Pant Chaitanya, Desai Madhav, Deshpande Abhishek, Taylor Ryan, Olyaee Mojtaba, Gilroy Richard
Division of Gastroenterology, Hepatology and Motility, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
Medicine Institute Center for Value Based Care Research, Cleveland Clinic, Cleveland, Ohio.
J Hosp Med. 2015 Jul;10(7):453-6. doi: 10.1002/jhm.2360. Epub 2015 May 14.
Esophageal variceal bleeding (EVB) is a frequent complication in cirrhotic patients resulting in considerable mortality and morbidity. The aim of this study was to investigate the occurrence, impact, and trends of EVB in hospitalized cirrhotic patients on a nationwide level in the United States. We interrogated data from the Nationwide Inpatient Sample from 2002 to 2012. Utilizing International Classification of Diseases, Ninth Revision, Clinical Modification codes, we analyzed hospital discharges for cirrhosis and related EVB in adult patients. EVB in cirrhotic patients was independently associated with overall worse outcomes with respect to in-hospital mortality (10% vs 5%; P < 0.01) and hospital charges (median $41,000 vs $26,000; P < 0.01). In the period from 2002 to 2012, the number of cirrhosis-related hospitalizations increased from 337,956 to 570,220 (P < 0.01). Concurrently, the incidence of EVB in hospitalized cirrhotic patients declined from 8.60% to 5.78%, with an overall decreased trend (P < 0.01). The decline in the rate of EVB in hospitalized cirrhotic patients from 2002 to 2012 likely reflects the effectiveness of primary and secondary prophylaxis.
食管静脉曲张破裂出血（EVB）是肝硬化患者常见的并发症，会导致相当高的死亡率和发病率。本研究的目的是在全国范围内调查美国住院肝硬化患者中EVB的发生情况、影响及趋势。我们查阅了2002年至2012年全国住院患者样本的数据。利用国际疾病分类第九版临床修订本编码，我们分析了成年患者肝硬化及相关EVB的出院情况。肝硬化患者的EVB与住院死亡率（10%对5%；P<0.01）和住院费用（中位数41,000美元对26,000美元；P<0.01）方面总体较差的结局独立相关。在2002年至2012年期间，肝硬化相关住院人数从337,956例增加到570,220例（P<0.01）。同时，住院肝硬化患者中EVB的发生率从8.60%下降到5.78%，呈总体下降趋势（P<0.01）。2002年至2012年住院肝硬化患者中EVB发生率的下降可能反映了一级和二级预防的有效性。
