Sempokuya Tomoki, Zhang Guangxiang, Nakagawa Kazuma
Department of Internal Medicine, the Queen's Medical Center, Honolulu, HI 968132, United States.
World J Hepatol. 2019 Jan 27;11(1):74-85. doi: 10.4254/wjh.v11.i1.74.
Chronic liver disease and cirrhosis is the 12 leading cause of death in the United States. Patients with decompensated-cirrhosis, especially with hepatic encephalopathy/coma (HC), have a higher rate of early readmission and contribute to higher healthcare cost.
To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis.
The publicly available Healthcare Cost and Utilization Project National Inpatient Sample database was utilized to examine the temporal trends of total number of discharges, mortalities and inpatient costs related to hospitalization with a primary diagnosis of HC, transjugular intrahepatic portosystemic shunt (TIPS), esophageal varices with bleeding (EV) and spontaneous bacterial peritonitis (SBP) from 2005 to 2014. The ten-year temporal trends were assessed using simple linear regressions and multiple regression analysis. Two-sided < 0.05 was considered statistically significant.
From 2005 to 2014, the total number of discharges with cirrhosis-associated complications trended up for HC, SBP and EV (HC by 70% increase, < 0.0001; SBP by 819% increase, = 0.0002; EV by 9% increase, = 0.016), but not for TIPS ( = 0.90). HC related to viral hepatitis showed faster increase by 357% ( < 0.0001) in comparison to HC not related to viral hepatitis by 33 % ( = 0.0006). Overall, in-hospital mortality rates for each condition decreased from 2005 to 2014 (HC by 29% reduction, = 0.0024; SBP by 26% reduction, = 0.0038; TIPS by 32% reduction, = 0.021) except for EV ( = 0.34). After adjustment for inflation, aggregate cost of hospitalization for EV, HC, and SBP significantly increased by 20%, 86%, and 980%, respectively, from 2005 to 2014 (all < 0.02), while TIPS had trend toward decreasing cost by 3% ( = 0.95).
The number of hospitalizations and costs for some of the cirrhosis-associated conditions increased. However, the inpatient mortality rates for most of these conditions decreased.
慢性肝病和肝硬化是美国第12大死因。失代偿期肝硬化患者，尤其是患有肝性脑病/昏迷（HC）的患者，再次入院率较高，导致医疗成本增加。
评估与四种常见肝硬化病症相关的全国住院患者出院情况、死亡率及经济影响的趋势。
利用公开的医疗成本和利用项目国家住院患者样本数据库，研究2005年至2014年期间，以HC、经颈静脉肝内门体分流术（TIPS）、食管静脉曲张出血（EV）和自发性细菌性腹膜炎（SBP）为主要诊断的住院患者的出院总数、死亡率及住院费用的时间趋势。使用简单线性回归和多元回归分析评估十年时间趋势。双侧P<0.05被认为具有统计学意义。
2005年至2014年期间，与肝硬化相关并发症的出院总数在HC、SBP和EV方面呈上升趋势（HC增加70%，P<0.0001；SBP增加819%，P = 0.0002；EV增加9%，P = 0.016），但TIPS并非如此（P = 0.90）。与非病毒性肝炎相关的HC相比，与病毒性肝炎相关的HC增长更快，分别为357%（P<0.0001）和33%（P = 0.0006）。总体而言，2005年至2014年期间，每种病症的住院死亡率均有所下降（HC下降29%，P = 0.0024；SBP下降26%，P = 0.0038；TIPS下降32%，P = 0.021），但EV除外（P = 0.34）。经通货膨胀调整后，2005年至2014年期间，EV、HC和SBP的住院总费用分别显著增加了20%、86%和980%（均P<0.02），而TIPS的费用有下降3%的趋势（P = 0.95）。
一些与肝硬化相关病症的住院人数和费用有所增加。然而，这些病症中大多数的住院死亡率有所下降。
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