo, Col Anna Dal, Minisola Salvatore, Colangelo Luciano, Cilli Mirella, Labbadia Giancarlo, Afeltra Antonella, Pipita Maria Elena, Castellino Pietro, Zanoli Luca, Gennaro Alfio, Gaudio Agostino, Saracco Valter, Fogliati Marisa, Bussolino Carlo, Mete Francesca, Gino Miriam, Vigorito Carlo, Cittadini Antonio, Moreo Guido, Prolo Silvia, Pina Gloria, Ballestrero Alberto, Ferrando Fabio, Gonella Roberta, Cerminara Domenico, Berra Sergio, Dassi Simonetta, Nava Maria Cristina, Graziella Bruno, Baldassarre Stefano, Fragapani Salvatore, Gruden Gabriella, Galanti Giorgio, Mascherini Gabriele, Petri Cristian, Stefani Laura, Girino Margherita, Piccinelli Valeria, Nasso Francesco, Gioffrè Vincenza, Pasquale Maria, Sechi Leonardo, Catena Cristiana, Colussi Gianluca, Cavarape Alessandro, Da Porto Andea, Passariello Nicola, Rinaldi Luca, Berti Franco, Famularo Giuseppe, Tarsitani Patrizia, Castello Roberto, Pasino Michela, Ceda Gian Paolo, Maggio Marcello Giuseppe, Morganti Simonetta, Artoni Andrea, Grossi Margherita, Del Giacco Stefano, Firinu Davide, Costanzo Giulia, Argiolas Giacomo, Montalto Giuseppe, Licata Anna, Montalto Filippo Alessandro, Corica Francesco, Basile Giorgio, Catalano Antonino, Bellone Federica, Principato Concetto, Malatino Lorenzo, Stancanelli Benedetta, Terranova Valentina, Di Marca Salvatore, Di Quattro Rosario, Malfa Lara La, Caruso Rossella, Mecocci Patrizia, Ruggiero Carmelinda, Boccardi Virginia, Meschi Tiziana, Ticinesi Andrea, Nouvenne Antonio, Minuz Pietro, Fondrieschi Luigi, Imperiale Giandomenico Nigro, Pirisi Mario, Fra Gian Paolo, Sola Daniele, Bellan Mattia, Porta Massimo, Riva Piero, Quadri Roberto, Larovere Erica, Novelli Marco, Scanzi Giorgio, Mengoli Caterina, Provini Stella, Ricevuti Laura, Simeone Emilio, Scurti Rosa, Tolloso Fabio, Tarquini Roberto, Valoriani Alice, Dolenti Silvia, Vannini Giulia, Volpi Riccardo, Bocchi Pietro, Vignali Alessandro, Harari Sergio, Lonati Chiara, Napoli Federico, Aiello Italia, Landolfi Raffaele, Montalto Massimo, Mirijello Antonio, Purrello Francesco, Di Pino Antonino, del Primario Nome e Cognome, Ghidoni Silvia, Salvatore Teresa, Monaco Lucio, Ricozzi Carmen, Pilotto Alberto, Indiano Ilaria, Gandolfo Federica,
Affiliation:
1. Unit of Geriatrics, University Campus Bio-Medico, Rome, Italy 2. Unit of Internal Medicine and Hepatology, University Campus Bio-Medico, Rome, Italy 3. Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy 4. IRCCS Ca' Granda Maggiore Hospital Foundation and University of Milan, Milan, Italy
Abstract
Abstract
Background
Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce.
Objectives
To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties.
Methods
A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed.
Results
LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age–sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10–1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37–3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT.
Conclusions
LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features.
Publisher
Oxford University Press (OUP)
Subject
Geriatrics and Gerontology,Ageing,General Medicine
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