Poor oral health associated with hospitalizations in outpatients with cirrhosis

Over three months, patients with cirrhosis hospitalized for nonelective reasons were more likely to be decompensated, with higher rates of minimal hepatic encephalopathy plus frailty and history of periodontitis.

Poor oral health in patients with cirrhosis is significantly associated with three-month hospitalizations independent of portal hypertensive complications, minimal hepatic encephalopathy (MHE), and frailty, a cohort study found.

Researchers used data on demographics, MHE, frailty, and comorbid conditions, including oral health, in patients with cirrhosis to evaluate potential factors associated with nonelective hospitalizations over three months. Four hundred forty-two outpatients from 10 facilities across North America were included. Of these, 70% were men and 40% had ascites. Oral health was specifically investigated via chart review, including history of periodontitis diagnosed by dental professionals, current number of natural teeth, partial or complete dentures, or edentulous status, and was confirmed by an oral exam. The study results were published online Oct. 31 by Clinical Gastroenterology and Hepatology.

Overall, 70% of patients had MHE, 10% had frailty, and 8% had both. Fifteen percent were edentulous, 27% had dentures, and 10% had prior periodontitis. Sixty-four patients (14%) were hospitalized over three months, mostly for liver-related reasons. The researchers noted that patients who were hospitalized were more likely than those who were not to be decompensated (88% vs. 59%), with higher rates of MHE plus frailty (23% vs. 6%) and history of periodontitis (20% vs. 13%). Prior periodontitis (P=0.026), MHE plus frailty (P=0.0016), ascites (P=0.004), prior hepatic encephalopathy (P=0.008), and hydrothorax (P=0.004) were associated with admissions. In a logistic regression analysis, history of periodontitis was the only oral health variable associated with hospital admission. Patients with a history of periodontitis and those without did not differ markedly in demographic characteristics, comorbid conditions, or cirrhosis severity and etiology.

Potential strategies to reduce hospitalizations should consider oral evaluation in addition to MHE and frailty assessment, because poor oral health was the only comorbid condition associated with hospitalizations at three months after controlling for portal hypertensive complications, MHE, and frailty, the authors wrote. They recommended that tests of MHE, frailty, and oral health be included in outpatient clinical practice pathways for patients with cirrhosis.