Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy.
Eur Rev Med Pharmacol Sci. 2019 Jan;23(2):811-817. doi: 10.26355/eurrev_201901_16895.
The relationship between in-hospital mortality (IHM) and acute oesophageal variceal bleeding (AOEVB) has not been fully assessed. The aim of this study was to establish the association between sex and mortality for patients hospitalized with AOEVB.
We analyzed hospitalizations from the Italian Health Ministry database by identifying all patients discharged with AOEVB from January 2001 to December 2015. A total of 144,943 hospitalizations were for oesophageal varices, but only 24,570 emergency admissions with AOEVB coded as the primary or secondary diagnosis were included for analysis. Factors independently associated with IHM were evaluated by multilevel logistic regression.
Approximately half of the population was aged ≥ 65 years, and nearly 10% was diagnosed with hepatocellular carcinoma. Overall, the IHM was 11.8%, with 12.1% in males and 11.3% in females, increasing from 9.2% among subjects aged < 55 years to 18.9% among those aged ≥ 85 years. The crude risk of death was slightly higher among females; however, when age and clinical presentation were considered, female sex was associated with reduced mortality. For liver disease, the risk of death in women was lower only in those with non-alcoholic liver disease (odds ratio= 0.77, 0.66-0.89), but it was similar to that in men for unspecified, cancer and alcoholic liver disease. The risk declined over time and was increased in patients with multiple comorbidities.
AOEVB-related IHM decreased from 2001-2005 to 2011-2015. Factors affecting mortality included liver disease, age, sex, development of hepatocellular carcinoma and comorbidities.
院内死亡率（IHM）与急性食管静脉曲张出血（AOEVB）之间的关系尚未得到充分评估。本研究旨在确定因 AOEVB 住院的患者的性别与死亡率之间的关系。
我们通过识别 2001 年 1 月至 2015 年 12 月期间所有因 AOEVB 出院的患者，分析了意大利卫生部数据库中的住院情况。共有 144943 例住院是食管静脉曲张，但只有 24570 例因 AOEVB 紧急入院被编码为主要或次要诊断被纳入分析。通过多水平逻辑回归评估与 IHM 独立相关的因素。
人群中约有一半年龄≥65 岁，近 10%被诊断为肝细胞癌。总体而言，IHM 为 11.8%，男性为 12.1%，女性为 11.3%，从<55 岁的 9.2%增加到≥85 岁的 18.9%。女性的死亡风险略高，但在考虑年龄和临床表现后，女性性别与死亡率降低相关。对于肝病，只有非酒精性肝病的女性死亡风险较低（比值比=0.77，0.66-0.89），但在未指定、癌症和酒精性肝病方面与男性相似。风险随时间下降，并在患有多种合并症的患者中增加。
与 AOEVB 相关的 IHM 从 2001-2005 年降至 2011-2015 年。影响死亡率的因素包括肝病、年龄、性别、肝细胞癌的发展和合并症。
