老年肝硬化患者的生存期和疾病进展:回顾性研究

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY
International Journal of Hepatology Pub Date : 2024-08-08 eCollection Date: 2024-01-01 DOI:10.1155/2024/5852680
Khaled Al-Smadi, Ammar Qureshi, Michelle Buitrago, Besher Ashouri, Zeid Kayali
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引用次数: 0

摘要

背景:老年肝硬化患者的发病率越来越高,但有关其存活率的数据却很有限。本研究旨在调查与年轻患者相比,老年肝硬化患者的存活率和疾病进展情况。研究方法这是一项回顾性单中心研究。纳入的患者年龄在 50 岁以上,根据活检、FibroSure 检测、脾脏肿大、血小板低 < 120 × 109/L)或包括 FibroScan 在内的影像学检查结果确诊为肝硬化。滥用药物、经颈静脉肝内门体分流术(TIPS)、自发性细菌性腹膜炎(SBP)、静脉曲张出血、终末期肝病模型-Na(MELD - Na)≥20、接受过肝移植的患者、排除恶性肿瘤(鳞状细胞癌除外),以及其他合并症,如充血性心力衰竭(CHF)、慢性阻塞性肺病(COPD)和肾小球滤过率(GFR)小于 30 的终末期肾病。研究人员查阅了患者在肝脏门诊的病历,并对人口统计学、实验室、补偿和失代偿状况进行了整理。根据 50-64 岁和≥65 岁将患者分为两组。主要终点是死亡,次要终点是疾病进展,以 MELD-Na 评分从基线到 12 个月的增加来衡量。对两组患者的生存率进行了卡普兰-梅耶尔分析比较。进行了 Cox 回归分析,以确定导致生存率低下的独立风险因素。结果共有 191 名肝硬化患者符合纳入和排除标准。其中 50-64 岁患者 80 人,≥ 65 岁患者 111 人。与 50-64 岁的患者相比,年龄≥ 65 岁的患者生存时间明显较短(73.3 ± 4.8 vs. 151.5 ± 22.7; p < .001)。研究发现,确诊年龄≥ 65 岁(p < 0.001)、男性(p = .013)、体重指数(BMI)< 30(p = 0.005)和失代偿(p = 0.008)是生存率低的独立危险因素。从基线开始随访 12 个月后,MELD-Na 评分显著增加,但只有失代偿期肝硬化患者的 MELD-Na 评分显著增加(p = 0.013)。结论与年轻患者相比,年龄≥ 65 岁的肝硬化患者生存率明显较低。需要进行前瞻性研究,进一步探讨年龄和肥胖对老年肝硬化患者生存和疾病进展的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Survival and Disease Progression in Older Adult Patients With Cirrhosis: A Retrospective Study.

Background: Cirrhosis incidence in older adult patients has been increasing with limited data on their survival. This study is aimed at investigating the survival and disease progression in older adult patients with cirrhosis compared to younger patients. Methods: This is a retrospective single-center study. Patients aged above 50 with a confirmed diagnosis of cirrhosis based on biopsy, FibroSure test, splenomegaly, and low platelets < 120 × 109/L) or imaging findings including FibroScan were included. Patients with active substance abuse, transjugular intrahepatic portosystemic shunt (TIPS), prior spontaneous bacterial peritonitis (SBP), variceal hemorrhage, model for end-stage liver disease-Na (MELD - Na) ≥ 20, had liver transplantation, malignancy except for squamous cell carcinoma, and other comorbidities such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and end-stage kidney disease with glomerular filtration rate (GFR) < 30 were excluded. Patients' records from the liver clinic were reviewed and demographics, laboratory, and compensation and decompensation status were collated. Patients were separated into two groups based on age 50-64 years and age ≥ 65. The primary endpoint was death, and the secondary endpoint was disease progression measured by the baseline to 12-month increase in MELD-Na score. The Kaplan-Meier analysis was conducted to compare the survival between the two groups. Cox regression analysis was performed to identify independent risk factors for poor survival. Results: A total of 191 patients diagnosed with cirrhosis met the inclusion and exclusion criteria. There were 80 patients aged 50-64 years and 111 patients aged ≥ 65 years. Significantly shorter survival times were seen among patients aged ≥ 65 years compared to those aged 50-64 years (73.3 ± 4.8 vs. 151.5 ± 22.7; p < .001). Age of diagnosis ≥ 65 years (p < 0.001), male gender (p = .013), body mass index (BMI) < 30 (p = 0.005), and decompensation (p = 0.008) were found to be independent risk factors for poor survival. MELD-Na scores increased significantly in 12 months of follow-up from baseline, but only in patients with decompensated cirrhosis (p = 0.013). Conclusions: Cirrhotic patients aged ≥ 65 years have significantly poor survival compared to younger patients. A prospective study is needed to further investigate the effect of age and obesity on survival and disease progression in older adult patients with cirrhosis.

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来源期刊
International Journal of Hepatology
International Journal of Hepatology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
3.80
自引率
0.00%
发文量
11
审稿时长
15 weeks
期刊介绍: International Journal of Hepatology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to the medical, surgical, pathological, biochemical, and physiological aspects of hepatology, as well as the management of disorders affecting the liver, gallbladder, biliary tree, and pancreas.
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