Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Endoscopy Unit, Oakland, CA, 94602, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th. Street, San Francisco, CA, 94158, USA.
Dig Dis Sci. 2019 Jun;64(6):1448-1457. doi: 10.1007/s10620-019-05576-9. Epub 2019 Mar 13.
Hepatic encephalopathy (HE) is associated with substantial morbidity and mortality, contributing significant burden on healthcare systems.
We aim to evaluate trends in clinical and economic burden of HE among hospitalized adults in the USA.
Using the 2010-2014 National Inpatient Sample, we identified adults hospitalized with HE using ICD-9-CM codes. Annual trends in hospitalizations with HE, in-hospital mortality, and hospital charges were stratified by the presence of acute liver failure (ALF) or cirrhosis. Adjusted multivariable regression models were evaluated for predictors of in-hospital mortality and hospitalization charges.
Among 142,860 hospitalizations with HE (mean age 59.3 years, 57.8% male), 67.7% had cirrhosis and 3.9% ALF. From 2010 to 2014, total number of hospitalizations with HE increased by 24.4% (25,059 in 2010 to 31,182 in 2014, p < 0.001). Similar increases were seen when stratified by ALF (29.7% increase) and cirrhosis (29.7% increase). Overall in-hospital mortality decreased from 13.4% (2010) to 12.3% (2014) (p = 0.001), with similar decreases observed in ALF and cirrhosis. Total inpatient charges increased by 46.0% ($8.15 billion, 2010 to $11.9 billion, 2014). On multivariable analyses, ALF was associated with significantly higher odds of in-hospital mortality (OR 5.37; 95% CI 4.97-5.80; p < 0.001) as well as higher mean inpatient charges (122.6% higher; 95% CI + 115.0-130.3%; p < 0.001) compared to cirrhosis. The presence of ascites, hepatocellular carcinoma, and hepatorenal syndrome was associated with increased mortality.
The clinical and economic burden of hospitalizations with HE in the USA continues to rise. In 2014, estimated national economic burden of hospitalizations with HE reached $11.9 billion.
肝性脑病（HE）与大量发病率和死亡率相关，对医疗体系造成了重大负担。
我们旨在评估美国住院成人中 HE 的临床和经济负担的变化趋势。
使用 2010-2014 年国家住院患者样本，我们使用 ICD-9-CM 代码确定患有 HE 的住院成年人。根据急性肝衰竭（ALF）或肝硬化的存在，对 HE 住院治疗、住院死亡率和住院费用的年度趋势进行分层。使用调整后的多变量回归模型评估住院死亡率和住院费用的预测因素。
在 142860 例 HE 住院患者（平均年龄 59.3 岁，57.8%为男性）中，67.7%有肝硬化，3.9%有 ALF。从 2010 年到 2014 年，HE 住院患者总数增加了 24.4%（2010 年为 25059 例，2014 年为 31182 例，p<0.001）。按 ALF（增加 29.7%）和肝硬化（增加 29.7%）分层时也观察到类似的增加。总的住院死亡率从 13.4%（2010 年）下降到 12.3%（2014 年）（p<0.001），在 ALF 和肝硬化中也观察到类似的下降。总住院费用增加了 46.0%（81.5 亿美元，2010 年至 119 亿美元，2014 年）。在多变量分析中，ALF 与住院死亡率显著升高相关（比值比 5.37；95%置信区间 4.97-5.80；p<0.001），以及平均住院费用显著升高（高 122.6%；95%置信区间+115.0-130.3%；p<0.001）相比肝硬化。腹水、肝细胞癌和肝肾综合征的存在与死亡率增加相关。
美国 HE 住院患者的临床和经济负担继续上升。2014 年，HE 住院患者的估计全国经济负担达到 119 亿美元。
