Thongprayoon Charat, Kaewput Wisit, Petnak Tananchai, O'Corragain Oisin A, Boonpheng Boonphiphop, Bathini Tarun, Vallabhajosyula Saraschandra, Pattharanitima Pattharawin, Lertjitbanjong Ploypin, Qureshi Fawad, Cheungpasitporn Wisit
Department of Medicine, Mayo Clinic, Division of Nephrology and Hypertension, Rochester, MN 55905, USA.
Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand.
Medicines (Basel). 2021 May 12;8(5):21. doi: 10.3390/medicines8050021.
This study aimed to determine the rates of inpatient palliative care service use and assess the impact of palliative care service use on in-hospital treatments and resource utilization in hospital admissions for hepatorenal syndrome. Using the National Inpatient Sample, hospital admissions with a primary diagnosis of hepatorenal syndrome were identified from 2003 through 2014. The primary outcome of interest was the temporal trend and predictors of inpatient palliative care service use. Logistic and linear regression was performed to assess the impact of inpatient palliative care service on in-hospital treatments and resource use. Of 5571 hospital admissions for hepatorenal syndrome, palliative care services were used in 748 (13.4%) admissions. There was an increasing trend in the rate of palliative care service use, from 3.3% in 2003 to 21.1% in 2014 ( < 0.001). Older age, more recent year of hospitalization, acute liver failure, alcoholic cirrhosis, and hepatocellular carcinoma were predictive of increased palliative care service use, whereas race other than Caucasian, African American, and Hispanic and chronic kidney disease were predictive of decreased palliative care service use. Although hospital admission with palliative care service use had higher mortality, palliative care service was associated with lower use of invasive mechanical ventilation, blood product transfusion, paracentesis, renal replacement, vasopressor but higher DNR status. Palliative care services reduced mean length of hospital stay and hospitalization cost. Although there was a substantial increase in the use of palliative care service in hospitalizations for hepatorenal syndrome, inpatient palliative care service was still underutilized. The use of palliative care service was associated with reduced resource use.
本研究旨在确定住院姑息治疗服务的使用比例，并评估姑息治疗服务的使用对肝肾综合征住院患者的院内治疗及资源利用的影响。利用全国住院患者样本，确定了2003年至2014年期间以肝肾综合征为主要诊断的住院病例。主要关注的结果是住院姑息治疗服务使用的时间趋势及预测因素。采用逻辑回归和线性回归来评估住院姑息治疗服务对院内治疗及资源使用的影响。在5571例肝肾综合征住院病例中，748例（13.4%）使用了姑息治疗服务。姑息治疗服务的使用率呈上升趋势，从2003年的3.3%升至2014年的21.1%（<0.001）。年龄较大、住院年份较近、急性肝衰竭、酒精性肝硬化和肝细胞癌是姑息治疗服务使用增加的预测因素，而除白种人、非裔美国人和西班牙裔以外的种族以及慢性肾病则是姑息治疗服务使用减少的预测因素。尽管接受姑息治疗服务的住院患者死亡率较高，但姑息治疗服务与有创机械通气、血液制品输血、腹腔穿刺、肾脏替代、血管活性药物的使用减少相关，但与“不要复苏”状态较高相关。姑息治疗服务缩短了平均住院时间并降低了住院费用。尽管肝肾综合征住院患者中姑息治疗服务的使用有显著增加，但住院姑息治疗服务仍未得到充分利用。姑息治疗服务的使用与资源使用减少相关。
