内科住院治疗与肝脏疾病：一项多中心队列的疾病负担比较分析。
Internal medicine hospitalisations and liver disease: a comparative disease burden analysis of a multicentre cohort.
机构信息
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
出版信息
Aliment Pharmacol Ther. 2021 Sep;54(5):689-698. doi: 10.1111/apt.16488. Epub 2021 Jun 28.
BACKGROUND
Liver disease is an increasing burden on population health globally.
AIMS
To characterise burden of liver disease among general internal medicine inpatients at seven Toronto-area hospitals and compare it to other common medical conditions.
METHODS
Data from April 2010 to October 2017 were obtained from hospitals participating in the GEMINI collaborative. Using these cohort data from hospital information systems linked to administrative data, we defined liver disease admissions using most responsible discharge diagnoses categorised according to international classification of diseases, 10th Revision-enhanced Canadian version (ICD-10-CA). We identified admissions for heart failure, chronic obstructive pulmonary disease (COPD) and pneumonia as comparators. We calculated standardised mortality ratios (SMRs) as the ratio of observed to expected deaths.
RESULTS
Among 239 018 discharges, liver disease accounted for 1.7% of most responsible discharge diagnoses. Liver disease was associated with marked premature mortality, with SMR of 8.84 (95% CI 8.06-9.67) compared to 1.06 (95% CI 0.99-1.12) for heart failure, 1.05 (95% CI 0.96-1.15) for COPD and 1.28 (95% CI 1.20-1.37) for pneumonia. The majority of deaths were among patients younger than 65 years (57.7%) compared to 3.3% in heart failure, 5.6% in COPD and 10.7% in pneumonia. Liver disease patients presented with worse Laboratory-Based Acute Physiology Scores, were more frequently admitted to the intensive care unit (14.4%), incurred higher average total costs (median $6723 CAD), had higher in-hospital mortality (11.4%), and were more likely to be a readmission from 30 days prior (19.8%). Non-alcoholic fatty liver disease admissions increased from 120 in 2011-2012 to 215 in 2016-2017 (P < 0.01).
CONCLUSION
In Canada's largest urban centre, liver disease admissions resulted in premature morbidity and mortality with higher resource use compared to common cardio-respiratory conditions. Re-evaluation of approaches to caring for inpatients with liver disease is timely and justified.
背景
肝脏疾病是全球人口健康的日益沉重负担。
目的
描述多伦多地区七家医院综合内科住院患者肝脏疾病的负担，并将其与其他常见医疗状况进行比较。
方法
我们从参与 GEMINI 合作的医院获取了 2010 年 4 月至 2017 年 10 月的数据。使用来自医院信息系统并与行政数据相关联的这些队列数据，我们根据国际疾病分类第十版增强型加拿大版（ICD-10-CA）将最主要的出院诊断归类为肝脏疾病入院。我们将心力衰竭、慢性阻塞性肺疾病（COPD）和肺炎的入院作为对照。我们计算了标准化死亡率比（SMR），即观察到的死亡人数与预期死亡人数之比。
结果
在 239018 次出院中，肝脏疾病占最主要的出院诊断的 1.7%。与心力衰竭（SMR 为 8.84，95%CI 为 8.06-9.67）、COPD（SMR 为 1.05，95%CI 为 0.96-1.15）和肺炎（SMR 为 1.28，95%CI 为 1.20-1.37）相比，肝脏疾病与明显的过早死亡率相关。大多数死亡发生在 65 岁以下的患者中（57.7%），而心力衰竭为 3.3%，COPD 为 5.6%，肺炎为 10.7%。与心力衰竭、COPD 和肺炎相比，肝脏疾病患者的实验室基于急性生理学评分更差，更频繁地入住重症监护病房（14.4%），平均总费用更高（中位数为 6723 加元），住院死亡率更高（11.4%），且更有可能在 30 天前再次入院（19.8%）。非酒精性脂肪性肝病的入院人数从 2011-2012 年的 120 人增加到 2016-2017 年的 215 人（P<0.01）。
结论
在加拿大最大的城市中心，与常见的心肺疾病相比，肝脏疾病入院导致过早发病和死亡，并导致更高的资源使用。及时且合理地重新评估对患有肝脏疾病的住院患者的护理方法是必要的。
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