Hepatic Manifestations in Common Variable Immunodeficiency Associated with Mortality and Worse Hospital Outcomes in Nationwide Analysis using National Readmission Database.

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-09-23 DOI:10.1016/j.jaip.2025.09.021

Ahmed Elmoursi, Daniel V DiGiacomo, Jocelyn R Farmer, Sara Barmettler

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引用次数: 0

Abstract

Background: Liver disease is associated with increased mortality in patients with common variable immunodeficiency (CVID), yet we lack population-level data on its impact on CVID-associated hospitalizations in the United States.

Objective: To conduct a nationwide analysis evaluating the prevalence, spectrum, clinical correlates, and outcomes of hepatic manifestations among admitted adults with CVID.

Methods: We performed a retrospective cross-sectional analysis using the National Readmission Database, part of the Healthcare Cost and Utilization Project (HCUP) by the Agency for Healthcare Research and Quality. International Classification of Diseases (ICD)-10 codes were used to assess hepatic complications, comorbidities, risk factors, and outcomes in CVID-associated admissions with liver involvement.

Results: Of 181,288 CVID-related index hospitalizations, 10% (18,823) had a co-diagnosed hepatic complication, specifically hepatic steatosis (38%), cirrhosis (24%), nonalcoholic fatty liver disease (17%), portal hypertension (PH) (15%), and nodular regenerative hyperplasia (NRH) (14%). CVID-associated admissions with hepatic disease had longer median lengths of stay (7 vs. 5 days, P<0.0001), higher in-hospital mortality (11% vs. 4%, P<0.0001), and higher median hospital charges ($68,114 vs. $44,757, P<0.0001). They also had a higher prevalence of hypertension, chronic kidney disease, diabetes, obesity, and autoimmune cytopenia (P<0.0001 for all). Alcohol use, hepatitis C, and hepatitis B were strong predictors of hepatic manifestations in CVID admissions (P<0.0001). CVID patients with NRH (HR: 1.3; 95% CI: 1.2-1.5, P<0.0001) and PH (HR: 1.4; 95% CI: 1.2-1.5, P<0.0001) had lower survival.

Conclusions: CVID-associated admissions with liver disease, particularly those with NRH and PH, were longer, more costly, and associated with increased mortality. Further studies are needed to improve early detection and long-term outcomes.

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在使用国家再入院数据库的全国分析中，常见可变免疫缺陷的肝脏表现与死亡率和较差的医院预后相关。

背景：肝脏疾病与常见变异性免疫缺陷（CVID）患者死亡率增加相关，但在美国，我们缺乏其对CVID相关住院治疗影响的人群水平数据。目的：开展一项全国性的分析，评估CVID住院成人的患病率、频谱、临床相关因素和肝脏表现的结果。方法：我们使用国家再入院数据库进行回顾性横断面分析，该数据库是医疗保健研究和质量局医疗保健成本和利用项目（HCUP）的一部分。国际疾病分类(ICD)-10代码用于评估与肝脏受累的cvd相关入院患者的肝脏并发症、合并症、危险因素和结局。结果：在181,288例cvd相关指数住院患者中，10%（18,823例）合并诊断为肝脏并发症，特别是肝脂肪变性（38%）、肝硬化（24%）、非酒精性脂肪性肝病（17%）、门脉高压（PH）（15%）和结节性再生增生（NRH）（14%）。与cvid相关的肝病住院患者的中位住院时间更长（7天vs. 5天）。结论：与cvid相关的肝病住院患者，特别是那些NRH和PH患者，住院时间更长，费用更高，并且与死亡率增加有关。需要进一步的研究来改善早期发现和长期结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.