Bajaj Jasmohan S, Ananthakrishnan Ashwin N, McGinley Emily L, Hoffmann Raymond G, Brasel Karen J
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Am J Gastroenterol. 2008 Jul;103(7):1674-81. doi: 10.1111/j.1572-0241.2008.01814.x. Epub 2008 Jul 4.
Alcohol abuse and minimal hepatic encephalopathy may predispose cirrhotics to a higher motor vehicle crash (MVC) rate. Cirrhotics have poor post-trauma outcomes on small-scale studies. The aim was to examine the effect of cirrhosis on mortality, charges, and length of stay (LOS) after MVCs using the Nationwide Inpatient Sample (NIS) 2004.
NIS 2004 was queried for cirrhotics with MVC (C-MVC), cirrhotics only, and MVC only for demographics, comorbidities, hospital characteristics, and the Injury Severity Score (ISS). C-MVC patients were compared with the other groups. Weighted uni/multivariate regression was performed for all MVCs (with/without cirrhosis).
There were 560,080 discharges for cirrhosis only, 262,244 for MVC only, and 1,565 for C-MVC. C-MVC patients were significantly younger (49.8 yr vs 58.6 yr, P < 0.0005) and had less comorbidities than cirrhosis only, but had similar mortality (C-MVC 10.8% vs cirrhosis only 9.9%, P= 0.23). C-MVC patients (49.8 yr) were older than MVC only patients (43.7 yr, P < 0.0005). C-MVC patients also had significantly higher mortality (10.8%) compared with MVC only (3.1%, P < 0.0005) despite similar ISS. C-MVC patients had significantly greater LOS (9.6 days) and charges ($67,119) compared with both MVC only (6.2 days, $43,314) and cirrhosis only (7.4 days, $35,522). Cirrhosis (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.5-5.5) and age >65 yr (OR 5.2, 95% CI 4.4-6.0) were most commonly associated with mortality. Male sex, high ISS, self-pay, teaching, and large and urban hospitals were also significantly associated with mortality. On multivariate regression, cirrhosis was associated with greater charges and LOS.
Cirrhosis is associated with greater mortality, LOS, and charges after MVC despite controlling for injury severity, comorbidities, and age in NIS 2004.
酒精滥用和轻微肝性脑病可能使肝硬化患者发生机动车碰撞事故（MVC）的几率更高。小规模研究表明，肝硬化患者创伤后预后较差。本研究旨在利用2004年全国住院患者样本（NIS），探讨肝硬化对MVC后死亡率、费用及住院时间（LOS）的影响。
查询2004年NIS中患有MVC的肝硬化患者（C-MVC）、仅肝硬化患者和仅MVC患者的人口统计学、合并症、医院特征及损伤严重程度评分（ISS）。将C-MVC患者与其他组进行比较。对所有MVC患者（有/无肝硬化）进行加权单因素/多因素回归分析。
仅肝硬化患者出院560,080例，仅MVC患者出院262,244例，C-MVC患者出院1,565例。C-MVC患者明显更年轻（49.8岁对58.6岁，P<0.0005），合并症比仅肝硬化患者少，但死亡率相似（C-MVC为10.8%对仅肝硬化患者为9.9%，P = 0.23）。C-MVC患者（49.8岁）比仅MVC患者（43.7岁，P<0.0005）年龄大。尽管ISS相似，但C-MVC患者的死亡率（10.8%）也明显高于仅MVC患者（3.1%，P<0.0005）。与仅MVC患者（6.2天，43,314美元）和仅肝硬化患者（7.4天，35,522美元）相比，C-MVC患者的住院时间（9.6天）和费用（67,119美元）明显更高。肝硬化（比值比[OR]3.5，95%置信区间[CI]2.5 - 5.5）和年龄>65岁（OR 5.2，95%CI 4.4 - 6.0）最常与死亡率相关。男性、高ISS、自费、教学医院以及大型城市医院也与死亡率显著相关。多因素回归分析显示，肝硬化与更高的费用和住院时间相关。
在2004年NIS中，尽管对损伤严重程度、合并症和年龄进行了控制，但肝硬化与MVC后的更高死亡率、住院时间和费用相关。
