髋部骨折患者的肝病与死亡率：一项基于人群的队列研究。
Liver disease and mortality among patients with hip fracture: a population-based cohort study.
作者信息
Montomoli Jonathan, Erichsen Rune, Gammelager Henrik, Pedersen Alma B
机构信息
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark,
出版信息
Clin Epidemiol. 2018 Aug 21;10:991-1000. doi: 10.2147/CLEP.S168237. eCollection 2018.
PURPOSE
The aim of this study was to examine the prognostic impact of liver disease on mortality following hip fracture (HF).
PATIENTS AND METHODS
This nationwide cohort study, based on prospectively collected data retrieved from Danish registries, included all patients diagnosed with incident HF in Denmark during 1996-2013. Patients were classified based on the coexisting liver disease at the time of HF, ie, no liver disease, noncirrhotic liver disease, and liver cirrhosis. We computed 30-day and 31-365-day mortality risks. To compare patients with and without liver disease, we computed mortality adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) using Cox regression controlled for potential confounders.
RESULTS
Among 152,180 HF patients, 2,552 (1.7%) patients had noncirrhotic liver disease and 1,866 (1.2%) patients had liver cirrhosis. Thirty-day mortality was 9.4% among patients with noncirrhotic liver disease, 12.6% among patients with liver cirrhosis patients, and 9.7% among patients without liver disease. Compared to patients without liver disease, crude and adjusted HRs within 30 days following HF were, respectively, 0.96 (95% CI: 0.85-1.10) and 1.24 (95% CI: 1.09-1.41) for patients with noncirrhotic liver disease and 1.30 (95% CI: 1.14-1.48) and 2.25 (95% CI: 1.96-2.59) for those with liver cirrhosis. Among patients who survived 30 days post-HF, the 31-365-day mortality was 18.5% among patients with noncirrhotic liver disease, 26.4% among patients with liver cirrhosis, and 19.4% among patients without liver disease. Corresponding crude and adjusted HRs were, respectively, 0.95 (95% CI: 0.86-1.04) and 1.08 (95% CI: 0.99-1.20) for patients with noncirrhotic liver disease and 1.40 (95% CI: 1.27-1.54) and 1.91 (95% CI: 1.72-2.12) for those with liver cirrhosis.
CONCLUSION
Liver disease patients, especially those with liver cirrhosis, had increased 30-day mortality and 31-365-day mortality following HF, compared to patients without liver disease.
目的
本研究旨在探讨肝脏疾病对髋部骨折（HF）后死亡率的预后影响。
患者与方法
这项全国性队列研究基于从丹麦登记处前瞻性收集的数据，纳入了1996年至2013年期间在丹麦被诊断为新发HF的所有患者。根据HF发生时并存的肝脏疾病对患者进行分类，即无肝脏疾病、非肝硬化性肝病和肝硬化。我们计算了30天和31 - 365天的死亡风险。为比较有无肝脏疾病的患者，我们使用Cox回归计算了死亡率调整后的风险比（HRs）及相应的95%置信区间（CIs），并对潜在混杂因素进行了控制。
结果
在152,180例HF患者中，2552例（1.7%）患有非肝硬化性肝病，1866例（1.2%）患有肝硬化。非肝硬化性肝病患者的30天死亡率为9.4%，肝硬化患者为12.6%，无肝脏疾病患者为9.7%。与无肝脏疾病的患者相比，HF后30天内，非肝硬化性肝病患者的粗风险比和调整后风险比分别为0.96（95% CI：0.85 - 1.10）和1.24（95% CI：1.09 - 1.41），肝硬化患者分别为1.30（95% CI：1.14 - 1.48）和2.25（95% CI：1.96 - 2.59）。在HF后存活30天的患者中，非肝硬化性肝病患者的31 - 365天死亡率为18.5%，肝硬化患者为26.4%，无肝脏疾病患者为19.4%。非肝硬化性肝病患者相应的粗风险比和调整后风险比分别为0.95（95% CI：0.86 - 1.04）和1.08（95% CI：0.99 - 1.20），肝硬化患者分别为1.40（95% CI：1.27 - 1.54）和1.91（95% CI：1.72 - 2.12）。
结论
与无肝脏疾病的患者相比，肝脏疾病患者，尤其是肝硬化患者，HF后的30天死亡率和31 - 365天死亡率有所增加。
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