Changes in hepatic functional reserve and renal function during hospitalization in patients with chronic liver disease

Evidence regarding inpatient rehabilitation for clinically complex patients with chronic liver disease (CLD), including those with advanced cirrhosis, remains limited. We aimed to describe real-world inpatient rehabilitation practice and unadjusted in-hospital changes in hepatic and renal laboratory measures. This single-center retrospective observational study included 200 patients hospitalized for CLD-related conditions at Wakayama Medical University Hospital between January and December 2023. Referral and treatment were determined clinically rather than by standardized criteria. We compared baseline characteristics and unadjusted between-group changes in hepatic and renal laboratory measures, with exploratory analyses stratified by Child–Pugh (CP) class. Rehabilitation-related adverse events were retrospectively assessed using complete inpatient medical records and institutional incident reports. Of 200 hospitalized patients, 57 received inpatient rehabilitation. The rehabilitation group was older, had higher Child–Pugh scores, was more often admitted emergently, and had longer hospital stays than the non-rehabilitation group. Median rehabilitation duration was 11.0 days (interquartile range [IQR], 6.0–20.0), and the median time from hospital admission to rehabilitation referral was 6.0 days (IQR, 3.0–9.0). Across Child-Pugh classes, unadjusted hepatic and renal laboratory changes did not show a consistent pattern of greater deterioration in the rehabilitation group. No serious rehabilitation-related adverse event was identified through review of the complete inpatient medical records or the institutional incident-reporting system. These real-world data characterize inpatient rehabilitation in a clinically complex CLD population, including patients with advanced cirrhosis, and may inform development of liver rehabilitation for hospitalized, medically vulnerable patients. Because referral and treatment were individualized and the comparisons were unadjusted, the observations should be interpreted as descriptive associations rather than evidence of a causal effect, overall safety, or efficacy.