Chirapongsathorn Sakkarin, Poovorawan Kittiyod, Soonthornworasiri Ngamphol, Pan-Ngum Wirichada, Phaosawasdi Kamthorn, Treeprasertsuk Sombat
Division of Gastroenterology and Hepatology Department of Medicine Phramongkutklao Hospital College of Medicine, Royal Thai Army Bangkok Thailand.
Department of Clinical Tropical Medicine Faculty of Tropical Medicine Mahidol University Bangkok Thailand.
Hepatol Commun. 2020 Jan 21;4(3):453-460. doi: 10.1002/hep4.1472. eCollection 2020 Mar.
Accurate population-based data are needed on the rate, economic impact, and the longterm outcomes of readmission among patients with cirrhosis. To examine the rates, costs, and 1-year outcomes of patients readmitted within 30 days following their index hospitalization for complications of cirrhosis, we conducted a nationwide, population-based cohort study involving all patients with cirrhosis in Thailand from 2009 through 2013, using data from the National Health Security Office databases, which included those from nationwide hospitalizations. Readmission was captured from hospitals at all health care levels across the country within the Universal Coverage Scheme. For the 134,038 patients hospitalized with cirrhosis, the overall 30-day readmission rate was 17%. Common causes of readmission consisted of complications of portal hypertension (47%) and infections (17%). After adjusting for multiple covariates, predictors of 30-day readmission included hepatocellular carcinoma (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.84-2.06), human immunodeficiency virus-related admission (OR 1.81, 95% CI 1.51-2.17) and cholangiocarcinoma (OR 1.64, 95% CI 1.3-2.05). In all, 2,936 deaths (13%) occurred during readmission, and an additional 14,425 deaths up to 1 year (63.5% total mortality among readmitted patients). Causes of death were mostly from liver-related mortality. Average cost at index admission for those with a 30-day readmission were significantly higher than those readmitted beyond 30 days or not readmitted. Patients hospitalized with cirrhosis complications had high rates of unscheduled 30-day readmission. Average hospitalization costs were high, and only 36.5% of patients readmitted within 30 days survived at 1 year.
需要基于人群的准确数据，以了解肝硬化患者再入院的发生率、经济影响和长期预后。为了研究肝硬化并发症首次住院后30天内再入院患者的发生率、费用和1年预后，我们进行了一项全国性的基于人群的队列研究，纳入了2009年至2013年泰国所有肝硬化患者，使用了国家健康保险办公室数据库的数据，其中包括全国住院患者的数据。再入院情况是通过全民覆盖计划在全国各级医疗保健机构的医院中获取的。对于134,038例因肝硬化住院的患者，总体30天再入院率为17%。再入院的常见原因包括门静脉高压并发症（47%）和感染（17%）。在调整了多个协变量后，30天再入院的预测因素包括肝细胞癌（比值比[OR]1.95，95%置信区间[CI]1.84-2.06）、人类免疫缺陷病毒相关入院（OR 1.81，95%CI 1.51-2.17）和胆管癌（OR 1.64，95%CI 1.3-2.05）。共有2936例（13%）患者在再入院期间死亡，另有14425例患者在1年内死亡（再入院患者总死亡率为63.5%）。死亡原因主要是肝脏相关死亡率。30天内再入院患者首次入院时的平均费用显著高于30天后再入院或未再入院的患者。因肝硬化并发症住院的患者计划外30天再入院率很高。平均住院费用很高，30天内再入院的患者中只有36.5%在1年内存活。
