{"title":"肝硬化如何影响非静脉曲张性上消化道出血的死亡率、发病率和资源利用?一个全国性的分析。","authors":"Umer Farooq, Zahid Ijaz Tarar, Adnan Malik, Muhammad Kashif Amin, Humberto Sifuentes","doi":"10.5114/pg.2022.115232","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Upper gastrointestinal bleeding is common in liver cirrhosis patients. Studies have described the prognostic impact of liver disease in non-variceal upper gastrointestinal bleeding (NVUGIB), but a direct subgroup comparison is lacking using a large database.</p><p><strong>Aim: </strong>To study the impact of NVUGIB on hospital-based outcomes in patients with cirrhosis.</p><p><strong>Material and methods: </strong>This is a retrospective study using Nationwide Inpatient Sample (NIS) employing International Classification of Diseases (ICD-10) codes for adult patients with a primary diagnosis of NVUGIB. Mortality, morbidity, and resource utilization were compared. Analyses were performed using STATA, proportions were compared using Fisher exact test, and continuous variables using Student's <i>t</i>-test. Confounding variables were adjusted using propensity matching, multivariate logistic, and linear regression analyses.</p><p><strong>Results: </strong>Of 107,001,355 discharges, 957,719 had a diagnosis of NVUGIB. Of those, 92,439 had cirrhosis upon admission. NVUGIB patients with cirrhosis had higher adjusted odds of mortality and intensive care unit (ICU) admission than patients without cirrhosis (adjusted odds ratio (AOR) for mortality 1.31, <i>p</i> < 0.001, ICU admission AOR = 1.29, <i>p</i> < 0.001). NVUGIB patients with cirrhosis had shorter length of stay (LOS) by 0.44 days (<i>p</i> < 0.001), greater hospital costs per day ($3114 vs. $2810, <i>p</i> < 0.001), and lower odds of acute kidney injury (AOR = 0.81, <i>p</i> < 0.001). In addition, the cirrhotic patients had higher odds of receiving endoscopic therapy (AOR = 1.08, <i>p</i> < 0.001). There was no difference between the 2 groups' requirements of packed red blood cell transfusion, parenteral nutrition, hypovolaemic shock, and endotracheal intubation. We also identified novel independent predictors of mortality from NVUGIB in cirrhosis patients.</p><p><strong>Conclusions: </strong>Cirrhosis presents greater mortality and morbidity burden and greater healthcare resource utilization from NVUGIB.</p>","PeriodicalId":20719,"journal":{"name":"Przegla̜d Gastroenterologiczny","volume":"18 2","pages":"204-215"},"PeriodicalIF":1.7000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/62/ce/PG-18-46804.PMC10395061.pdf","citationCount":"1","resultStr":"{\"title\":\"How does cirrhosis impact mortality, morbidity, and resource utilization in non-variceal upper gastrointestinal bleeding? 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Analyses were performed using STATA, proportions were compared using Fisher exact test, and continuous variables using Student's <i>t</i>-test. Confounding variables were adjusted using propensity matching, multivariate logistic, and linear regression analyses.</p><p><strong>Results: </strong>Of 107,001,355 discharges, 957,719 had a diagnosis of NVUGIB. Of those, 92,439 had cirrhosis upon admission. NVUGIB patients with cirrhosis had higher adjusted odds of mortality and intensive care unit (ICU) admission than patients without cirrhosis (adjusted odds ratio (AOR) for mortality 1.31, <i>p</i> < 0.001, ICU admission AOR = 1.29, <i>p</i> < 0.001). NVUGIB patients with cirrhosis had shorter length of stay (LOS) by 0.44 days (<i>p</i> < 0.001), greater hospital costs per day ($3114 vs. $2810, <i>p</i> < 0.001), and lower odds of acute kidney injury (AOR = 0.81, <i>p</i> < 0.001). 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引用次数: 1
摘要
上消化道出血在肝硬化患者中很常见。已有研究描述了肝脏疾病对非静脉曲张性上消化道出血(NVUGIB)预后的影响，但缺乏使用大型数据库进行直接亚组比较。目的:研究NVUGIB对肝硬化患者医院预后的影响。材料和方法:本研究采用全国住院患者样本(NIS)，采用国际疾病分类(ICD-10)代码，对初步诊断为NVUGIB的成年患者进行回顾性研究。比较死亡率、发病率和资源利用情况。采用STATA进行分析，比例比较采用Fisher精确检验，连续变量比较采用Student’st检验。使用倾向匹配、多元逻辑分析和线性回归分析调整混杂变量。结果:107,001,355例出院患者中，957,719例诊断为NVUGIB。其中，92439人在入院时患有肝硬化。NVUGIB合并肝硬化患者的调整死亡率和重症监护病房(ICU)入院比均高于无肝硬化患者(死亡率调整优势比(AOR)为1.31,p < 0.001, ICU入院AOR = 1.29, p < 0.001)。NVUGIB合并肝硬化患者的住院时间(LOS)缩短0.44天(p < 0.001)，每天的住院费用较高(3114美元对2810美元，p < 0.001)，急性肾损伤的发生率较低(AOR = 0.81, p < 0.001)。此外，肝硬化患者接受内镜治疗的几率更高(AOR = 1.08, p < 0.001)。两组对填充红细胞输血、肠外营养、低血容量性休克、气管插管的需求无差异。我们还发现了肝硬化患者NVUGIB死亡率的新的独立预测因子。结论:NVUGIB肝硬化带来更高的死亡率和发病率负担以及更高的医疗资源利用率。
How does cirrhosis impact mortality, morbidity, and resource utilization in non-variceal upper gastrointestinal bleeding? A nationwide analysis.
Introduction: Upper gastrointestinal bleeding is common in liver cirrhosis patients. Studies have described the prognostic impact of liver disease in non-variceal upper gastrointestinal bleeding (NVUGIB), but a direct subgroup comparison is lacking using a large database.
Aim: To study the impact of NVUGIB on hospital-based outcomes in patients with cirrhosis.
Material and methods: This is a retrospective study using Nationwide Inpatient Sample (NIS) employing International Classification of Diseases (ICD-10) codes for adult patients with a primary diagnosis of NVUGIB. Mortality, morbidity, and resource utilization were compared. Analyses were performed using STATA, proportions were compared using Fisher exact test, and continuous variables using Student's t-test. Confounding variables were adjusted using propensity matching, multivariate logistic, and linear regression analyses.
Results: Of 107,001,355 discharges, 957,719 had a diagnosis of NVUGIB. Of those, 92,439 had cirrhosis upon admission. NVUGIB patients with cirrhosis had higher adjusted odds of mortality and intensive care unit (ICU) admission than patients without cirrhosis (adjusted odds ratio (AOR) for mortality 1.31, p < 0.001, ICU admission AOR = 1.29, p < 0.001). NVUGIB patients with cirrhosis had shorter length of stay (LOS) by 0.44 days (p < 0.001), greater hospital costs per day ($3114 vs. $2810, p < 0.001), and lower odds of acute kidney injury (AOR = 0.81, p < 0.001). In addition, the cirrhotic patients had higher odds of receiving endoscopic therapy (AOR = 1.08, p < 0.001). There was no difference between the 2 groups' requirements of packed red blood cell transfusion, parenteral nutrition, hypovolaemic shock, and endotracheal intubation. We also identified novel independent predictors of mortality from NVUGIB in cirrhosis patients.
Conclusions: Cirrhosis presents greater mortality and morbidity burden and greater healthcare resource utilization from NVUGIB.
期刊介绍：
Gastroenterology Review is a journal published each 2 months, aimed at gastroenterologists and general practitioners. Published under the patronage of Consultant in Gastroenterology and Polish Pancreatic Club.
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