Jamil Khurram, Huang Xingyue, Lovelace Belinda, Pham An T, Lodaya Kunal, Wan George
a Mallinckrodt Pharmaceuticals, Inc , Bedminster , NJ , USA.
b Formerly of Mallinckrodt Pharmaceuticals, Inc , Bedminster , NJ , USA.
J Med Econ. 2019 May;22(5):421-429. doi: 10.1080/13696998.2019.1580201. Epub 2019 Mar 4.
Hepatorenal Syndrome (HRS) is characterized by renal failure in patients with advanced chronic liver disease (CLD) and is the leading cause of hospitalizations in CLD. This study examines the clinical and economic burden, outcomes, and unmet need of HRS treatment in US hospitals.
A retrospective cohort study was conducted based on a large electronic health records database (Cerner HealthFacts) with records for hospitalized HRS patients from January 2009-June 2015. Demographics, clinical characteristics, treatment patterns, and economic outcomes were analyzed. Prognostic indicators of cirrhosis, kidney injury, end-stage liver disease, and acute-on-chronic liver failure were used to determine mortality risk.
A total of 2,542 patients hospitalized with HRS were identified (average age = 57.9 years, 61.8% males, 74.2% Caucasian), with an average total hospital charge of $91,504 per patient and a mean length of stay (LOS) of 30.5 days. The mortality rate was 36.9% with 8.9% of patients discharged to hospice. Of all patients, 1,660 patients had acute kidney injury, 859 with Stage 3 disease, and 26.7% had dialysis. The 30-day readmission rate was 33.1%, 41% of which were unplanned. Nearly one-third of study patients had commercial insurance (30.2%), followed by Medicare (29.9%); hospital charges varied by LOS, receipt of dialysis, and discharge status. Regression analysis demonstrated that HRS costs are associated with LOS, dialysis, and hospital mortality.
HRS is associated with poor outcomes and high hospital costs. Analysis of HRS cost drivers demonstrated an unmet need for additional treatment options to improve outcomes in this patient population.
肝肾综合征（HRS）的特征是晚期慢性肝病（CLD）患者出现肾衰竭，是CLD患者住院的主要原因。本研究调查了美国医院中HRS治疗的临床和经济负担、治疗结果及未满足的需求。
基于一个大型电子健康记录数据库（Cerner HealthFacts）进行回顾性队列研究，该数据库包含2009年1月至2015年6月期间住院的HRS患者记录。分析了人口统计学、临床特征、治疗模式和经济结果。使用肝硬化、肾损伤、终末期肝病和慢加急性肝衰竭的预后指标来确定死亡风险。
共确定了2542例因HRS住院的患者（平均年龄=57.9岁，男性占61.8%，白种人占74.2%），每位患者的平均总住院费用为91504美元，平均住院时间（LOS）为30.5天。死亡率为36.9%，8.9%的患者出院后进入临终关怀。所有患者中，1660例有急性肾损伤，859例为3期疾病，26.7%的患者接受透析。30天再入院率为33.1%，其中41%为非计划再入院。近三分之一的研究患者有商业保险（30.2%），其次是医疗保险（29.9%）；住院费用因住院时间、是否接受透析和出院状态而异。回归分析表明，HRS成本与住院时间、透析和医院死亡率相关。
HRS与不良治疗结果和高昂的医院成本相关。对HRS成本驱动因素的分析表明，在这一患者群体中，改善治疗结果的额外治疗选择存在未满足的需求。
