2011年至2017年自身免疫性肝病住院率和死亡率趋势:美国全国分析

IF 2.5 Q2 GASTROENTEROLOGY & HEPATOLOGY
A. Wakil, Yasameen E Muzahim, Mina Awadallah, Vikash Kumar, Natale Mazzaferro, Patricia Greenberg, Nikolaos T. Pyrsopoulos
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引用次数: 0

摘要

背景:自身免疫性肝病(AiLD)包括多种针对肝细胞(自身免疫性肝炎,AIH)或胆管(原发性胆汁性胆管炎(PBC)和原发性硬化性胆管炎(PSC))的疾病。这些疾病可发展为慢性肝病(CLD),其特点是纤维化、肝硬化和肝细胞癌。最近的研究表明,在美国,CLD 的住院人数和相关费用都在增加,但专门针对 AiLD 的住院信息仍然有限。目的 研究 2011 年至 2017 年 AiLD 住院趋势和死亡率。方法 本研究是一项利用全国住院病人抽样(NIS)数据库进行的回顾性分析。使用国际疾病分类(ICD-9)和国际疾病分类(ICD-10)代码对 2011 年至 2017 年期间所有诊断为 AiLD(AIH、PBC、PSC)的入院对象进行识别。如果首次入院代码为 AiLD 代码之一,则定义为原发性 AiLD 入院;如果入院诊断(25 项诊断)中的任何一项有 AiLD 诊断,则定义为继发性 AiLD 入院。受试者年龄在 21 岁及以上。全国住院估算值是使用国家统计研究所提供的样本权重得出的。对分类数据进行了 χ 2 检验。主要趋势特征为院内死亡率、住院费用和住院时间。结果 从 2011 年到 2017 年,住院率显著下降,从 83263 人次降至 74850 人次(P < 0.05)。住院患者主要为老年人(年龄大于 65 岁的中位数占 53%),大部分为女性(中位数占 59%)(P < 0.05),以白种人为主(中位数占 68%)(P < 0.05)。医疗保险是主要的保险(中位数为 56%),其次是私人支付者(中位数为 27%)(P < 0.05)。南方是这些住院患者的主要地理分布(中位数为 33%)(P < 0.05),大多数住院患者发生在大型教学机构(中位数为 63%)(P < 0.05)。入院总费用从2011年的66031上升到2017年的78987(P<0.05),而住院病人死亡率的中位数为4.9%(P<0.05),从2011年的4.67%上升到2017年的5.43%。住院时间中位数保持相对稳定,从2011年的6.94天(SD = 0.07)变为2017年的6.51天(SD = 0.06)(P < 0.05)。急性肾功能衰竭是与死亡率增加相关的最常见风险因素,影响了近 68% 的患者(P < 0.05)。结论 在研究的几年中,AiLD住院病人的总体趋势有所下降,但是,随着AiLD住院病人的死亡率上升,住院费用增加,医疗保健的经济负担显著增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Trends of autoimmune liver disease inpatient hospitalization and mortality from 2011 to 2017: A United States nationwide analysis
BACKGROUND Autoimmune liver diseases (AiLD) encompass a variety of disorders that target either the liver cells (autoimmune hepatitis, AIH) or the bile ducts [(primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC)]. These conditions can progress to chronic liver disease (CLD), which is characterized by fibrosis, cirrhosis, and hepatocellular carcinoma. Recent studies have indicated a rise in hospitalizations and associated costs for CLD in the US, but information regarding inpatient admissions specifically for AiLD remains limited. AIM To examine the trends and mortality of inpatient hospitalization of AiLD from 2011 to 2017. METHODS This study is a retrospective analysis utilizing the National Inpatient Sample (NIS) databases. All subjects admitted between 2011 and 2017 with a diagnosis of AiLD (AIH, PBC, PSC) were identified using the International Classification of Diseases (ICD-9) and ICD-10 codes. primary AiLD admission was defined if the first admission code was one of the AiLD codes. secondary AiLD admission was defined as having the AiLD diagnosis anywhere in the admission diagnosis (25 diagnoses). Subjects aged 21 years and older were included. The national estimates of hospitalization were derived using sample weights provided by NIS. χ 2 tests for categorical data were used. The primary trend characteristics were in-hospital mortality, hospital charges, and length of stay. RESULTS From 2011 to 2017, hospitalization rates witnessed a significant decline, dropping from 83263 admissions to 74850 admissions (P < 0.05). The patients hospitalized were predominantly elderly (median 53% for age > 65), mostly female (median 59%) (P < 0.05), and primarily Caucasians (median 68%) (P < 0.05). Medicare was the major insurance (median 56%), followed by private payer (median 27%) (P < 0.05). The South was the top geographical distribution for these admissions (median 33%) (P < 0.05), with most admissions taking place in big teaching institutions (median 63%) (P < 0.05). Total charges for admissions rose from 66031 in 2011 to 78987 in 2017 (P < 0.05), while the inpatient mortality rate had a median of 4.9% (P < 0.05), rising from 4.67% in 2011 to 5.43% in 2017. The median length of stay remained relatively stable, changing from 6.94 days (SD = 0.07) in 2011 to 6.51 days (SD = 0.06) in 2017 (P < 0.05). Acute renal failure emerged as the most common risk factor associated with an increased death rate, affecting nearly 68% of patients (P < 0.05). CONCLUSION AiLD-inpatient hospitalization showed a decrease in overall trends over the studied years, however there is a significant increase in financial burden on healthcare with increasing in-hospital costs along with increase in mortality of hospitalized patient with AiLD.
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来源期刊
World Journal of Hepatology
World Journal of Hepatology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.10
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4.20%
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172
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