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- Title
Healthcare Resource Utilization and Goals of Care Discussions in Patients with Cirrhosis and Acute Kidney Injury.
- Authors
Petrosyan, Romela; Endres, Paul; Ufere, Nneka N.; St. Hillien, Shelsea A.; Krinsky, Scott; Kalim, Sahir; Nigwekar, Sagar U.; Ouyang, Tianqi; Allegretti, Andrew S.
- Abstract
Background: Patients with cirrhosis and acute kidney injury (AKI) are critically ill and have high health care resource utilization (HCRU). The impact and timing of goals of care discussions on HCRU are not well described. Methods: 221 patients enrolled in a prospective cohort study of patients admitted with AKI and cirrhosis were reviewed. Documentation and timing of a goals of care discussions were analyzed as predictors of HCRU, defined as a composite outcome of intubation, initiation of renal replacement therapy, and/or admission to the intensive care unit. Results: Median MELD score was 26 [IQR 19, 33]. 29% patients were listed for liver transplant. 90-day mortality was 61%. 51% patients had at least one HCRU episode. Code status changed from admission to discharge from 91%/7%/0% to 68%/14%18% (full code/do not resuscitate/comfort measures, p < 0.001). 28% patients underwent goals of care discussions, with change in code status at a median of 16 [9, 22] days into admission. Only 18% of discussions were within 7 days of admission and all were after an HCRU event. Being listed for liver transplant was not associated with whether goals of care discussions occurred (23% listed vs. 31% non-listed, p = 0.24) but was associated with higher HCRU (69% vs. 43%; p < 0.001). Conclusion: Goals of care discussions occurred late into the hospital course, after episodes of HCRU. Efforts should be made to engage in these discussions earlier in the hospital stay, which may decrease HCRU rates in this critically ill population and align with patients' goals of care.
- Subjects
ACUTE kidney failure; CRITICALLY ill patient care; ORGAN transplant waiting lists; CIRRHOSIS of the liver; INTENSIVE care units; RENAL replacement therapy; LIVER transplantation
- Publication
Digestive Diseases & Sciences, 2024, Vol 69, Issue 6, p1948
- ISSN
0163-2116
- Publication type
Article
- DOI
10.1007/s10620-024-08317-9