Baylor University Medical Center, Baylor Scott and White, Dallas, Texas, USA.
Center for Clinical Effectiveness, Baylor Scott and White, Dallas, Texas, USA.
Am J Gastroenterol. 2019 Jan;114(1):98-106. doi: 10.1038/s41395-018-0365-4.
In a population-based study, we examined time trends in chronic liver disease (CLD)-related hospitalizations in a large and diverse metroplex.
We examined all CLD-related inpatient encounters (2000-2015) in Dallas-Fort Worth (DFW) using data from the DFW council collaborative that captures claims data from 97% of all hospitalizations in DFW (10.7 million regional patients).
There were 83,539 CLD-related hospitalizations in 48,580 unique patients across 84 hospitals. The age and gender standardized annual rate of CLD-related hospitalization increased from 48.9 per 100,000 in 2000 to 125.7 per 100,000 in 2014. Mean age at hospitalization increased from 54.0 (14.1) to 58.5 (13.5) years; the proportion of CLD patients above 65 years increased from 24.2% to 33.1%. HCV-related hospitalizations plateaued, whereas an increase was seen in hospitalizations related to alcohol (9.1 to 22.7 per 100,000) or fatty liver (1.4 per 100,000 to 19.5 per 100,000). The prevalence of medical comorbidities increased for CLD patients: coronary artery disease (4.8% to 14.3%), obesity (2.8% to 14.6%), chronic kidney disease (2.8% to 18.2%), and diabetes (18.0% to 33.2%). Overall hospitalizations with traditional complications of portal hypertension (ascites, varices, and peritonitis) remained stable over time. However, hospitalization with complications related to infection increased from 54.7% to 66.4%, and renal failure increased by sevenfold (2.7% to 19.5%).
CLD-related hospitalizations have increased twofold over the last decade. Hospitalized CLD patients are older and sicker with multiple chronic conditions. Traditional complications of portal hypertension have been superseded by infection and renal failure, warranting a need to redefine what it means to have decompensated CLD.
在一项基于人群的研究中，我们研究了在一个大型且多样化的大都市区中，慢性肝病（CLD）相关住院治疗的时间趋势。
我们使用达拉斯-沃斯堡（DFW）理事会合作的数据，对 DFW 中的所有 CLD 相关住院治疗（2000-2015 年）进行了检查，该合作数据涵盖了 DFW 所有住院治疗的 97%（区域内 1070 万患者）。
在 84 家医院中，共有 48580 名独特患者发生了 83539 例 CLD 相关住院治疗。CLD 相关住院治疗的年龄和性别标准化年发生率从 2000 年的每 10 万人 48.9 例增加到 2014 年的每 10 万人 125.7 例。住院时的平均年龄从 54.0（14.1）岁增加到 58.5（13.5）岁；65 岁以上 CLD 患者的比例从 24.2%增加到 33.1%。HCV 相关住院治疗趋于平稳，而酒精相关（每 10 万人 9.1 例至 22.7 例）或脂肪肝相关（每 10 万人 1.4 例至 19.5 例）住院治疗则有所增加。CLD 患者的合并症患病率增加：冠状动脉疾病（4.8%至 14.3%）、肥胖症（2.8%至 14.6%）、慢性肾脏病（2.8%至 18.2%）和糖尿病（18.0%至 33.2%）。传统门静脉高压症并发症（腹水、静脉曲张和腹膜炎）相关的总体住院治疗保持稳定。但是，与感染相关的并发症住院治疗增加了（从 54.7%增加到 66.4%），肾功能衰竭增加了七倍（从 2.7%增加到 19.5%）。
在过去十年中，CLD 相关住院治疗增加了两倍。住院 CLD 患者年龄更大、病情更重，且合并多种慢性疾病。传统的门静脉高压症并发症已被感染和肾功能衰竭所取代，这需要重新定义失代偿性 CLD 的含义。
