# Predictors of 30-Day Readmission in Patients With Cirrhosis: A Retrospective Cohort Study

## TL;DR

This study identifies factors that increase the risk of hospital readmission within 30 days for patients with cirrhosis, aiming to improve care strategies.

## Contribution

The study provides new insights into specific clinical predictors of 30-day readmission in cirrhosis patients.

## Key findings

- Higher MELD scores, ascites, and prior hospitalization were strong predictors of 30-day readmission.
- Hepatic encephalopathy and hyponatremia also significantly increased readmission risk.
- Readmission rates were 27.3% among the studied cirrhosis patients.

## Abstract

Introduction: Cirrhosis is associated with significant morbidity and frequent hospital readmissions due to recurrent complications. Thirty-day readmission is an important quality metric linked to increased healthcare costs and mortality. Identifying predictors of early readmission may help guide targeted interventions.

Methods: We conducted a retrospective cohort study of adult patients (≥18 years) with cirrhosis admitted to a tertiary care center in Bahrain between January 1, 2023, and December 31, 2025. Demographic, clinical, and laboratory data were collected from electronic medical records. The primary outcome was 30-day hospital readmission. Multivariate logistic regression was used to identify independent predictors.

Results: A total of 527 patients were included, with a mean age of 56.8 ± 13.2 years; 324 (61.5%) were male. The most common etiologies were metabolic dysfunction-associated steatotic liver disease (203 (38.5%)), alcohol-related liver disease (143 (27.1%)), and viral hepatitis (130 (24.7%)). Ascites was present in 329 patients (62.4%) and hepatic encephalopathy in 184 patients (34.9%). Hyponatremia (serum sodium < 130 mmol/L) occurred in 148 patients (28.1%), and prior hospitalization within six months occurred in 211 patients (40.0%). The mean Model for End-Stage Liver Disease (MELD) score was 16.7 ± 6.3. The 30-day readmission rate was 144 (27.3%). Independent predictors of readmission included a higher MELD score (odds ratio (OR) 1.08 per point increase, 95% confidence interval (CI) 1.04-1.12, p < 0.001), ascites (OR 2.14, 95% CI 1.38-3.31, p = 0.001), hepatic encephalopathy (OR 1.89, 95% CI 1.21-2.95, p = 0.005), hyponatremia (OR 1.76, 95% CI 1.12-2.77, p = 0.014), and prior hospitalization (OR 2.58, 95% CI 1.65-4.04, p < 0.001).

Conclusion: Thirty-day readmission among patients with cirrhosis is common and is primarily driven by disease severity and complications. Higher MELD score, ascites, hepatic encephalopathy, hyponatremia, and prior hospitalization were independently associated with increased readmission risk. Identifying high-risk patients may allow implementation of targeted interventions, including optimization of medical management and early outpatient follow-up, to reduce readmission and improve outcomes.