Remote patient management reduces liver-related hospitalizations in patients with acutely decompensated cirrhosis

BACKGROUND: Patients with decompensated cirrhosis experience frequent hospitalizations, yet evidence supporting remote post-discharge care remains limited. This study assessed the impact of cirrhosis-specific Remote Patient Management (CiRPM) program following hospitalization for acutely decompensated (AD) cirrhosis. METHODS: Adults hospitalized for AD cirrhosis were included in a three-cohort observational study comparing CiRPM (2021-2024) with contemporary (C-control) and historical controls (H-control, 2018-2019). CiRPM enabled vital-sign and symptom transmission with 24/7 virtual nursing support. Subgroup analyses were conducted by disease etiology, CLIF-C AD score, and decompensation type. IPTW was used to adjust for confounding, and time-to-event outcomes were analyzed using Cox proportional hazards models. RESULTS: Among 430 patients (156 CiRPM, 152 H-control, 122 C-control), mean age was 59 years, 65% had alcohol-associated liver disease (ALD), CLIF-C AD score of 56. CiRPM was associated with lower 90-day liver-related readmissions versus C-control (39% vs. 58%; HR 0.57, p=0.01) and a similar trend versus H-control (39% vs. 52%; HR 0.67, p=0.07). Associations were stronger among patients with CLIF-C AD ≥60 (HR 0.43 vs. H-control, p=0.005; HR 0.51 vs. C-control, p=0.02). Among ALD patients, fewer fluid-related readmissions (OR 0.40 and 0.37; both p<0.001) and recurrent hospitalizations (OR 0.51; p=0.001 and p=0.002) were observed in the CiRPM group. In non-ALD patients, hepatic encephalopathy readmissions were lower (OR 0.29, p=0.004; OR 0.36, p=0.02). Mortality did not differ across groups. CONCLUSION: CiRPM enrollment was associated with fewer liver-related hospitalizations, particularly among patients with ALD and CLIF-C AD ≥60, supporting targeted remote management as a scalable post-discharge strategy for this high-risk population.