Flinders Medical Centre, Adelaide, SA
Flinders Medical Centre, Adelaide, SA.
Med J Aust. 2018 Sep 1;209(7):301-305. doi: 10.5694/mja17.01164.
To compare the incidence of liver-related emergency admissions and survival of patients after hospitalisation for decompensated cirrhosis at two major hospitals, one applying a coordinated chronic disease management model (U1), the other standard care (U2); to examine predictors of mortality for these patients.
Retrospective observational cohort study.
Two major tertiary hospitals in an Australian capital city.
Patients admitted with a diagnosis of decompensated cirrhosis during October 2013 - October 2014, identified on the basis of International Classification of Diseases (ICD-10) codes.
Incident rates of liver-related emergency admissions; survival (to 3 years).
Sixty-nine patients from U1 and 54 from U2 were eligible for inclusion; the median follow-up time was 530 days (range, 21-1105 days). The incidence of liver-related emergency admissions was lower for U1 (mean, 1.14 admissions per person-year; 95% CI, 0.95-1.36) than for U2 (mean, 1.55 admissions per person-year; 95% CI, 1.28-1.85; adjusted incidence rate ratio [U1 v U2], 0.52; 95% CI, 0.28-0.98; P = 0.042). The adjusted probabilities of transplantation-free survival at 3 years were 67.7% (U1) and 37.2% (U2) (P = 0.009). Independent predictors of reduced transplantation-free free survival were Charlson comorbidity index score (per point: hazard ratio [HR], 1.27; 95% CI, 1.05-1.54, P = 0.014), liver-related emergency admissions within 90 days of discharge (HR, 3.60; 95% CI, 1.87-6.92; P < 0.001), and unit (U2 v U1: HR, 2.54, 95% CI, 1.26-5.09; P = 0.009).
A coordinated care model for managing patients with decompensated cirrhosis was associated with improved survival and fewer liver-related emergency admissions than standard care.
比较两家大型医院（一家采用协调慢性病管理模式（U1），另一家采用标准护理（U2））中因失代偿性肝硬化住院患者的肝脏相关急诊入院率和生存情况；检验这些患者的死亡率预测因素。
回顾性观察性队列研究。
澳大利亚首都的两家主要三级医院。
根据国际疾病分类（ICD-10）代码，2013 年 10 月至 2014 年 10 月期间，确定因失代偿性肝硬化住院的患者。
肝脏相关急诊入院率；生存（3 年）。
U1 组有 69 名患者和 U2 组有 54 名患者符合纳入标准；中位随访时间为 530 天（范围，21-1105 天）。U1 组肝脏相关急诊入院率较低（U1 组的平均值为 1.14 人年入院率；95%CI，0.95-1.36），U2 组平均值为 1.55 人年入院率（95%CI，1.28-1.85；U1 与 U2 的调整发病率比为 0.52；95%CI，0.28-0.98；P = 0.042）。3 年时无移植存活率的调整概率分别为 U1 组的 67.7%和 U2 组的 37.2%（P = 0.009）。无移植存活率降低的独立预测因素包括 Charlson 合并症指数评分（每增加 1 分：风险比 [HR]，1.27；95%CI，1.05-1.54，P = 0.014）、出院后 90 天内的肝脏相关急诊入院（HR，3.60；95%CI，1.87-6.92；P < 0.001）和单位（U2 与 U1：HR，2.54，95%CI，1.26-5.09；P = 0.009）。
与标准护理相比，管理失代偿性肝硬化患者的协调护理模式与生存改善和肝脏相关急诊入院减少相关。
