完全符合急性静脉曲张出血的质量指标可降低6周死亡率。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-09-01 DOI:10.1016/j.aohep.2025.101993

Edgar Suarez , Juan Carlos Montaño , Ezequiel Demirdjian , Diego Arufe

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引用次数: 0

摘要

简介和目的简介：急性静脉曲张出血（AVB）管理的质量指标（QIs）包括指南推荐的旨在降低死亡率的干预措施。然而，全面遵守这些措施的累积影响仍不清楚。评估AVB发作期间完全遵守5个已建立的QIs是否与降低6周死亡率相关。材料与方法本回顾性观察研究纳入2017 - 2024年135例AVB发作。评估5个QIs的依从性：24小时内给药抗生素，24小时内使用血管活性药物，24小时内诊断内窥镜检查，内窥镜治疗，出院时处方β受体阻滞剂。完全依从性被定义为遵守所有五种干预措施。主要终点为6周死亡率。对MELD评分（<15 vs.≥15）和Child-Pugh分级（A/B vs. C）进行描述性统计和多因素logistic回归校正。采用交互作用项来评价不同Child-Pugh班级的QI依从性是否存在差异。结果6周总死亡率为13.8%。54.8%的发作达到完全依从性。完全依从性组死亡率为4.1%，4次QIs组死亡率为16.3%，3次或更少QIs组死亡率为42.9% （p < 0.001）。在多变量分析中，完全依从性与较低的死亡率独立相关（OR 0.20; 95% CI 0.05-0.82; p = 0.025）。Child-Pugh C级也与死亡率增加显著相关（OR 9.68; p = 0.001）。相互作用分析显示，QI依从性的保护作用在Child-Pugh A/B和Child-Pugh C患者之间没有显著差异（相互作用项p = 0.87），表明在不同严重程度的患者中都有一致的益处。结论：完全符合循证质量指标可显著降低AVB患者6周死亡率，与基线肝病严重程度无关。严格实施这些措施应优先作为肝硬化AVB患者的标准护理。

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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FULL COMPLIANCE TO QUALITY INDICATORS IN ACUTE VARICEAL BLEEDING REDUCES 6-WEEK MORTALITY.

Introduction and Objectives

Introduction: Quality indicators (QIs) for the management of acute variceal bleeding (AVB) encompass guideline-recommended interventions aimed at reducing mortality. However, the cumulative impact of full adherence to these measures remains unclear.

To evaluate whether complete compliance with five established QIs during AVB episodes is associated with reduced 6-week mortality.

Materials and Methods

This retrospective observational study included 135 AVB episodes from 2017 to 2024. Adherence to five QIs was assessed: antibiotic administration within 24 hours, vasoactive agent used within 24 hours, diagnostic endoscopy within 24 hours, endoscopic treatment, and beta-blocker prescription at discharge. Full adherence was defined as compliance with all five interventions. The primary outcome was 6-week mortality. Descriptive statistics and multivariate logistic regression adjusted for MELD score (<15 vs. ≥15) and Child-Pugh class (A/B vs. C) were performed. An interaction term was included to evaluate whether the effect of QI compliance differed by Child-Pugh class.

Results

Overall 6-week mortality was 13.8%. Full adherence was achieved in 54.8% of episodes. Mortality rates by adherence level were 4.1% for full adherence, 16.3% for four QIs, and 42.9% for three or fewer QIs (p < 0.001). In multivariate analysis, full adherence was independently associated with lower mortality (OR 0.20; 95% CI 0.05–0.82; p = 0.025). Child-Pugh class C was also significantly associated with increased mortality (OR 9.68; p = 0.001). An interaction analysis showed that the protective effect of QI adherence did not differ significantly between Child-Pugh A/B and Child-Pugh C patients (interaction term p = 0.87), suggesting a consistent benefit across severity strata.

Conclusions

Complete compliance with evidence-based quality indicators significantly reduces 6-week mortality in patients with AVB, independent of baseline liver disease severity. Rigorous implementation of these measures should be prioritized as a standard of care in cirrhotic patients presenting with AVB.

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来源期刊

Annals of hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.60%

发文量

183

审稿时长

4-8 weeks

期刊介绍： Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.