Jamal M Mazen, Samarasena Jason B, Hashemzadeh Mehrtash
Division of Gastroenterology, Veterans Affairs Medical Center, Long Beach, California 90822, USA.
Eur J Gastroenterol Hepatol. 2008 Oct;20(10):947-55. doi: 10.1097/MEG.0b013e32830280c7.
To date, no study has analyzed nationwide trends of in-hospital mortality related to oesophageal variceal hemorrhage in the USA. The aim of this study was to analyze trends of in-hospital mortality related to oesophageal variceal bleeding over the past two decades using a large national database. In addition, our aim was to study patient demographics and to identify risk factors for in-hospital mortality based on administrative data routinely collected in this population.
The nationwide inpatient sample database was used from 1988 to 2004. Patients with an International Classification of Diseases, ninth revision, Clinical Modification discharge diagnosis of oesophageal variceal bleeding were included. Patient demographics, hospital, and admission characteristics were collected. t-test and Poisson regression analysis were used to evaluate trends. Logistic regression analysis was performed to determine the relationship between mortality and patient/hospital characteristics.
From 1988 to 2004, crude in-hospital mortality decreased from 18 to 11.5%, whereas the age-adjusted in-hospital mortality rate decreased 45.4% from 1289 per 100,000 to 704 per 100,000 (P<0.01). Mortality was consistently higher for males and for African-Americans over the study period. For the 2001 dataset, multivariate logistic regression analysis showed that male sex, African-American race, age, large hospital size, urban location, teaching hospitals, and hospitals located in the northeast were independent risk factors for increased mortality.
The in-hospital mortality of patients with oesophageal variceal bleeding has decreased over the past two decades and is likely due to the advances made in the acute management of variceal bleeding as well as improved resuscitative methods. Male sex, African-American race, age, large hospital size, urban location, teaching hospitals, and hospitals located in the northeast are independent risk factors for increased in-hospital mortality.
迄今为止，尚无研究分析美国全国范围内与食管静脉曲张出血相关的住院死亡率趋势。本研究的目的是使用一个大型国家数据库分析过去二十年中与食管静脉曲张出血相关的住院死亡率趋势。此外，我们的目的是研究患者人口统计学特征，并根据该人群常规收集的行政数据确定住院死亡率的危险因素。
使用1988年至2004年的全国住院患者样本数据库。纳入国际疾病分类第九版临床修订本出院诊断为食管静脉曲张出血的患者。收集患者人口统计学、医院和入院特征。采用t检验和泊松回归分析评估趋势。进行逻辑回归分析以确定死亡率与患者/医院特征之间的关系。
1988年至2004年，粗住院死亡率从18%降至11.5%，而年龄调整后的住院死亡率从每10万人1289例降至每10万人704例，下降了45.4%（P<0.01）。在研究期间，男性和非裔美国人的死亡率一直较高。对于2001年的数据集，多变量逻辑回归分析显示，男性、非裔美国人种族、年龄、医院规模大、城市位置、教学医院以及位于东北部的医院是死亡率增加的独立危险因素。
在过去二十年中，食管静脉曲张出血患者的住院死亡率有所下降，这可能归因于静脉曲张出血急性处理方面的进展以及复苏方法的改进。男性、非裔美国人种族、年龄、医院规模大、城市位置、教学医院以及位于东北部的医院是住院死亡率增加的独立危险因素。
