烧伤中的肝脏疾病：来自31338名成年患者全国样本的证据。
Liver disease in burn injury: evidence from a national sample of 31,338 adult patients.
作者信息
Price Leigh Ann, Thombs Brett, Chen Catherine L, Milner Stephen M
机构信息
The Johns Hopkins Burn Center, Baltimore, Maryland, USA.
出版信息
J Burns Wounds. 2007 Jun 12;7:e1.
OBJECTIVE
To assess mortality risk and extent of increased length of hospital stay in patients with burn injury with preexisting liver disease.
METHODS
Records of 31,338 adults who were admitted with burns to 70 burn centers were reviewed from the American Burn Association National Burn Repository. Demographics, percentage burn, and medical characteristics of 180 patients with liver disease were compared with all patients without liver disease and to a propensity score-matched sample of 180 patients without liver disease. Risk of mortality as well as lengths of both intensive care and total stay were compared after matching for demographics, burn injury, and preexisting medical conditions.
RESULTS
Patients with liver disease were significantly more likely to have a history of a number of medical comorbidities, including alcohol abuse, drug abuse, a psychiatric diagnosis, chronic pulmonary disease, hypertension, and diabetes. Patients with liver disease were significantly more likely to die in the hospital (27.2% vs 6.9%, odds ratio = 5.0, 95% confidence interval = 3.6-7.0, P < .01), and this held even when compared with a propensity score-matched group of patients without liver disease, but with similar demographics, burn injury, and medical profiles. Lengths of both intensive care and total hospital stay were 122.5% (P < .01) and 86.7% (P < .01) longer, respectively, among patients with liver disease than among all other patients. In a matched sample, lengths of both intensive care and total stays were longer, albeit not significantly so (41.6%, P = .12; 35.5%, P = .07).
CONCLUSIONS
Liver impairment worsens the prognosis in patients with thermal injury.
目的
评估合并有肝病的烧伤患者的死亡风险及住院时间延长的程度。
方法
从美国烧伤协会国家烧伤资料库中回顾了70个烧伤中心收治的31338例成年烧伤患者的记录。将180例肝病患者的人口统计学资料、烧伤百分比和医学特征与所有无肝病患者以及180例倾向评分匹配的无肝病患者样本进行比较。在对人口统计学、烧伤损伤和既往病史进行匹配后，比较死亡风险以及重症监护和总住院时间。
结果
肝病患者更有可能有多种合并症病史，包括酗酒、药物滥用、精神疾病诊断、慢性肺病、高血压和糖尿病。肝病患者在医院死亡的可能性显著更高（27.2%对6.9%，优势比=5.0，95%置信区间=3.6-7.0，P<.01），即使与倾向评分匹配的无肝病患者组相比也是如此，但两组在人口统计学、烧伤损伤和医学特征方面相似。肝病患者的重症监护和总住院时间分别比所有其他患者长122.5%（P<.01）和86.7%（P<.01）。在匹配样本中，重症监护和总住院时间也更长，尽管差异不显著（分别为41.6%，P=.12；35.5%，P=.07）。
结论
肝功能损害会恶化热损伤患者的预后。
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