Increased Morbidity and Mortality Associated with Falls Among Patients with Cirrhosis
Increased Morbidity and Mortality Associated with Falls Among Patients with Cirrhosis
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DOI：
10.1016/j.amjmed.2018.01.026
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发表时间：
2018-06-01
影响因子：
5.9
通讯作者：
Tapper, Elliot B.
中科院分区：
文献类型：
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作者：
Ezaz, Ghideon;Murphy, Susan L.;Tapper, Elliot B.
背景：在肝硬变患者中，损伤的处理更加病态和复杂。然而，关于肝硬变患者与非肝硬变患者相比，因跌倒而受伤的相对风险和严重程度的数据有限。方法：我们研究了具有全国代表性的国家急诊科样本，这是一个包括2009-2012年间所有有跌倒症状的患者的支付者数据库。我们确定了严重损伤的相对风险和临床相关性。结果包括住院时间、住院时间、费用和住院死亡。结果：我们确定了102,977例涉及肝硬变患者和26,996,120例非肝硬变患者出现跌倒的病例。总体而言，与充血性心力衰竭患者相比，肝硬变患者调整后的严重损伤风险更高。其中包括颅内出血(2.33；95%可信区间2.02-2.68)、颅骨骨折(1.75；95%可信区间1.53-2.00)和骨盆骨折(1.71；95%可信区间1.56-1.88)。不太严重的损伤，如脑震荡(0.95；95%可信区间，0.86-1.06)和小腿骨折(0.86；95%可信区间，0.80-0.91)风险较低。多因素分析显示，与严重损伤显著正相关的危险因素是肝性脑病、酗酒和感染。肝硬变与住院死亡风险增加、住院时间较长以及跌倒后的费用较高有关。与充血性心力衰竭患者相比，所有结果都更差。结论：跌倒在肝硬变患者中很常见，而且更有可能导致严重伤害，增加医院费用和死亡风险。预后不佳主要与腹水、肝性脑病、酗酒和感染有关，突出了风险最高、最有可能从预防性干预中受益的亚群。(C)2018 Elsevier Inc.保留所有权利。
BACKGROUND: Injuries are more morbid and complicated to manage in patients with cirrhosis. However, data are limited regarding the relative risk of injury and severity of injury from falls in patients with cirrhosis compared with those without cirrhosis.METHODS: We examined the nationally representative National Emergency Department Sample, an all-payer database including all patients presenting with falls, 2009-2012. We determined the relative risks for and clinical associations with severe injuries. Outcomes included hospitalization, length of stay, costs, and in-hospital death. Outcomes were compared with those of patients with congestive heart failure.RESULTS: We identified 102,977 visits involving patients with cirrhosis and 26,996,120 involving patients without cirrhosis who presented with a fall. Overall and compared with patients with congestive heart failure, the adjusted risk of severe injury was higher for patients with cirrhosis. These included intracranial hemorrhage (2.33; 95% confidence interval [CI], 2.02-2.68), skull fracture (1.75; 95% CI, 1.53-2.00), and pelvic fracture (1.71; 95% CI, 1.56-1.88). Risk was lower for less-severe injuries, such as concussion (0.95; 95% CI, 0.86-1.06) and lower-leg fracture (0.86; 95% CI, 0.80-0.91). Risk factors significantly positively associated with severe injury on multivariate analysis were hepatic encephalopathy, alcohol abuse, and infection. Cirrhosis was associated with increased risk of in-hospital death, longer length of stay, and higher costs after a fall. All outcomes were worse compared with those for patients with congestive heart failureCONCLUSION: Falls are common in patients with cirrhosis, and they are more likely to incur severe injuries, with increased hospital costs and risk of death. Poor outcomes are most associated with ascites, hepatic encephalopathy, alcohol abuse, and infection, highlighting the subgroups at highest risk and most likely to benefit from preventative interventions. (C) 2018 Elsevier Inc. All rights reserved.