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The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy: A retrospective observational study (IMPRESS)

Lookup NU author(s): Dr Mark Hudson



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Objective To compare all-cause and liver-related hospital resource use in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation in UK patients with hepatic encephalopathy (HE). Design A UK multicentre, retrospective, observational study. Patients' medical records were reviewed for demographics, clinical outcomes and adverse events (AEs) to rifaximin-α. Details of hospital admissions/attendances in the 6 and 12 months pre-rifaximin-α and postrifaximin- α initiation were extracted from hospital electronic databases. Setting 13 National Health Service centres. Patients 207 patients with HE who initiated rifaximin-α between July 2008 and May 2014. Hospital resource use data were available for 145/207 patients. Main outcome measure Change in mean number of liver-related hospital bed days/patient (total and critical care) between the 6 months pre-rifaximin-α and post-rifaximin-α initiation. Results Comparing the 6 months pre-rifaximin-α and post-rifaximin-α initiation in alive patients at the end of the observation period (N=114): there were significant reductions in the mean number of hospitalisations/patient (liver-related 1.3 to 0.5, p<0.0.001; all-cause 1.9 to 0.9, p<0.0.001), hospital bed days/patient (liver-related 17.8 to 6.8, p<0.0.001; all-cause 25.4 to 10.6, p<0.0.001), 30-day hospital readmissions/patient (liver-related 0.5 to 0.2, p=0.039; all-cause 0.8 to 0.4, p=0.024) and emergency department (ED) attendances/patient (all-cause, 1.0 to 0.5, p<0.0.001). The mean critical care bed days/ patient reduced significantly for all-cause admissions (1.3 to 0.3, p=0.049); non-significant reduction for liver-related admissions. 4% of patients (9/207) developed AEs. Conclusions In UK clinical practice, treatment with rifaximin-α for HE is well-tolerated and associated with significant reductions in hospitalisations, bed days (including critical care), ED attendances and 30-day readmissions.

Publication metadata

Author(s): Hudson M, Radwan A, Di Maggio P, Cipelli R, Ryder SD, DIllon JF, Cash WJ, Przemioslo RT, Wright M, Shawcross DL, Jalan R, Saksena S, Allison M, Richardson P, Farrington E, Aspinall RJ

Publication type: Article

Publication status: Published

Journal: Frontline Gastroenterology

Year: 2017

Volume: 8

Issue: 4

Pages: 243-251

Print publication date: 01/10/2017

Online publication date: 11/09/2017

Acceptance date: 17/03/2017

Date deposited: 13/11/2017

ISSN (print): 2041-4137

ISSN (electronic): 2041-4145

Publisher: BMJ Publishing Group


DOI: 10.1136/flgastro-2016-100792


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