Role Of Oral Health, Frailty and Minimal Hepatic Encephalopathy In The Risk Of Hospitalization: A Prospective Multi-Center Cohort Of Outpatients with Cirrhosis.

Hospitalizations are a sentinel event in cirrhosis; however, the changing cirrhosis demographics in require updated hospitalization prediction models. Periodontitis is a risk factor for liver disease and potentially progression. AIM: Determine factors, including poor oral health, associated with 3-month hospitalizations in a multi-center cohort of cirrhosis outpatients. NACSELD-3 (North American Consortium for Study of End-stage Liver disease), a new study cohort, recruits outpatients with cirrhosis. Cirrhosis details, demographics, minimal hepatic encephalopathy (MHE), frailty, co-morbid conditions including oral health were collected. All patients were followed for 3-months for non-elective hospitalizations. Multi-variable models were created for this outcome using demographics, cirrhosis details, oral health, MHE, frailty and co-morbid conditions with K-fold internal validation using 25%/75% split. 442 outpatients (70% men, 37% compensated, MELD-Na 12, 42% ascites and 33% prior HE) were included. MHE was found in 70%, frailty in 10%; 8% with both. Oral health: 15% were edentulous and 10% had prior periodontitis. 3-month hospitalizations: 14% were admitted for mostly liver-related reasons. These patients were more likely to be decompensated with higher cirrhosis complications, MHE, frailty and periodontitis history. Multi-variable analysis: Prior periodontitis (p=0.026), composite MHE+frailty score (p=0.0016), ascites (p=0.004), prior HE (0.008). hydrothorax (p=0.004) associated with admissions using the training and validation subsets. CONCLUSIONS: In a contemporaneous prospective, multi-center cohort study in outpatients with cirrhosis, poor oral health is significantly associated with 3-month hospitalizations independent of portal hypertensive complications, MHE and frailty. Potential strategies to reduce hospitalizations should consider oral evaluation in addition to MHE and frailty assessment in practice pathways.