Lagman Carlito, Nagasawa Daniel T, Sheppard John P, Jacky Chen Cheng Hao, Nguyen Thien, Prashant Giyarpuram N, Niu Tianyi, Tucker Alexander M, Kim Won, Pouratian Nader, Kaldas Fady M, Busuttil Ronald W, Yang Isaac
Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.
Department of Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.
World Neurosurg. 2018 May;113:e320-e327. doi: 10.1016/j.wneu.2018.02.025. Epub 2018 Feb 13.
To determine if end-stage liver disease (ESLD) in patients with intracranial hemorrhage (ICH) is associated with increased mortality.
This single-center, retrospective cohort study included 53 patients (33 in ESLD cohort and 20 in non-ESLD cohort) who received neurosurgical care between 2006 and 2017. ESLD was defined clinically as severely impaired liver function and at least 1 major complication of liver failure. The primary outcome was mortality.
Overall, in-hospital, and 30-day mortality rates were higher in the ESLD cohort versus the non-ESLD cohort (79 vs. 30%, 79 vs. 20%, and 64 vs. 25%, all P ≤ 0.01). We identified a significant difference in overall survival between ESLD and non-ESLD cohorts on Kaplan-Meier analysis (P = 0.004 with log-rank and Wilcoxon tests). Odds of overall, in-hospital, and 30-day mortality in the ESLD cohort were 8.67 (95% confidence interval [CI], 2.44-30.84), 14.86 (95% CI, 3.75-58.90), and 5.25 (95% CI, 1.53-18.08). Other predictors of overall mortality included primary admission diagnosis of liver disease (odds ratio [OR] = 9.60; 95% CI, 3.75-58.90), higher Child-Pugh (OR = 1.64; 95% CI, 2.66-34.67) and Model for End-Stage Liver Disease (OR = 1.12; 95% CI, 1.04-1.20) scores, lower Glasgow Coma Scale score (OR = 0.73; 95% CI, 0.61-0.88), ICH that developed in the hospital (OR = 4.11; 95% CI, 1.21-13.98), and intraparenchymal hemorrhage (OR = 9.23; 95% CI, 1.72-49.56).
ESLD in patients with ICH is associated with increased mortality.
确定颅内出血（ICH）患者的终末期肝病（ESLD）是否与死亡率增加相关。
这项单中心回顾性队列研究纳入了2006年至2017年间接受神经外科治疗的53例患者（ESLD队列33例，非ESLD队列20例）。ESLD临床定义为肝功能严重受损且至少有1项肝功能衰竭主要并发症。主要结局为死亡率。
总体而言，ESLD队列的院内死亡率和30天死亡率均高于非ESLD队列（分别为79%对30%、79%对20%、64%对25%，P均≤0.01）。Kaplan-Meier分析显示ESLD和非ESLD队列的总生存率存在显著差异（对数秩检验和Wilcoxon检验P = 0.004）。ESLD队列的总体、院内和30天死亡 odds 分别为8.67（95%置信区间[CI]，2.44 - 30.84）、14.86（95% CI，3.75 - 58.90）和5.25（95% CI，1.53 - 18.08）。总体死亡率的其他预测因素包括肝病的初次入院诊断（比值比[OR]=9.60；95% CI，3.75 - 58.90）、更高的Child-Pugh（OR = 1.64；95% CI，2.66 - 34.67）和终末期肝病模型（OR = 1.12；95% CI，1.04 - 1.20）评分、更低的格拉斯哥昏迷量表评分（OR = 0.73；95% CI，0.61 - 0.88）、院内发生的ICH（OR = 4.11；95% CI，1.21 - 13.98）和脑实质内出血（OR = 9.23；95% CI，1.72 - 49.56）。
ICH患者的ESLD与死亡率增加相关。
