Symptom Burden Is Associated with Increased Emergency Department Utilization among Patients with Cirrhosis.
Symptom Burden Is Associated with Increased Emergency Department Utilization among Patients with Cirrhosis.
复制标题
症状负担与肝硬化患者急诊科使用率的增加有关。
DOI：
10.1089/jpm.2021.0219
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发表时间：
2022
影响因子：
2.8
通讯作者：
Bischoff,KaraE
中科院分区：
文献类型：
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作者：
Deng,LisaX;Kent,DorotheaS;O'Riordan,DavidL;Pantilat,StevenZ;Lai,JenniferC;Bischoff,KaraE
目的：探讨肝硬变患者的症状负担与住院医疗服务利用的关系。方法：对美国某学术机构正在接受或等待肝移植的成年肝硬变患者进行埃德蒙顿症状评定量表(ESAS)测试，该量表总分为0~90分。感兴趣的结果包括急诊科(ED)就诊、非选择性住院、住院天数、重症监护病房(ICU)入院以及6个月内30天的再入院。结果：233例患者(女性占43%，中位年龄61岁)，ESAS总分中位数为16(四分位数范围为6~30)。ESAS总分越高，急诊室就诊、住院、住院天数和ICU天数越多(ALP<； 0.04)。在调整了年龄、性别和终末期肝病模型-钠后，ESAS总分仍然是ED就诊的独立预测因素(IRR1.05，可信区间[95%CI]1.00-1.10，p= 0.03)。多变量ESAS子量表分析显示，躯体症状评分与ED就诊有关(IRR1.09，95%CI 1.02~1.16，p= 0.01)，而心理症状评分与ED就诊无关(IRR1.03，95%CI 1.00~1.08，p= 0.15)。结论：患者报告的症状，尤其是躯体症状与急诊就诊独立相关。需要进一步的研究来检验是否更积极地处理症状，例如通过姑息治疗共同管理，可以减少这一人群中ED的使用。
Background:Patients with cirrhosis have significant morbidity and mortality, as well as substantial symptom burden.Objective:We investigated the relationship between symptom burden and inpatient health care utilization among patients with cirrhosis.Methods:Adult patients with cirrhosis being evaluated for or awaiting liver transplantation at an academic institution in the United States completed the Edmonton Symptom Assessment Scale (ESAS), a validated symptom evaluation tool with total scores ranging from 0 to 90. The outcomes of interest were emergency department (ED) visits, nonelective hospitalizations, hospital days, intensive care unit (ICU) admissions, and 30-day readmissions within 6 months. Adjusted incidence rate ratios (IRRs) were used to examine the relationship between ESAS scores and outcomes.Results:Of 233 patients (43% female, median age 61), the median total ESAS score was 16 (interquartile range 6–30). Higher total scores on the ESAS were associated with increased ED visits, hospitalizations, hospital days, and ICU days (allp< 0.04). After adjusting for age, gender, and Model for End-Stage Liver Disease-sodium, ESAS total score remained an independent predictor of ED visits (IRR 1.05, confidence interval [95% CI] 1.00–1.10,p= 0.03). Multivariate ESAS subscale analyses revealed that the physical symptom score was associated with ED visits (IRR 1.09, 95% CI 1.02–1.16,p= 0.01), but the psychological symptom score was not (IRR 1.03, 95% CI 1.00–1.08,p= 0.15).Conclusions:Patient-reported symptoms, particularly physical symptoms, are independently associated with ED visits among patients with cirrhosis being considered for liver transplantation. Further research is needed to examine whether addressing symptoms more aggressively, such as with palliative care co-management, could decrease ED utilization in this population.