In-Hospital Mortality and Economic Burden Associated With Hepatic Encephalopathy in the United States From 2005 to 2009
In-Hospital Mortality and Economic Burden Associated With Hepatic Encephalopathy in the United States From 2005 to 2009
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DOI：
10.1016/j.cgh.2012.05.016
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发表时间：
2012-09-01
影响因子：
12.6
通讯作者：
Younossi, Zobair M.
中科院分区：
文献类型：
--
作者：
Stepanova, Maria;Mishra, Alita;Younossi, Zobair M.
背景与目的：肝性脑病（HE）是肝硬化的主要并发症，可导致大量死亡率和资源利用率。方法：我们分析了2005年至2009年间全国住院患者样本的5个周期，以确定全国对HE住院患者的发病率、患病率、住院患者死亡率、疾病严重程度和资源利用的估计。结果：HE的年住院发病率为20,918（2005年）至22,931（2009年）（P = .2226），约占美国所有住院患者的0.33%。在5年的分析期间，HE住院患者的死亡率保持相对稳定，为14.13% ~ 15.61% (P = 0.062)；然而，严重和极端严重疾病的患者比例增加（P < 0.0001）。平均住院时间由8.1天增加至8.5天（P = 0.019）。平均住院总费用从每例46,663美元增加到63,108美元（P < 0.0001）。此外，与高等教育有关的全国总费用从4.6767亿美元（2005年）增加到7.2447亿美元（2009年）。在多变量分析中，住院患者死亡率的独立预测因子包括每次入院诊断的次数（优势比[OR] = 1.022； 95%可信区间[CI]，每次诊断1.016 - 1.029）、每次入院的手术次数（OR = 1.192次手术；95% CI, 1.177-1.208）和疾病的严重程度或极端严重程度（OR = 3.16; 95% CI, 2.84 - 3.50）。成本、收费和住院时间最重要的预测因素是入住大型城市医院；使用医疗补助计划或医疗补助计划作为付款人；严重或极端严重的疾病；出院诊断数；每次入院的程序（P < 0.05）。结论：2005 - 2009年，美国医院诊断为HE的出院患者的资源利用率有所增加。然而，住院病人的死亡率保持稳定，尽管病情有加重的趋势。
BACKGROUND & AIMS: Hepatic encephalopathy (HE) is a major complication of cirrhosis that causes substantial mortality and utilization of resources. METHODS: We analyzed 5 cycles of the Nationwide Inpatient Sample, conducted between 2005 and 2009, to determine national estimates of incidence, prevalence, inpatient mortality, severity of illness, and resource utilization for inpatients with HE. RESULTS: The yearly inpatient incidence of HE ranged from 20,918 (2005) to 22,931 (2009) (P = .2226), comprising approximately 0.33% of all hospitalizations in the United States. Over the 5-year period of analysis, mortality of inpatients with HE remained relatively stable, at 14.13%-15.61% (P = .062); however, the proportion of patients with major and extreme severity of illness increased (P < .0001). The average length of inpatient stay increased from 8.1 to 8.5 days (P = .019). The average total inpatient charges increased from $46,663 to $ 63,108 per case (P < .0001). Furthermore, total national charges related to HE increased from $4676.7 million (2005) to $7244.7 million (2009). In multivariate analysis, independent predictors of inpatient mortality included the number of diagnoses per admission (odds ratio [OR] = 1.022; 95% confidence interval [CI], 1.016 - 1.029 per diagnosis), number of procedures per admission (OR = 1.192 per procedure; 95% CI, 1.177-1.208), and major or extreme severity of illness (OR = 3.16; 95% CI, 2.84 - 3.50). The most important predictors of cost, charge, and length of stay were admission to a large, urban hospital; use of Medicaid or Medicaid as the payer; major or extreme severity of illness; number of diagnoses at discharge; and procedures per admission (P < .05). CONCLUSIONS: Resource utilization increased from 2005 to 2009 for patients discharged from US hospitals with the diagnosis of HE. The inpatient mortality rate, however, remained stable, despite a trend toward more severe disease.