Trends in Characteristics, Mortality, and Other Outcomes of Patients With Newly Diagnosed Cirrhosis
Trends in Characteristics, Mortality, and Other Outcomes of Patients With Newly Diagnosed Cirrhosis
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DOI：
10.1001/jamanetworkopen.2019.6412
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发表时间：
2019-06-01
影响因子：
13.8
通讯作者：
Chalasani, Naga
中科院分区：
文献类型：
--
作者：
Orman, Eric S.;Roberts, Anna;Chalasani, Naga
重要性肝硬化患者特征的变化可能影响未来的结果，并且在计划这一人群的护理时理解这一点很重要。目的：确定新诊断肝硬化患者的人口统计学和临床特征以及结果的变化。和参与者使用印第安纳州患者护理网络对新诊断为肝硬化的患者进行回顾性队列研究，2004年至2014年期间，在全州范围内进行了一次大型区域卫生信息交流。肝硬化诊断前至少连续随访1年的患者随访至2015年8月1日。分析时间为2018年12月至2019年1月。暴露年龄、肝硬化原因和诊断年份。主要结局和指标死亡率、肝移植、肝细胞癌和肝功能失代偿的总体发生率结果共确定了9261例新诊断的肝硬化患者（平均[SD]年龄，57.9 [12.6]岁; 5109 [55.2%]例男性）。在研究期间，新诊断增加了69%（2004年为620例，2014年为1045例）。40岁以下人群比例每年增加0.20%（95%CI，0.04%至0.36%;趋势P = 0.02），65岁及以上人群比例每年增加0.81%（95%CI，0.51%至1.11%;趋势P
IMPORTANCE Changes in the characteristics of patients with cirrhosis are likely to affect future outcomes and are important to understand in planning for the care of this population.OBJECTIVE To identify changes in demographic and clinical characteristics and outcomes in patients with newly diagnosed cirrhosis.DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of patients with a new diagnosis of cirrhosis was conducted using the Indiana Network for Patient Care, a large statewide regional health information exchange, between 2004 and 2014. Patients with at least 1 year of continuous follow-up before the cirrhosis diagnosis were followed up through August 1, 2015. The analysis was conducted from December 2018 to January 2019.EXPOSURES Age, cause of cirrhosis, and year of diagnosis.MAIN OUTCOMES AND MEASURES Overall rates for mortality, liver transplant, hepatocellular carcinoma, and hepatic decompensation (composite of ascites, hepatic encephalopathy, or variceal bleeding).RESULTS A total of 9261 patients with newly diagnosed cirrhosis were identified (mean [SD] age, 57.9 [12.6] years; 5109 [55.2%] male). A 69% increase in new diagnoses occurred over the course of the study period (620 in 2004 vs 1045 in 2014). The proportion of those younger than 40 years increased by 0.20% per year (95% CI, 0.04% to 0.36%; P for trend=.02), and the proportion of those aged 65 years and older increased by 0.81% per year (95% CI, 0.51% to 1.11%; P for trend