Ahmed Elmoursi, Daniel V DiGiacomo, Jocelyn R Farmer, Sara Barmettler
{"title":"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。","authors":"Ahmed Elmoursi, Daniel V DiGiacomo, Jocelyn R Farmer, Sara Barmettler","doi":"10.1016/j.jaip.2025.09.021","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>To conduct a nationwide analysis evaluating the prevalence, spectrum, clinical correlates, and outcomes of hepatic manifestations among admitted adults with CVID.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":6.6000,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Hepatic Manifestations in Common Variable Immunodeficiency Associated with Mortality and Worse Hospital Outcomes in Nationwide Analysis using National Readmission Database.\",\"authors\":\"Ahmed Elmoursi, Daniel V DiGiacomo, Jocelyn R Farmer, Sara Barmettler\",\"doi\":\"10.1016/j.jaip.2025.09.021\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>To conduct a nationwide analysis evaluating the prevalence, spectrum, clinical correlates, and outcomes of hepatic manifestations among admitted adults with CVID.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>CVID-associated admissions with liver disease, particularly those with NRH and PH, were longer, more costly, and associated with increased mortality. 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Hepatic Manifestations in Common Variable Immunodeficiency Associated with Mortality and Worse Hospital Outcomes in Nationwide Analysis using National Readmission Database.
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.
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.
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