Time Trends in the Health Care Burden and Mortality of Acute on Chronic Liver Failure in the United States
Time Trends in the Health Care Burden and Mortality of Acute on Chronic Liver Failure in the United States
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DOI：
10.1002/hep.28812
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发表时间：
2016-12-01
期刊：
影响因子：
13.5
通讯作者：
Kamath, Patrick S.
中科院分区：
文献类型：
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作者：
Allen, Alina M.;Kim, W. Ray;Kamath, Patrick S.
急性慢性肝功能衰竭(ACLF)在住院的肝硬变患者中与多系统器官衰竭和预后不良相关。我们的目标是确定美国ACLF的流行病学、经济负担和死亡率的时间趋势。2001年至2011年期间对国家住院患者样本数据库进行了查询。ACLF定义为肝硬变患者出现两个或两个以上肝外器官衰竭。主要结果是住院、住院费用和住院死亡率的趋势。美国因肝硬变住院的人数几乎翻了一番，从2001年的37.1万人增加到2011年的65.9万人。住院患者中ACLF的患病率从1.5%(n=5400)上升到5%(n=32300)。肝硬变的住院费用增加了2倍(48亿美元到98亿美元)，ACLF的住院费用增加了5倍(3.2亿美元到17亿美元)。2011年，ACLF的每次住院费用是肝硬变的3.5倍(53,570美元对15,193美元)。ACLF的住院病死率从65%降至50%，肝硬变的病死率从10%降至7%。ACLF的器官衰竭趋势表现为心脑血管功能衰竭比例增加，呼吸、肾功能衰竭比例下降。年龄、男性、器官衰竭的数量和类型是ACLF死亡的预测因素。结论：在美国，肝硬变和急性肝功能衰竭是一个巨大且不断增加的健康和经济负担；这些数据突显了迫切需要研究病理生理机制和有效的治疗方法，以及教育卫生保健提供者它在护理肝硬变患者方面的重要性。
Acute on chronic liver failure (ACLF) is associated with multisystem organ failure and poor prognosis in hospitalized patients with cirrhosis. We aimed to determine time trends in the epidemiology, economic burden, and mortality of ACLF in the United States. The National Inpatient Sample database was queried between 2001 and 2011. ACLF was defined as two or more extrahepatic organ failures in patients with cirrhosis. The primary outcomes were trends in hospitalizations, hospital costs, and inpatient mortality. The number of hospitalizations for cirrhosis in the United States nearly doubled from 371,000 in 2001 to 659,000 in 2011. The prevalence of ACLF among those hospitalizations increased from 1.5% (n = 5,400) to 5% (n = 32,300). The inpatient costs increased 2-fold for cirrhosis ($4.8 billion to $9.8 billion) and 5-fold ($320 million to $1.7 billion) for ACLF. In 2011, the cost per hospitalization for ACLF was 3.5-fold higher than that for cirrhosis ($53,570 versus $15,193). The in-hospital fatality rates decreased from 65% to 50% for ACLF and from 10% to 7% for cirrhosis. The organ failure trends in ACLF showed an increasing proportion of cardiovascular and cerebral and decreasing proportion of respiratory and renal failure. Age, male sex, and the number and types of organ failure were predictors of death in ACLF. Conclusion: Cirrhosis and ACLF represent a substantial and increasing health and economic burden in the United States; these data highlight an urgent need for research on pathophysiological mechanisms and effective therapy as well as for education of health care providers of its importance in the care of patients with cirrhosis.