Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047, USA.
Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA.
Dig Dis Sci. 2022 Jun;67(6):2087-2093. doi: 10.1007/s10620-021-07011-4. Epub 2021 May 1.
Variceal upper gastrointestinal bleeding (VUGIB) is a common and potentially lethal complication of cirrhosis. Population-based data regarding hospital readmission and other outcomes in VUGIB are limited.
In a large United States database of patients with VUGIB, we evaluated readmission rates, mortality rates, healthcare resource consumption, and identified predictors of readmission.
The 2017 Nationwide Readmission Database using ICD-10 codes was used to identify all adult patients admitted for VUGIB. Primary outcomes were 30- and 90-day readmission rates. Secondary outcomes included mortality, healthcare resource consumption, and predictors of readmission. Multivariate regression analysis was used to adjust for potential confounders.
In 2017, there were 26,498 patients with VUGIB discharged from their index hospitalization, and 24.7% were readmitted (all-cause) within 30-days and 41.5% within 90-days. Recurrent VUGIB accounted for 26.7% and 28.9% of 30- and 90-day readmissions, respectively. Compared to index admissions, 30-day readmissions were associated with higher mortality (4.3% vs. 6.4%, p < 0.01), increased mean hospital length of stay (5.6 days vs. 4.5 days, p < 0.01), and charges ($65,984 vs. $53,784, p < 0.01), with similar findings in 90-day readmissions. Factors associated with 30-day readmission included end-stage renal disease (HR 1.2, p < 0.05), chronic kidney disease (HR 1.31, p < 0.01), and acute kidney injury (HR 1.14, p < 0.05).
Based on a nationwide cohort of hospitalized VUGIB patients, 25% were readmitted within 30-days and 42% within 90-days. Readmission was associated with increased mortality and healthcare consumption compared to the index admission. Additionally, acute and chronic renal injury were predictors of patients at high-risk for readmission.
静脉曲张性上消化道出血（VUGIB）是肝硬化的一种常见且潜在致命的并发症。有关 VUGIB 患者住院再入院和其他结局的基于人群的数据有限。
在一项针对 VUGIB 患者的美国大型数据库中，我们评估了再入院率、死亡率、医疗资源消耗，并确定了再入院的预测因素。
使用 ICD-10 代码的 2017 年全国再入院数据库，确定所有因 VUGIB 接受住院治疗的成年患者。主要结局为 30 天和 90 天的再入院率。次要结局包括死亡率、医疗资源消耗以及再入院的预测因素。使用多变量回归分析来调整潜在的混杂因素。
2017 年，有 26498 例 VUGIB 患者出院，出院后 30 天内（全因）再入院率为 24.7%，90 天内再入院率为 41.5%。复发性 VUGIB 分别占 30 天和 90 天再入院的 26.7%和 28.9%。与指数入院相比，30 天再入院与更高的死亡率（4.3%比 6.4%，p<0.01）、平均住院时间延长（5.6 天比 4.5 天，p<0.01）和费用增加（65984 美元比 53784 美元，p<0.01）相关，90 天再入院也有类似的发现。30 天再入院的相关因素包括终末期肾病（HR 1.2，p<0.05）、慢性肾脏病（HR 1.31，p<0.01）和急性肾损伤（HR 1.14，p<0.05）。
基于一项全国性的 VUGIB 住院患者队列研究，25%的患者在 30 天内再入院，42%的患者在 90 天内再入院。与指数入院相比，再入院与更高的死亡率和医疗资源消耗相关。此外，急性和慢性肾功能损伤是患者再入院风险较高的预测因素。
