与非学术中心相比，学术中心因慢性肝衰竭急性发作而住院的患者死亡率更高。
Hospitalizations for Acute on Chronic Liver Failure at Academic Compared to Non-academic Centers Have Higher Mortality.
机构信息
Division of Gastroenterology and Hepatology, Department of Medicine, Transplant Hepatologist and Chief Clinical Research Affairs, Avera McKennan University Hospital Transplant Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, 57105, USA.
Department of Internal Medicine, University of Alabama at Birmingham, Montgomery, AL, USA.
出版信息
Dig Dis Sci. 2021 Apr;66(4):1306-1314. doi: 10.1007/s10620-020-06263-w. Epub 2020 Apr 21.
BACKGROUND AND AIM
Acute on chronic liver failure (ACLF) in patients with cirrhosis has high short-term mortality. Data comparing ACLF admissions to academic centers (AC) and non-academic centers (NAC) are scanty.
METHODS
National Inpatient Sample (2006-2014) was queried for admissions with cirrhosis and ACLF using the ICD-09 codes, and was stratified to AC or NAC.
RESULTS
Of 1,928,764 admissions with cirrhosis (2006-2014), 112,174 (5. 9%) had ACLF. 6.7% of 1,018,568 cirrhosis admissions to AC had ACLF versus 5% of 910,196 admissions to NAC, P < 0.0001. Proportion of ACLF admissions to AC increased from 49% during 2006-2008 to 59% during 2012-2014. In a cohort of 73,630 ACLF admissions (36,615 each to AC and NAC) matched for patient demographics, cirrhosis etiology, number of comorbidities, elective versus emergent admission, ACLF grade, and type of organ failure. In-hospital mortality declined by 7% over the study period, but remained higher in AC (46% vs. 42%, P < 0.001), with 11% increased odds for in-hospital mortality compared to admission to NAC. Further admissions to AC versus NAC had higher median (IQR) length of stay at 13 (6-25) versus 11 (5-20) days, with higher median (IQR) hospital charges: 138,239 (66,772-275,603) versus 116,209 (55,767-232,699) USD, P < 0.001 for both.
CONCLUSION
Patients with ACLF have high in-hospital mortality. Further, this is higher among admissions to AC. Although the in-hospital mortality is improving, strategies are needed on early identification of patients with futility of care for early discussion on goals of care, and optimal utilization of hospital resources among admissions with ACLF.
背景与目的
肝硬化合并慢加急性肝衰竭（ACLF）患者的短期死亡率较高。比较肝硬化患者在学术中心（AC）和非学术中心（NAC）就诊的 ACLF 入院数据很少。
方法
使用 ICD-09 代码，从 2006 年至 2014 年的国家住院患者样本（National Inpatient Sample，NIS）中查询肝硬化和 ACLF 患者入院数据，并分层为 AC 或 NAC。
结果
在 2006 年至 2014 年期间，1928764 例肝硬化患者中（NIS），有 112174 例（5.9%）患有 ACLF。AC 中 1018568 例肝硬化患者中有 6.7%患有 ACLF，而 NAC 中 910196 例肝硬化患者中有 5%患有 ACLF，P<0.0001。AC 中 ACLF 入院比例从 2006 年至 2008 年的 49%增加到 2012 年至 2014 年的 59%。在 73630 例 ACLF 入院患者（AC 和 NAC 各 36615 例）中，两组患者的人口统计学特征、肝硬化病因、合并症数量、择期或紧急入院、ACLF 分级和器官衰竭类型相匹配。在研究期间，住院死亡率下降了 7%，但 AC 仍较高（46%比 42%，P<0.001），与 NAC 入院相比，AC 入院的住院死亡率增加了 11%。与 NAC 入院相比，进一步 AC 入院的中位（IQR）住院时间更长，分别为 13（6-25）天和 11（5-20）天，中位（IQR）住院费用更高，分别为 138239（66772-275603）美元和 116209（55767-232699）美元，均 P<0.001。
结论
ACLF 患者的住院死亡率较高。此外，AC 入院患者的死亡率更高。尽管住院死亡率有所改善，但仍需要在早期识别治疗无效的患者方面制定策略，以便尽早讨论护理目标，并在 ACLF 患者中优化利用医院资源。
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