Sam Justina, Nguyen Geoffrey C
Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, Ontario, Canada.
Liver Int. 2009 Oct;29(9):1396-402. doi: 10.1111/j.1478-3231.2009.02077.x. Epub 2009 Jul 7.
We conducted a nationwide analysis of the prevalence of protein-calorie malnutrition (PCM) in patients with cirrhosis and portal hypertension (PHTN) and to determine its mortality and economic impact.
We used the Nationwide Inpatient Sample (NIS) to identify admissions throughout the US with cirrhosis and PHTN between 1998 and 2005 using the International Classification of Diseases, 9th Revision diagnostic codes. Prevalence of PCM in this group of patients with cirrhosis was compared with that of general medical inpatients. The impact of PCM on in-hospital mortality was quantified using multiple logistic regression analysis.
There were 114 703 admissions with cirrhosis and PHTN in the NIS between 1998 and 2005. The prevalence of PCM was substantially higher among patients with cirrhosis and PHTN compared with general medical inpatients (6.1 vs. 1.9%, P<0.0001), with an adjusted odds ratio of 1.55 (95% CI: 1.4-1.7). There was greater prevalence of ascites (64.6 vs. 47.8%, P<0.0001) and hepatorenal syndrome (5.1 vs. 2.8%, P<0.0001) among those with PCM and cirrhosis. In-hospital mortality was two-fold higher among patients with cirrhosis and PCM (14.1 vs. 7.5%, P<0.0001), with an adjusted mortality of 1.76 (95% CI: 1.59-1.94). PCM was associated with greater length of stay (8.7 vs. 5.7 days, P<0.0001) and hospital charges (US$36 818 vs. US$22 673; P<0.0001) among patients with cirrhosis.
PCM is more common among patients with cirrhosis and PHTN than the general medical population, and is associated with higher in-hospital mortality and resource utilization. PCM may be an indicator of greater disease severity and should be routinely assessed on admission.
我们对肝硬化和门静脉高压症（PHTN）患者中蛋白质 - 热量营养不良（PCM）的患病率进行了全国性分析，并确定其死亡率和经济影响。
我们使用全国住院患者样本（NIS），通过国际疾病分类第九版诊断代码，识别1998年至2005年间美国所有肝硬化和PHTN患者的住院情况。将这组肝硬化患者中PCM的患病率与普通内科住院患者的患病率进行比较。使用多元逻辑回归分析量化PCM对住院死亡率的影响。
1998年至2005年间，NIS中有114703例肝硬化和PHTN患者住院。与普通内科住院患者相比，肝硬化和PHTN患者中PCM的患病率显著更高（6.1%对1.9%，P<0.0001），调整后的优势比为1.55（95%CI：1.4 - 1.7）。PCM和肝硬化患者中腹水（64.6%对47.8%，P<0.0001）和肝肾综合征（5.1%对2.8%，P<0.0001）的患病率更高。肝硬化和PCM患者的住院死亡率高出两倍（14.1%对7.5%，P<0.0001），调整后的死亡率为1.76（95%CI：1.59 - 1.94）。PCM与肝硬化患者住院时间延长（8.7天对5.7天，P<0.0001）和住院费用增加（36818美元对22673美元；P<0.0001）相关。
PCM在肝硬化和PHTN患者中比普通内科人群更常见，并且与更高的住院死亡率和资源利用相关。PCM可能是疾病严重程度更高的一个指标，应在入院时常规评估。
