Do Albert, Ilagan-Ying Ysabel C, Taddei Tamar H
Section of Digestive Diseases Department of Internal Medicine Yale School of Medicine New Haven Connecticut USA.
Yale School of Medicine New Haven Connecticut USA.
Health Sci Rep. 2019 Nov 22;3(1):e139. doi: 10.1002/hsr2.139. eCollection 2020 Mar.
Severe acute liver injury (ALI) can lead to poor outcomes without timely management. Comparatively worse outcomes in various severe, emergent conditions have been attributed to reduced hospital resources experienced by patient weekend admissions, a phenomenon termed "weekend effect." To date, a weekend effect has not been studied in severe ALI, an emergency also necessitating timely management. We aimed to evaluate such an effect in this condition by analyzing a large national inpatient database in the United States.
We analyzed the Nationwide/National Inpatient Sample (NIS) 2000 to 2014, the largest inpatient, all-payer database in the United States (US), containing sociodemographic, clinical, patient-, and hospital-level data. We identified severe ALI using International Classification of Disease, 9 Revision diagnosis codes for acute/subacute hepatic necrosis (570) with encephalopathy (572.2). Our primary outcome was in-hospital mortality. Using a full-model approach for covariate selection, we performed multiple logistic regression modeling to assess for weekend effect and identify predictors of in-hospital mortality.
We identified 15 762 eligible hospitalizations, with 12 182 (77.3%) having complete covariate data. This sample comprised 53.3% males, 69.3% White race, and had an average (± SD) age of 55.0 ± 14.1 years. We utilized a full-model approach for covariate inclusion but did not include patient transfer data due to limited availability. We observed no significant mortality differences in weekend admissions (OR = 1.06, 95% CI: 0.97-1.15, = 0.02). However, significantly higher mortality was associated with male sex, older age, Black or Hispanic race, Northeast US hospitalization, urban teaching status, and larger hospital size. Sensitivity analyses using multiple imputation datasets and transfer covariates did not change our results.
We did not observe a weekend effect of in-hospital mortality for weekend admissions for severe ALI, but our overall diagnosis ascertainment yield was low-indicating that lack of accurate documentation for the etiology of severe ALI may be masking an effect. Additionally, our findings suggest that racial differences and hospital-level characteristics in the context of severe ALI may be associated with varying outcomes, regardless of admission day, which warrants further research.
严重急性肝损伤（ALI）若不及时治疗，可能导致不良后果。在各种严重的紧急情况下，相对较差的治疗结果被归因于周末入院患者可利用的医院资源减少，这一现象被称为“周末效应”。迄今为止，尚未对严重ALI中的周末效应进行研究，而严重ALI也是一种需要及时治疗的急症。我们旨在通过分析美国一个大型全国住院患者数据库来评估这种效应。
我们分析了2000年至2014年的全国住院患者样本（NIS），这是美国最大的住院患者全付费数据库，包含社会人口统计学、临床、患者和医院层面的数据。我们使用国际疾病分类第9版诊断代码，通过急性/亚急性肝坏死（570）伴脑病（572.2）来识别严重ALI。我们的主要结局是住院死亡率。采用全模型方法进行协变量选择，我们进行了多项逻辑回归建模，以评估周末效应并确定住院死亡率的预测因素。
我们确定了15762例符合条件的住院病例，其中12182例（77.3%）有完整的协变量数据。该样本中男性占53.3%，白人占69.3%，平均（±标准差）年龄为55.0±14.1岁。我们采用全模型方法纳入协变量，但由于数据有限未纳入患者转运数据。我们观察到周末入院患者的死亡率无显著差异（比值比=1.06，95%置信区间：0.97 - 1.15，P = 0.02）。然而，男性、年龄较大、黑人或西班牙裔种族、在美国东北部住院、城市教学医院身份以及医院规模较大与死亡率显著升高相关。使用多重填补数据集和转运协变量进行的敏感性分析并未改变我们的结果。
我们未观察到严重ALI周末入院患者的住院死亡率存在周末效应，但我们总体诊断的确定率较低，这表明严重ALI病因缺乏准确记录可能掩盖了一种效应。此外，我们的研究结果表明，在严重ALI情况下，种族差异和医院层面的特征可能与不同的结局相关，无论入院日期如何，这值得进一步研究。
