Decreasing mortality among patients hospitalized with cirrhosis in the United States from 2002 through 2010.
Decreasing mortality among patients hospitalized with cirrhosis in the United States from 2002 through 2010.
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从2002年到2010年，美国住院的患者死亡率降低。
DOI：
10.1053/j.gastro.2015.01.032
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发表时间：
2015-05
期刊：
影响因子：
29.4
通讯作者：
Hayashi PH
中科院分区：
文献类型：
--
作者：
Schmidt ML;Barritt AS;Orman ES;Hayashi PH
目前尚不清楚肝硬化患者住院护理的循证建议是否广泛实施或在社区中有效。我们调查了住院患者结局和相关特征随时间的变化。通过使用医疗保健成本和利用项目，国家住院患者样本，我们分析了2002年至2010年781,515例肝硬化患者的住院情况。我们将数据与相同数量的非肝硬化患者和充血性心力衰竭（CHF）患者的住院数据进行比较，这些患者的年龄、性别和出院年份相匹配。主要结局是出院状态随时间的变化。结果相关因素采用Poisson模型进行分析。肝硬化和非肝硬化患者以及CHF患者的死亡率随时间推移而降低。肝硬化患者的绝对下降（从9.1%到5.4%）明显大于非肝硬化患者（从2.6%到2.1%）或CHF患者（从2.5%到1.4%）（P <0.01）。然而，肝硬化患者（41%）和CHF患者（44%）的相对降低相似。对于肝硬化患者，独立死亡风险比在2010年稳定下降至0.50（95%置信区间，0.48-0.52），尽管患者的年龄和合并症增加。肝肾综合征、肝细胞癌、静脉曲张出血和自发性细菌性腹膜炎与较高的死亡率相关，但每种疾病的独立死亡风险均稳步下降。脓毒症与死亡率增加密切相关，并且风险随时间增加。在美国的肝硬化患者中，尽管患者年龄和医疗复杂性增加，但住院死亡率从2002年到2010年稳步下降。肝硬化护理的改善可能有助于提高患者的生存率，超出了住院护理的一般改善。进一步的改善可能需要更多地使用已证实的治疗方法和开发新的治疗方法，特别是针对脓毒症。
It is not clear whether evidence-based recommendations for inpatient care of patients with cirrhosis are implemented widely or are effective in the community. We investigated changes in inpatient outcomes and associated features over time. By using the Healthcare Cost and Utilization Project, National Inpatient Sample, we analyzed 781,515 hospitalizations of patients with cirrhosis from 2002 through 2010. We compared data with those from equal numbers of hospitalizations of patients without cirrhosis and patients with congestive heart failure (CHF), matched for age, sex, and year of discharge. The primary outcome was a change in discharge status over time. Factors associated with outcomes were analyzed by Poisson modeling. The mortality of patients with and without cirrhosis, and patients with CHF, decreased over time. The absolute decrease was significantly greater for patients with cirrhosis (from 9.1% to 5.4%) than for patients without cirrhosis (from 2.6% to 2.1%) or patients with CHF (from 2.5% to 1.4%) (P < .01). However, relative decreases were similar for patients with cirrhosis (41%) and patients with CHF (44%). For patients with cirrhosis, the independent mortality risk ratio decreased steadily to 0.50 by 2010 (95% confidence interval, 0.48–0.52), despite patients’ increasing age and comorbidities. Hepatorenal syndrome, hepatocellular carcinoma, variceal bleeding, and spontaneous bacterial peritonitis were associated with a higher mortality rate, but the independent mortality risks for each decreased steadily. Sepsis was associated strongly with increased mortality, and the risk increased over time. Among patients with cirrhosis in the United States, inpatient mortality decreased steadily from 2002 through 2010, despite increases in patient age and medical complexity. Improvements in cirrhosis care may have contributed to increases in patient survival beyond those attributable to general improvements in inpatient care. Further improvements might require an increased use of proven therapies and the development of new treatments—particularly for sepsis.
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影响因子：
12.6
作者：
Orman, Eric S.;Hayashi, Paul H.;Barritt, A. Sidney
通讯作者：
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