Poor Oral Health Associated With Hospitalization Risk in Cirrhosis

These study results highlight the need for routine careful oral examination and treatment in patients with cirrhosis.

Poor oral health is associated with increased risk for hospitalization at 3 months among outpatients with cirrhosis independent of traditional cirrhosis severity biomarkers and patient-related outcomes, according to study findings published in Clinical Gastroenterology and Hepatology.

Researchers conducted a multicenter, prospective trial that comprised patients (N=442) aged 18 years or older with cirrhosis diagnosed via liver biopsy or with a combination of hepatic decompensating events, endoscopic evidence of portal hypertension, or thrombocytopenia. The study participants were followed for at least 3 months at which time non-elective admissions and death were assessed with direct questioning, chart review, or questioning of caregivers and companions. Oral health was evaluated in a chart review.

The researchers compared baseline clinical, demographic, disease, medication, and comorbid condition characteristics between patients who were admitted at 3 months with those who were not admitted.

Among the study participants, 37% were compensated, and the others were decompensated with a median Model for End-stage Liver Disease-Sodium score (MELD-Na) of 12. A majority of participants (70%) were men, 40% had ascites, and 36% had previous hepatic encephalopathy (HE).

Potential strategies to reduce admissions should focus on the incorporation tests of MHE, frailty, and inspection of oral health into outpatient clinical practice pathways in patients with cirrhosis.

A total of 64 participants (median age, 63 years; 31% women) were admitted at 3 months primarily for liver-related reasons, and 378 participants were not admitted (median age, 62 years; 31% women).

Minimal hepatic encephalopathy (MHE) was observed in 70% of participants. The overall median Clinical Frailty Scale (CFS) score for the group was 3 (range, 1-7). When using a cutoff of at least 5, 9% of patients had frailty, 21% had neither MHE nor frailty, 63% had only MHE but did not have frailty, and 16% had both frailty and MHE.

A history of periodontitis was increased in patients who were hospitalized at 3 months (P =.028), while edentulism (P =.46), number of natural teeth (P =.93), and partial or complete dentures (P =.86) were not.

In logistic regression analysis, a history of periodontitis was significantly associated with hospitalizations. No significant association was found between periodontitis and alcohol use (P =.69), the Alcohol Use Disorders Identification Test-10 score (P =.90), or illicit substance use (P =.67). In addition, no significant association was observed between periodontitis and tobacco use (current use-periodontitis interaction, P =.73; past tobacco use-periodontitis interaction, P= .51; past or current tobacco use-periodontitis interaction, P =.75).

Multivariable logistic regression developed from the training set and was used for the full dataset that showed a history of periodontitis; cirrhosis complications such as ascites, hepatic hydrothorax, and previous HE; and MHE plus frailty composite variable were associated with an increased risk for hospitalization.

Limitations of the study include the requirement for stable disease etiology and enrollment of compensated and decompensated patients with cirrhosis.

“Potential strategies to reduce admissions should focus on the incorporation tests of MHE, frailty, and inspection of oral health into outpatient clinical practice pathways in patients with cirrhosis,” the study authors conclude.

Disclosure: NACSELD-3 is partly supported by investigator-initiated grants from Salix and Sequana Pharmaceuticals. Please see the original reference for a full list of disclosures.

References:

Bajaj JS, Lai JC, Tandon P, et al. Role of oral health, frailty, and minimal hepatic encephalopathy in the risk of hospitalization: a prospective multi-center cohort of outpatients with cirrhosis. Clin Gastroenterol Hepatol. Published online November 1, 2022. doi:10.1016/j.cgh.2022.10.023