Trends in 30-Day and 1-Year Mortality Among Patients Hospitalized With Cirrhosis From 2004 to 2013
Trends in 30-Day and 1-Year Mortality Among Patients Hospitalized With Cirrhosis From 2004 to 2013
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DOI：
10.1038/ajg.2017.175
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发表时间：
2017-08-01
影响因子：
9.8
通讯作者：
El-Serag, Hashem B.
中科院分区：
文献类型：
--
作者：
Kanwal, Fasiha;Tansel, Aylin;El-Serag, Hashem B.
目的：最近的数据表明肝硬化住院患者的住院死亡率有所降低。我们试图确定肝硬化患者短期结局的改善是否与长期结局的变化相关。方法：我们检查了 2004 年至 2013 年期间在 126 家退伍军人管理局医院中住院的肝硬化患者 30 天和 1 年出院后死亡率的时间趋势。我们对一系列人口统计、肝病严重程度和合并症相关因素进行了调整，以解释患者队列中的差异结果：我们确定了 2004 年至 2013 年间因肝硬化住院的 109,358 名独特患者。院内死亡率从 11.4% 下降到 7.6%，而 1 年死亡率从 34.5% 下降到 33.2%。超过三分之一的院外死亡发生在出院后的前 30 天内； 30 天死亡率从 9.3% 上升至 10.1%。调整患者因素后，2013年院内死亡率下降了30%（调整后优势比（OR）=0.70，95%置信区间（CI），0.64-0.78），1年死亡率下降13%（调整后OR=0.87，95%CI=0.82-0.93），而30天死亡率则高出10%与 2004 年相比（调整后 OR=1.10，95% CI=0.99-1.21），尽管后者没有达到统计显着性。结论：在入院的肝硬化患者中，院内死亡率的降低与 1 年死亡率的不太显着降低相关，出院后 30 天死亡率即使不更高，也保持不变。我们的数据表明，肝硬化的部分死亡率负担已从住院期间转移到出院后不久。
OBJECTIVES: Recent data suggest decreasing in-patient mortality in patients hospitalized with cirrhosis. We sought to determine if improvements in short-term outcomes for patients with cirrhosis are associated with changes in longer-term outcomes.METHODS: We examined temporal trends in 30 days and 1-year postdischarge mortality among patients hospitalized with cirrhosis at any of the 126 Veterans Administration hospitals from 2004 and 2013. We adjusted for a range of demographic, liver disease severity, and comorbidity-related factors to account for differences in patient cohorts over time.RESULTS: We identified 109,358 unique patients who were hospitalized with cirrhosis between 2004 and 2013. In-hospital mortality decreased from 11.4 to 7.6%, whereas 1-year mortality decreased from 34.5 to 33.2%. Over a third of out-of-hospital deaths occurred within the first 30 days after discharge; 30-day mortality increased from 9.3 to 10.1%. After adjusting for patient factors, the odds of in-hospital mortality in 2013 were 30% lower (adjusted odds ratio (OR)=0.70, 95% confidence interval (CI), 0.64-0.78), 1-year mortality were 13% lower (adjusted OR=0.87, 95% CI=0.82-0.93), whereas the 30-day mortality were 10% higher than 2004 (adjusted OR=1.10, 95% CI=0.99-1.21), although the latter did not reach statistical significance.CONCLUSIONS: In patients admitted with cirrhosis, reduction in in-hospital mortality was associated with less marked reduction in 1-year mortality, and an unchanged, if not higher, 30-day mortality following discharge. Our data suggest that some of the burden of mortality in cirrhosis has shifted from inhospital to the immediate postdischarge period.