Palliative Care, Patient-Reported Measures, and Outcomes in Hospitalized Patients With Cirrhosis.
Palliative Care, Patient-Reported Measures, and Outcomes in Hospitalized Patients With Cirrhosis.
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DOI：
10.1016/j.jpainsymman.2022.02.022
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发表时间：
2022-06
影响因子：
4.7
通讯作者：
Chalasani, Naga
中科院分区：
文献类型：
--
作者：
Orman, Eric S.;Yousef, Andrew;Xu, Chenjia;Shamseddeen, Hani;Johnson, Amy W.;Nephew, Lauren;Ghabril, Marwan;Desai, Archita P.;Patidar, Kavish R.;Chalasani, Naga
肝硬化住院患者姑息治疗（PC）的研究是回顾性的，对患者报告的措施和结局的评价有限。检查PC、患者报告的测量（生活质量和功能状态）和结局之间的关系。我们对2014-2019年住院的肝硬化患者进行了一项前瞻性队列研究。我们记录了PC咨询细节，生活质量（慢性肝病问卷）和功能状态（功能状态问卷）。患者随访90天，以评估再入院、费用和死亡率。74/679例患者出现PC，通常在住院后期（中位住院日8天; IQR 4-16）。那些看到PC的人有更大的Charlson合并症指数（平均6.8 vs. 5.9），MELD（平均25 vs. 20），和之前30天的入院（47% vs. 35%）。与那些没有看到PC的人相比，PC患者在日常生活的中间活动中有更大的损害（83% vs. 72%），社交活动（72%对59%），互动质量（49% vs. 36%）、腹部症状（平均评分3.1 vs. 3.6）、活动（平均评分3.3 vs. 3.6）和总体生活质量（平均评分3.6 vs. 3.8）。PC与较少的输血和上消化道内镜检查以及更多的高级指令完成相关。多变量校正后，PC与重症监护、30天再入院、90天费用或死亡率无关。PC很少发生在那些更严重的肝脏疾病和功能障碍的晚期。PC可能与利用率降低和高级指令完成率提高有关。需要进行随机试验来评估这一人群的PC。
Studies of palliative care (PC) in hospitalized patients with cirrhosis have been retrospective, with limited evaluation of patient-reported measures and outcomes. To examine the relationship between PC, patient-reported measures (quality of life and functional status), and outcomes. We performed a prospective cohort study of patients with cirrhosis hospitalized from 2014–2019. We recorded PC consultation details, quality of life (chronic liver disease questionnaire), and functional status (functional status questionnaire). Patients were followed for 90 days to assess readmissions, costs, and mortality. 74/679 patients saw PC, often later in the hospitalization (median hospital day 8; IQR 4–16). Those who saw PC had greater Charlson comorbidity index (mean 6.8 vs. 5.9), MELD (mean 25 vs. 20), and prior 30-day admission (47% vs. 35%). Compared to those who did not see PC, PC patients had greater impairments in intermediate activities of daily living (83% vs. 72%), social activity (72% vs. 59%), quality of interactions (49% vs. 36%), abdominal symptoms (mean score 3.1 vs. 3.6), activity (mean 3.3 vs. 3.6), and overall quality of life (mean 3.6 vs. 3.8). PC was associated with fewer transfusions and upper endoscopies and with greater completion of advanced directives. After multivariable adjustment, PC was not associated with intensive care, 30-day readmissions, 90-day costs, or mortality. PC occurs infrequently and late in those with more severe liver disease and functional impairment. PC may be associated with reduction in utilization and greater completion of advanced directives. Randomized trials are needed to evaluate PC for this population.
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影响因子：
4.7
作者：
Brown, Cristal L.;Hammill, Bradley G.;Muir, Andrew J.
通讯作者：
Muir, Andrew J.
影响因子：
2.9
作者：
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通讯作者：
Jones L
影响因子：
4.4
作者：
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通讯作者：
Gao W
DOI：
10.5500/wjt.v6.i3.594
发表时间：
2016-09-24
期刊：
World journal of transplantation
影响因子：
--
作者：
Kathpalia, Priya;Smith, Alexander;Lai, Jennifer C
通讯作者：
Lai, Jennifer C
影响因子：
9.8
作者：
Patidar, Kavish R.;Shamseddeen, Hani;Orman, Eric S.
通讯作者：
Orman, Eric S.