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Predictors of 1-month and 3-months Hospital Readmissions in Decompensated Cirrhosis: A Prospective Study in a Large Asian Cohort
Ruchir Patel
Corresponding author
ruchir.cn@gmail.com

Correspondence and reprint request:
, Prateik Poddar, Dhaval Choksi, Vikas Pandey, Meghraj Ingle, Harshad Khairnar, Prabha Sawant
Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Introduction</span><p id="p0010" class="elsevierStylePara elsevierViewall">Early hospital readmission has been considered as a surrogate marker of quality of any healthcare delivery system&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a> Hospital readmissions not only put financial burden on patients and their families but employ significant amount of healthcare resources&#44; physician consultations and economic as well as social burden on the society&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">2</span></a> Readmissions usually result from relapsing nature of the underlying disease&#44; complications during previous hospitalisation&#44; miscommunication between discharging hospital and physicians giving outpatient care and patient noncompliance&#46; Therefore evaluation of the causes and thereby their prevention are of utmost importance&#46; Sufficient amount of data have been produced delineating pre-dictors of readmissions in chronic heart failure and chronic obstructive lung disease and their implementation in patient care have reduced the number of readmissions enormously&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">Cirrhosis of liver is a chronic progressive disorder and an end result for various chronic liver diseases&#46; Decompensated chronic liver disease has been reported to be the third most common cause of death in USA in patients aged 45 to 64 years<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">5</span></a> and carries 10-fold higher risk of death as compared to general population&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">6</span></a> Apart from death&#44; it is also one of the leading causes of morbidity requiring frequent hospitalizations and readmissions&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">7</span></a> Studies have shown readmission rates of 20-37&#37; within 1-month and upto 53&#37; at 3-months&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">8-10</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">A handful of studies have come up in the last five years evaluating predictors of early readmissions in cirrhosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">8-12</span></a> However&#44; all of them have been conducted in the North America with majority of population being Caucasian and most of them are single center studies showing divergent results&#46; Severity of cirrhosis&#44; presence of diabetes and nosocomial infections predicted early readmissions in one study&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">10</span></a> whereas other brought Model for End stage Liver Disease &#40;MELD&#41; score&#44; serum sodium and number of medications to be associated with frequent readmissions&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">9</span></a> Also there is little uniformity in the time duration upto which readmissions have been considered as early&#46; Few have taken 30 days as the cut-off&#44;8&#44;9&#44;11 while some have measured 3-months readmission rates producing inconsistent results&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">10</span></a></p><p id="p0025" class="elsevierStylePara elsevierViewall">Our study is a prospective study to evaluate whether the severity of liver disease&#44; aetiology of cirrhosis and complications during initial hospitalisation for decompensated cirrhosis predict early &#40;1-month&#41; or late &#40;3-month&#41; readmissions&#46; It will also highlight the subtle differences&#44; if any&#44; in risk factors profile between these two time periods&#46; In addition&#44; this will be the first study to validate the predictors of readmission in decompensated cirrhosis in any Asian population&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Material and Methods</span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Study design</span><p id="p0030" class="elsevierStylePara elsevierViewall">This was a single center prospective study conducted at a large tertiary level public hospital in the Western India between August 2014 and August 2016&#46; Study protocol was approved by the institutional ethics committee of Lok-manya Tilak Municipal Medical College and complies with the ethical guidelines of 1975 declaration of Helsinki&#46; Informed written consent was obtained from all the study participants&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Inclusion criteria and exclusion criteria</span><p id="p0035" class="elsevierStylePara elsevierViewall">Study cohort included all the patients with age &#62; 18 years with cirrhosis of liver hospitalized due to any of the hepatic decompensations&#46; Patients who refused to give consent&#44; discharged against medical advice&#44; underwent liver transplantation or died during index hospitalisation or with inconclusive diagnosis of cirrhosis were excluded from the study&#46; Similarly&#44; patients admitted for elective reasons &#40;i&#46;e&#46; cirrhosis patient with hepatocellular carcinoma admitted for TACE&#44; cirrhosis patients admitted for conditions unrelated to liver cirrhosis&#41; were not included in the study population&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Patients</span><p id="p0040" class="elsevierStylePara elsevierViewall">Cirrhosis was diagnosed by combination of clinical symptoms&#44; laboratory evaluation &#40;e&#46;g&#46; low platelet count&#44; detailed liver profile&#41;&#44; radiological parameters &#40;coarse nodular liver&#44; splenomegaly and features of portal hypertension&#41; and endoscopic detection of oesophageal or gastric varices or portal hypertensive gastropathy &#40;PHG&#41;&#46; Liver biopsy was performed only in cases of doubtful chronic liver disease where diagnosis was uncertain&#46;</p><p id="p0045" class="elsevierStylePara elsevierViewall">Hepatic decompensation during the index hospitalisation included the following&#58; Volume overload &#40;ascites&#44; lower limb edema&#44; anasarca&#41;&#44; renal failure&#44; hepatic encephalopathy &#40;HE&#41;&#44; portal hypertensive bleeding and spontaneous bacterial peritonitis &#40;SBP&#41;&#46; They were defined as under&#46;</p><p id="p0050" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0010"><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">&#8226;</span><p id="p0055" class="elsevierStylePara elsevierViewall">Volume overload&#46; Ascites or anasarca or pedal edema requiring hospitalisation or paracentesis in patients with cirrhosis&#46;</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">&#8226;</span><p id="p0060" class="elsevierStylePara elsevierViewall">Hepatic encephalopathy&#46; Altered mental status or neuropsychiatric abnormalities in the presence of liver cirrhosis&#44; after exclusion of other causes&#46;</p></li><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">&#8226;</span><p id="p0065" class="elsevierStylePara elsevierViewall">Spontaneous bacterial peritonitis&#46; More than 250 polymorphonuclear leukocytes per high power field and&#47;or positive culture in the ascitic fluid&#46;</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">&#8226;</span><p id="p0070" class="elsevierStylePara elsevierViewall">Portal hypertensive bleeding&#46; Patients with gastrointestinal &#40;GI&#41; bleed with varices seen on endoscopy or significant bleed in a diagnosed case of cirrhosis&#46;</p></li><li class="elsevierStyleListItem" id="u0030"><span class="elsevierStyleLabel">&#8226;</span><p id="p0075" class="elsevierStylePara elsevierViewall">Renal failure&#46; Serum creatinine &#62; 1&#46;5 mg&#47;dL or rise in serum creatinine &#62; 0&#46;3 mg&#47;dL from the baseline in patients with ascites&#46;</p></li></ul></p><p id="p0080" class="elsevierStylePara elsevierViewall">In presence of more than one complications in one patient&#44; principal cause of hospitalisation was defined as per the following&#58; Patients with renal failure in presence of ascites were considered in renal failure group&#46; Likewise&#44; admissions with HE in presence of precipitating factors like GI bleed&#44; SBP or renal failure were attributed to the respective precipitating factor&#46; SBP in presence of GI bleed or renal failure were taken as SBP&#46;</p></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Study protocol</span><p id="p0085" class="elsevierStylePara elsevierViewall">Patients were enrolled in the study when they were hospitalized with decompensated cirrhosis&#46; During index hospitalisation&#44; data were collected and compiled regarding demographic profile&#44; history&#44; clinical features&#44; presence of other comorbidities&#44; aetiology of cirrhosis&#44; type of decompensation and number of complications&#44; blood laboratory parameters on discharge &#40;complete haemogram&#44; bilirubin&#44; transaminases&#44; albumin&#44; prothrombin time with international normalised ratio &#40;INR&#41;&#44; renal function tests and electrolytes&#41;&#44; Child Turcotte Pugh &#40;CTP&#41; score at discharge&#44; Model for End-Stage Liver Disease &#40;MELD&#41; score at discharge and length of stay during hospitalisation&#46; Patients were followed for 3 month to look for any event of readmission using liver clinic records&#44; institutional medical records or telephonic conversations&#46; Readmissions details that occurred in other hospitals were compiled either from the discharge cards or via telephonic talks&#46; Similarly&#44; patients electively readmitted for planned procedures&#44; surgery or therapy for hepatocellular carcinoma or admitted for reasons unrelated to liver disease were not considered in the evaluation&#46; Patients with incomplete follow up were not included in the final analysis&#46; The study protocol has been outlined in <a class="elsevierStyleCrossRef" href="#f0010">Figure 1</a>&#46;</p><elsevierMultimedia ident="f0010"></elsevierMultimedia></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Statistical analysis</span><p id="p0090" class="elsevierStylePara elsevierViewall">Incidence of readmission at 1-month and 3-months were calculated as percentage of total eligible readmissions&#46; Patients who were readmitted within 1-month of index hospitalisation were compared with those without readmission for demographic&#44; laboratory and disease variables during index hospitalisation&#46; Univariate analysis was done using Student&#8217;s t-test for parametric continuous variables and Mann-Whitney U test for nonparametric data&#46; Categorical variables were evaluated using &#37;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">2</span></a> test&#46; Variables with P value &#60; 0&#46;05 were further analysed by multivariate logistic regression analysis by forward stepwise selection model&#46; P value &#60; 0&#46;05 was considered as statistically significant&#46; Similar protocol was used to determine the predictors of readmission at 3-months&#46; Receiver operating characteristics &#40;ROC&#41; curves were obtained to get the cut-off values of variables that best predict hospital readmissions&#46; Differences between predictors at 1 and 3-months readmissions were also noted&#46; All statistical analyses were done using SPSS software version 16 &#40;SPSS Inc&#46;&#44; Chicago&#44; USA&#41;&#46;</p></span></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Results</span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Index hospitalisation</span><p id="p0095" class="elsevierStylePara elsevierViewall">Total 281 patients hospitalized with decompensated chronic liver disease and completed desired follow-up were included in the study analysis&#46; Mean age of the study population was 51&#46;3 &#177; 11&#46;1 years&#46; Majority of the patients were male &#40;195&#47;281&#44; 69&#46;4&#37;&#41;&#46; Demographic&#44; biochemical and aetiological characteristics of the study population are outlined in <a class="elsevierStyleCrossRef" href="#t0010">Table 1</a>&#46; Predominant aetiology of chronic liver disease was alcohol found in 47&#46;33&#37; patients &#40;133&#47;281&#41;&#44; followed by hepatitis B &#40;14&#46;95&#37;&#41;&#44; cryptogenic cirrhosis &#40;9&#46;96&#37;&#41; and non-alcoholic steatohepatitis &#40;NASH&#41; &#40;8&#46;19&#37;&#41;&#46; While&#44; the most common decompensation event responsible for index hospitalisation was volume over-load&#47;ascites &#40;27&#46;05&#37;&#41; followed by upper GI bleed&#44; renal failure&#44; spontaneous bacterial peritonitis and hepatic en-cephalopathy&#46; Average length of stay was 7&#46;97 &#177; 4&#46;28 days and average MELD score at discharge was 13&#46;9 &#177; 4&#46;2&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0085">Readmission at 1-month</span><p id="p0100" class="elsevierStylePara elsevierViewall">Seventy eight patients &#40;27&#46;8&#37;&#41; were readmitted within 1-month of index hospitalisation&#46; Median time to readmission was 18 days&#46; Volume overload related complications &#40;ascites in 26&#46;9&#37; and renal failure in 21&#46;8&#37;&#41; were the most common causes of readmission&#44; while incidence was highest in patients with HE during index stay &#40;46&#46;2&#37;&#41; and alcoholic cirrhosis &#40;35&#46;3&#37;&#41;&#46;</p></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0090">Univariate analysis</span><p id="p0105" class="elsevierStylePara elsevierViewall">Several continuous and categorical parameters during index hospitalisation were compared between patients who were readmitted within 1-month and those who were not &#40;<a class="elsevierStyleCrossRef" href="#t0015">Tables 2</a><a class="elsevierStyleCrossRef" href="#t0020">Table 3</a>&#41;&#46; Readmission rate was higher in males than in females &#40;32&#46;3&#37; <span class="elsevierStyleItalic">vs&#46;</span> 17&#46;4&#37;&#44; p-0&#46;014&#41;&#46; Among laboratory parameters&#44; serum bilirubin &#40;p &#60; 0&#46;001&#41;&#44; alanine aminotransferase &#40;p-0&#46;001&#41;&#44; aspartate aminotransferase &#40;p-0&#46;021&#41;&#44; INR &#40;p &#60; 0&#46;001&#41; and serum sodium &#40;p-0&#46;001&#41; were significantly associated with 1-month readmission&#46; Severity of liver disease as calculated by Model for End stage Liver Disease &#40;MELD&#41; score &#40;16&#46;6 vs&#46; 12&#46;9&#44; p &#60; 0&#46;001&#41; and Child Pugh &#40;CTP&#41; score &#40;9&#46;26 vs&#46; 8&#46;1&#44; P &#60; 0&#46;001&#41; were also correlated significantly with early readmissions at 1-month&#46; <a class="elsevierStyleCrossRef" href="#f0015">Figure 2</a> illustrates a bar diagram showing 1-month readmission rates in different MELD groups&#46; Patients with readmissions had longer index hospital stay &#40;9&#46;04 &#177; 5&#46;27 <span class="elsevierStyleItalic">vs</span> 7&#46;57 &#177; 3&#46;78&#44; p-0&#46;01&#41;&#46; Among categorical variables&#44; aetiology of liver disease &#40;p-0&#46;048&#41; and cause of decompensation during index hospitalisation &#40;p-0&#46;029&#41; were significantly associated with 1-month readmission&#44; whereas number of complications during index admission was statistically similar in both the groups &#40;p-0&#46;966&#41;&#46;</p><elsevierMultimedia ident="t0015"></elsevierMultimedia><elsevierMultimedia ident="t0020"></elsevierMultimedia><elsevierMultimedia ident="f0015"></elsevierMultimedia></span><span id="s0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0095">Multivariate analysis</span><p id="p0110" class="elsevierStylePara elsevierViewall">Variables with p value &#60; 0&#46;05 on univariate analysis were considered for building a forward stepwise model for multivariate binary logistic regression analysis&#46; Out of eleven risk factors&#44; only MELD score at discharge &#91;Odds Ratio &#40;OR&#41;&#58; 1&#46;24&#59; 95&#37; confidence interval &#40;CI&#41;&#58;1&#46;15 - 1&#46;34&#59; p-&#60; 0&#46;001&#93; and serum sodium during index stay &#91;OR&#58; 0&#46;94&#59; CI&#58; 0&#46;88 - 1&#46;00&#58; p&#58; 0&#46;039&#93; turned out to be the independent predictors of hospital readmissions at 1-month&#46; Interestingly&#44; neither the aetiology of cirrhosis nor the type of decompensation during index hospitalisation were the risk factors for early readmissions&#46; <a class="elsevierStyleCrossRef" href="#f0020">Figure 3A</a> shows ROC curve for MELD score for prediction of 1-month readmission with area under the curve &#40;AUC&#41; of 0&#46;778&#46; MELD score more than 14 best predicted 1-month readmissions&#46; Similarly&#44; AUC for serum sodium was 0&#46;599 with sodium level less than 133 as the best cut-off &#40;<a class="elsevierStyleCrossRef" href="#f0020">Figure 3B</a>&#41;&#46;</p><elsevierMultimedia ident="f0020"></elsevierMultimedia></span><span id="s0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0100">Readmissions at 3-months</span><p id="p0115" class="elsevierStylePara elsevierViewall">Incidence of 3-months readmissions was 42&#46;3&#37; in our study with total 119 patients readmitted 1 or more times&#46; Males had higher readmissions than females &#40;48&#46;7 vs&#46; 27&#46;9&#37;&#44; p-0&#46;002&#41;&#44; so as patients with alcoholic liver disease &#40;49&#46;6&#37;&#41;&#46; Continued alcohol intake post discharge was observed in 19&#46;5&#37; patients&#59; out of them&#44; readmissions were seen in 65&#46;4&#37; patients&#46; Patients with HE had highest readmissions at 3-months &#40;65&#46;4&#37;&#41;&#46;</p></span><span id="s0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0105">Univariate analysis</span><p id="p0120" class="elsevierStylePara elsevierViewall">When index hospitalisation variables were compared&#44; patients with 3-months hospital readmission had more severe cirrhosis &#40;MELD score &#91;p &#60; 0&#46;001&#93;&#44; CTP score &#91;p &#60; 0&#46;001&#93; and INR &#91;p-0&#46;009&#93;&#41; and low serum sodium &#40;p0&#46;003&#41; &#40;<a class="elsevierStyleCrossRef" href="#t0015">Table 2</a>&#41;&#46; Whereas&#44; no significant difference was noted in proportion of patients rehospitalised depending on the aetiology of cirrhosis &#40;p-0&#46;273&#41;&#46; Similarly&#44; number of complications during index hospitalisation &#40;p-0&#46;370&#41; and continued alcohol intake during follow up &#40;p-0&#46;084&#41; did not differ significantly between two groups&#46; &#40;<a class="elsevierStyleCrossRef" href="#t0020">Table 3</a>&#41;&#46;</p></span><span id="s0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0110">Multivariate analysis</span><p id="p0125" class="elsevierStylePara elsevierViewall">Similar to 1-month readmission&#44; MELD score at discharge &#91;OR&#58; 1&#46;11&#59; CI&#58; 1&#46;03-1&#46;19&#59; p&#58; 0&#46;003&#93; and low serum sodium &#91;OR&#58; 0&#46;94&#59; CI&#58; 0&#46;87 - 0&#46;99&#59; p&#58; 0&#46;027&#93; were also independent predictors of 3-month readmissions on binary logistic regression analysis&#46; In addition&#44; Male gender emerged as independent risk factor for 3-months readmissions &#91;OR&#58; 2&#46;19&#59; CI&#58; 1&#46;26 - 3&#46;92&#59; p&#58; 0&#46;008&#93;&#46; ROC curve of MELD score predicting 3-months readmission has been drafted in <a class="elsevierStyleCrossRef" href="#f0025">Figure 4A</a>&#44; which is showing AUC of 0&#46;678&#46; Most accurate cut-offs for the MELD score and serum sodium levels were 14 and 133 mEq&#47;L respectively&#44; beyond which the risk of readmission was highest &#40;<a class="elsevierStyleCrossRef" href="#f0025">Figure 4B</a>&#41;&#46;</p><elsevierMultimedia ident="f0025"></elsevierMultimedia><p id="p01000" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="t0025"></elsevierMultimedia></p></span></span><span id="s0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0115">Discussion</span><p id="p0130" class="elsevierStylePara elsevierViewall">Patients with decompensated cirrhosis are most vulnerable to hospital readmissions early after discharge because of several reasons e&#46;g&#46; immediate effects and recurrent nature of complications prevalent during index admission&#44; need for frequent titration of medications like diuretics and lactulose&#44; need for laboratory tests and frequent follow up visits&#44; side effects of medications and transfer of patients from indoor tertiary care to community level physicians&#46; In addition to that&#44; noncompliance to medications and diet&#44; alcohol addiction and intake of complementary and alternative medications further predispose this already vulnerable population to increased risk of rehospitalisation&#46;</p><p id="p0135" class="elsevierStylePara elsevierViewall">The present study showed incidence of readmission of 27&#46;8&#37; at 1-month and 42&#46;3&#37; at 3-months in an Asian Indian cohort of decompensated chronic liver disease&#46; These rates were lower than those found in the North American cohorts&#44; which showed readmission rates of upto 37&#37; at 1-month<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">9</span></a> and 53&#37; at 3 months&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">10</span></a> Only MELD score at discharge and serum sodium during hospital stay independently predicted both 1-month and 3-months readmissions&#44; whereas male gender predicted only 3-months readmissions&#46; MELD score was a better predictor than serum sodium for both the time periods &#40;difference of AUC-0&#46;179&#44; p-0&#46;0001 for 1-month readmission&#59; difference of AUC-0&#46;086&#44; p-0&#46;038 for 3-months readmission&#41;&#46; Despite of being a single center study&#44; the results were comparable to other larger multicentre studies&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">10</span></a></p><p id="p0140" class="elsevierStylePara elsevierViewall">Severity of liver disease during index hospitalisation&#44; as represented by MELD score at discharge&#44; was independently associated with readmissions in our study&#46; Initially developed to predict 3-months survival of patients undergoing transjugular intrahepatic portosystemic shunt &#40;TIPS&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">13</span></a> MELD score has been validated for multiple outcomes in cirrhosis ranging from organ allocation in liver transplantation<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">14</span></a> and acute liver failure<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">15</span></a> to prediction of perioperative mortality in other surgical procedures&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">14</span></a> prognosis and treatment of acute on chronic liver failure &#40;ACLF&#41;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">16</span></a> and alcoholic hepatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">17</span></a> This finding was analogous to the reports from the NACSELD group and other single center studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">8-12</span></a> Our study corroborates the previous studies<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">8-12</span></a> and validates the MELD score to predict hospital readmissions upto 3-months in the Asian population&#46; The odds of 1-month readmission increased by 24&#37; and 3-months readmission increased by 11&#37; for each one point increase in the MELD score at discharge in our study&#46; Patients with MELD score more than 14 had the largest area under the ROC curve &#40;AUC-0&#46;778&#41; with sensitivity of 73&#46;4&#37; and specificity of 70&#46;4&#37; in predicting 1-month readmissions&#59; higher than predicting 3-months readmission &#40;AUC-0&#46;678&#41;&#46; In our study&#44; serum sodium independently predicted early hospital readmissions&#46; With each 1 mEq&#47;L decrease in serum sodium concentration&#44; odds of readmission increased by 6&#37; both at 1-month and 3-months&#46; Serum sodium less than 133 mEq&#47;L best predicted early readmissions with 52&#46;6&#37; sensitivity and 65&#46;8&#37; specificity &#40;1-month readmission AUC-0&#46;599&#44; 3-months readmission AUC-0&#46;592&#41;&#46; Hyponatremia is common in advanced chronic liver disease and predicts mortality independent of the MELD score&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">18</span></a> Additionally&#44; studies have also shown that combining hyponatremia with MELD score predicts mortality better than MELD score alone<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">19&#44;20</span></a> and thereby serum sodium has been recently included in the organ allocation criteria for liver transplantation&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">21</span></a> Our study described another predictive role of serum sodium in estimating 1-month and 3-months readmissions in decompensated cirrhosis&#46;</p><p id="p0145" class="elsevierStylePara elsevierViewall">Males were highly predisposed to readmissions with odds of readmission 119&#37; higher than the females&#46; Males constitute nearly 70&#37; of our study population and 90&#37; of the alcoholic cirrhosis cohort&#44; which had the highest readmission rates among all the aetiologies &#40;upto 49&#46;6&#37;&#41;&#46; In India&#44; alcohol still predominates as a cause of cirrhosis and males form the majority among patients with alcohol abuse&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">22</span></a> Anecdotally&#44; we see high prevalence of certain psychosocial factors like noncompliance&#44; substance addictions and avoidance of healthcare in males and that might explain the drastic difference of readmission between the genders&#59; however these should be confirmed by evidence based studies&#46;</p><p id="p0150" class="elsevierStylePara elsevierViewall">Contradictory to many North American studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">8&#44;10&#44;12</span></a> presence of diabetes did not turn up as a risk factor for early or late hospital readmissions in advanced cirrhosis in this study&#46; Few reasons could elucidate this finding&#46; First&#44; lesser prevalence of NASH in India as compared to the West might be the primary justification&#46; In India&#44; the prevalence of NASH has been estimated between 9-32&#37; in epidemiological studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">23&#44;24</span></a> NASH as a cause of cirrhosis was seen in only 8&#46;2&#37; of patients in our study&#46; Alcohol and chronic viral hepatitis B and C are still the leading causes of cirrhosis in India than the west&#44; where much sizeable proportion is formed by NASH related cirrhosis&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">25</span></a> Second&#44; our center is a tertiary care public hospital where majority of the treated patients belong to lower or middle income groups&#46; NASH is seen less commonly in these class of patients with higher proportions of country liquor abuse&#46;</p><p id="p0155" class="elsevierStylePara elsevierViewall">Clinical experience suggests that complications like renal failure or HE are more recurrent than others and elevate readmissions within days of discharge&#46; We initially hypothesized that they could be the possible risk factors for 1-month readmissions&#46; Despite of higher proportion of readmissions in patients with HE than others &#40;46&#46;2&#37; <span class="elsevierStyleItalic">vs&#46;</span> 27&#46;8&#37;&#59; p-0&#46;029&#41;&#44; only MELD score and serum sodium turned to be the better predictors on logistic regression&#46; Similarly&#44; aetiology of cirrhosis did not predict readmissions&#44; even though very high readmission rates were seen in certain aetiologies like alcoholic liver disease&#46; In spite of being an index of cirrhosis severity&#44; CTP score did not appear as a risk factor&#46; Individually bilirubin and INR were associated with readmissions but other insignificant factors like albumin&#44; ascites and mental status made all-inclusive CTP score insignificant&#46;</p><p id="p0160" class="elsevierStylePara elsevierViewall">Few recognised limitations of our study must be discussed&#46; Being a single center study&#44; it does not represent the entire region&#46; However patients are referred to our hospital from a larger region of a country extending from the Northern states to the East and South India&#46; Socioeconomic risk factors like patient education&#44; social status&#44; economic class and other influencing variables like use of complementary and alternative medications&#44; presence and degree of noncompliance by the patient were not taken into consideration in the present study&#46; They will need to be addressed in similar studies&#46; Not exactly a limitation&#44; but liver transplantation should be mentioned in brief&#46; We have a common public hospital transplant program in our city&#46; In spite of that none of our patients underwent liver transplantation during index hospitalisation or during follow-up&#46; Extremely high costs&#44; poor availability of organs and nonparticipation of public hospitals have made liver transplantation out of reach to even middle income groups in India&#59; only &#60; 2&#37; transplantations occur in public hospitals&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">25</span></a> However its overall impact on incidence and prediction of readmissions remains negligible&#46;</p><p id="p0165" class="elsevierStylePara elsevierViewall">In conclusion&#44; this study showed high early and late readmission rates in the Asian Indian cohort of decompensated chronic liver disease&#46; MELD score&#44; serum sodium and male gender turned up as independent risk factors for readmission&#46; Our study will provide useful insight to design such targeted interventions in patients with advanced liver disease and help mitigate readmissions&#46; Finally&#44; our study was notable in such a way that it was the first to validate the above described risk factors as predictors of hospital readmission in advanced cirrhosis in an Asian population&#46;</p></span><span id="s0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0120">Abbreviations</span><p id="p0170" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0015"><li class="elsevierStyleListItem" id="u0035"><span class="elsevierStyleLabel">&#8226;</span><p id="p0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">ACLF</span>&#58; cute on chronic liver failure&#46;</p></li><li class="elsevierStyleListItem" id="u0040"><span class="elsevierStyleLabel">&#8226;</span><p id="p0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">AUC</span>&#58; area under the curve&#46;</p></li><li class="elsevierStyleListItem" id="u0045"><span class="elsevierStyleLabel">&#8226;</span><p id="p0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">CI</span>&#58; confidence interval&#46;</p></li><li class="elsevierStyleListItem" id="u0050"><span class="elsevierStyleLabel">&#8226;</span><p id="p0190" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">CTP</span>&#58; child turcotte pugh&#46;</p></li><li class="elsevierStyleListItem" id="u0055"><span class="elsevierStyleLabel">&#8226;</span><p id="p0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">GI</span>&#58; gastrointestinal&#46;</p></li><li class="elsevierStyleListItem" id="u0060"><span class="elsevierStyleLabel">&#8226;</span><p id="p0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HE</span>&#58; hepatic encephalopathy&#46;</p></li><li class="elsevierStyleListItem" id="u0065"><span class="elsevierStyleLabel">&#8226;</span><p id="p0205" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">INR</span>&#58; International Normalised Ratio&#46;</p></li><li class="elsevierStyleListItem" id="u0070"><span class="elsevierStyleLabel">&#8226;</span><p id="p0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">MELD</span>&#58; Model for End stage Liver Disease&#46;</p></li><li class="elsevierStyleListItem" id="u0075"><span class="elsevierStyleLabel">&#8226;</span><p id="p0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">cNACSELD</span>&#58; The North American Consortium for End Stage Liver Disease&#46;</p></li><li class="elsevierStyleListItem" id="u0080"><span class="elsevierStyleLabel">&#8226;</span><p id="p0220" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">NASH</span>&#58; non-alcoholic steatohepatitis&#46;</p></li><li class="elsevierStyleListItem" id="u0085"><span class="elsevierStyleLabel">&#8226;</span><p id="p0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">OR</span>&#58; Odd&#8217; ratio&#46;</p></li><li class="elsevierStyleListItem" id="u0090"><span class="elsevierStyleLabel">&#8226;</span><p id="p0230" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">PHG</span>&#58; portal hypertensive gastropathy&#46;</p></li><li class="elsevierStyleListItem" id="u0095"><span class="elsevierStyleLabel">&#8226;</span><p id="p0235" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">ROC urve</span>&#58; receiver operating characteristics curve&#46;</p></li><li class="elsevierStyleListItem" id="u0100"><span class="elsevierStyleLabel">&#8226;</span><p id="p0240" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">SBP</span>&#58; spontaneous bacterial peritonitis&#46;</p></li><li class="elsevierStyleListItem" id="u0105"><span class="elsevierStyleLabel">&#8226;</span><p id="p0245" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">TIPS</span>&#58; transjugular intrahepatic portosystemic shunt&#46;</p></li></ul></p></span><span id="s0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0125">Financial Support</span><p id="p0250" class="elsevierStylePara elsevierViewall">No financial assistance was taken for the execution of the study&#46;</p></span><span id="s0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0130">Conflicts of Interest</span><p id="p0255" class="elsevierStylePara elsevierViewall">The authors declares that there is no conflict of interest regarding the publication of this article&#46;</p></span></span>"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Introduction and aim</span><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Considered as a healthcare quality indicator&#44; hospital readmissions in decompensated cirrhosis predispose the patients and the society to physical&#44; social and economic distresses&#46; Few studies involving North American cohorts have identified different predictors&#46; The aim of this study was to determine and validate the predictors of 1-month and 3-months readmission in an Asian cohort&#46;</p></span> <span id="abs0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Material and methods&#46;</span><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">We prospectively studied 281 hospitalised patients with decompensated cirrhosis at a large tertiary care public hospital in India between August 2014 and August 2016 and followed them for 3 months&#46; Data regarding demographic&#44; laboratory and disease related risk factors were compiled&#46; We used multivariate logistic regression to determine predictors of readmission at 1-month and 3-months and receiver operating curves &#40;ROC&#41; for significant predictors to obtain the best cut-offs&#46;</p></span> <span id="abs0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Results</span><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall">1-month and 3-months readmission rates in our study were 27&#46;8&#37; and 42&#46;3&#37;&#44; respectively&#46; Model for End stage Liver Disease &#40;MELD&#41; score at discharge &#40;OR&#58;1&#46;24&#44; p &#60; 0&#46;001&#41; and serum sodium &#40;OR&#58;0&#46;94&#44; p-0&#46;039&#41; independently predicted 1-month and MELD score &#40;OR&#58;1&#46;11&#44; p-0&#46;003&#41;&#44; serum sodium &#40;OR&#58;0&#46;94&#44; p-0&#46;027&#41; and male gender &#40;OR&#58;2&#46;19&#44; p-0&#46;008&#41; independently predicted 3-months readmissions&#46; Neither aetiology nor complications of cirrhosis emerged as risk factors&#46; MELD score &#62;14 at discharge and serum sodium &#60; 133 mEq&#47;L best predicted readmissions&#59; MELD score being a better predictor than serum sodium &#40;p - 0&#46;0001&#41;&#46;</p></span> <span id="abs0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Conclusions</span><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">High rates of early and late readmissions were found in our study&#46; Further&#44; this study validated readmission predictors in Asian patients&#46; Structured interventions targeting this risk factors may diminish readmissions in decompensated cirrhosis&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abs0010"
            "titulo" => "Introduction and aim"
          ]
          1 => array:2 [
            "identificador" => "abs0015"
            "titulo" => "Material and methods&#46;"
          ]
          2 => array:2 [
            "identificador" => "abs0020"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abs0025"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:8 [
      0 => array:7 [
        "identificador" => "f0010"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1050
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        "descripcion" => array:1 [
          "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Study protocol showing patient enrollment criteria and 1 month and 3 months readmissions&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "f0015"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 824
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        "descripcion" => array:1 [
          "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Rates of 1 month readmission according to MELD score&#46; Patients with higher MELD had significantly higher 1 month readmission &#40;P &#60; 0&#46;001&#41;&#46; &#40;mElD-Model for End stage Liver Disease&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "f0020"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 843
            "Ancho" => 1986
            "Tamanyo" => 95335
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">A&#46; Receiver operating characteristic curve of Model for End Stage Liver Disease &#40;MELD&#41; score that predicts 1-month readmission in decompensated cirrhosis &#40;area under the curve-0&#46;778&#41;&#46; A MELD score more than 14 best predicts readmission at 1 month with sensitivity of 73&#46;1&#37; and specificity of 70&#46;4&#37;&#46; <span class="elsevierStyleBold">B</span>&#46; Receiver operating characteristic curve of serum sodium that predicts 1-month readmission in decompensated cirrhosis &#40;area under the curve - 0&#46;599&#41;&#46; Serum sodium level less than 133 meq&#47;L best predicts readmission at 1-month with sensitivity of 52&#44;6&#37; and specificity of 65&#46;8&#37;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "f0025"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 843
            "Ancho" => 1984
            "Tamanyo" => 89840
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A</span>&#46; Receiver operating characteristic curve of Model for End Stage Liver Disease &#40;MELD&#41; score that predicts 3-months readmission in decompensated cirrhosis &#40;area under the curve-0&#46;678&#41;&#46; A MELD score more than 14 best predicts readmission at 3 months with 57&#46;1&#37; sensitivity and 69&#46;8&#37; specificity&#46; <span class="elsevierStyleBold">B</span>&#46; Receiver operating characteristic curve of serum sodium that predicts 3-months readmission in decompensated cirrhosis &#40;area under the curve - 0&#46;592&#41;&#46; Serum sodium level less than 133 mEq&#47;L best predicts readmission at 3-months with sensitivity of 49&#44;2&#37; and specificity of 67&#46;9&#37;&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "t0010"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "SD&#58; standard deviation&#46; n&#58; number&#46; SBP&#58; spontaneous bacterial peritonitis&#46; MELD&#58; Model for End stage Liver Disease&#46;"
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient parameter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total number of patients &#40;n-281&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#40;Mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;3 &#177; 11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gender &#40;n&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">195 &#40;69&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86 &#40;30&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 month readmission &#40;n&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;27&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 month readmission &#40;n&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119 &#40;42&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aetiology of cirrhosis &#40;n&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133 &#40;47&#46;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatitis B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;14&#46;95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatitis C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;7&#46;83&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-alcoholic steatohepatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;8&#46;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cryptogenic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;9&#46;96&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;11&#46;74&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cause of index admission &#40;n&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ascites&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;27&#46;05&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;15&#46;66&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatic encephalopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;9&#46;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;14&#46;59&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Portal hypertensive bleed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;21&#46;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;11&#46;74&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Length of stay &#40;days&#41; &#40;Mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;97 &#177; 4&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MELD score at discharge &#40;Mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;9 &#177; 4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presence of diabetes &#40;n&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;17&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Continued alcohol intake at 3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#47;133 &#40;19&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Parameter&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients with 1 month Readmission &#40;Mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients without 1 month Readmission &#40;Mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P Value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients with 3 months Readmission &#40;Mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients without 3 months Readmission &#40;Mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P Value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6492 &#177; 3304&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;21&#44;957 &#177; 81&#44;124&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;20&#44;999 &#177; 84&#44;254&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;14&#44;516 &#177; 71&#44;103&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;26&#44;222 &#177; 91&#44;053&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Bilirubin &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">AST &#40;IU&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Protein &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Albumin &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15&#46;28 &#177; 8&#46;61&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Creatinine &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">CTP score&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">MELD score&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Length of stay &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#46;04 &#177; 5&#46;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;57 &#177; 3&#46;78&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;010&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#46;44 &#177; 5&#46;10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#46;64 &#177; 3&#46;55&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;121&nbsp;\t\t\t\t\t\t\n
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                  """
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              "imagenFichero" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">Univariate analysis of continuous variables between patients who readmitted at 1 month or 3 months and those who did not require readmission within same time durations&#46;</p>"
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "fuente" => "<span class="elsevierStyleItalic">n&#58; number&#46; NASH&#58; non-alcoholic steatohepatitis&#46; HE&#58; hepatic encephalopathy&#46; SBP&#58; spontaneous bacterial peritonitis&#46;</span>"
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Parameter&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients with 1 month Readmission &#40;n-78&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients with 3 month Readmission &#40;n-119&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aetiology of cirrhosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;048&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;273&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatitis B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatitis C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NASH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cryptogenic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cause of index admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;062&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ascites&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Portal hypertensive bleed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;966&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;370&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Continued alcohol intake&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;084&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presence of diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;451&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;631&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">Univariate analysis of categorical variables between patients who readmitted at 1 month or 3 months and those who did not require readmissions&#46;</p>"
        ]
      ]
      7 => array:8 [
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        "fuente" => "<span class="elsevierStyleItalic">CI&#58; confidence interval&#46; MELD&#58; Model for End stage Liver Disease&#46;</span>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Predictors&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Odds Ratio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 month readmission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MELD score at discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;15-1&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Serum Sodium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;88-1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 months readmission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;26-3&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MELD score at discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;03-1&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Serum Sodium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;87-0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2092120.png"
              ]
            ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0065" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis of independent predictors associated with early hospital readmissions&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bs0010"
          "bibliografiaReferencia" => array:25 [
            0 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early readmissions to the department of medicine as a screening tool for monitoring quality of care problems&#46;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Balla U&#46;"
                            1 => "Malnick S&#46;"
                            2 => "Schattner A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MD.0b013e3181886f93"
                      "Revista" => array:6 [
                        "tituloSerie" => "Medicine"
                        "fecha" => "2008"
                        "volumen" => "87"
                        "paginaInicial" => "294"
                        "paginaFinal" => "300"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18794712"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "2&#46;"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unplanned readmission rates&#44; length of hospital stay&#44; mortality&#44; and medical costs of ten common medical conditions&#58; a retrospective analysis of Hong Kong hospital data&#46;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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ISSN: 16652681
Original language: English
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