Pellegrini James R, Munshi Rezwan, Patel Pranavi, Pelletier Brandon, Patel Palakkumar, Mustacchia Paul
Internal Medicine, Nassau University Medical Center, East Meadow, USA.
Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA.
Cureus. 2021 Jul 13;13(7):e16368. doi: 10.7759/cureus.16368. eCollection 2021 Jul.
We aimed to study the impact of Hepatic Cirrhosis (HC) on chronic obstructive pulmonary disease (COPD). Our study is a retrospective cohort study using the 2016-2017 National Readmission Database (NRD). NRD is part of the Healthcare Cost and Utilization Project (HCUP), organized and supported by means of the Agency for Healthcare Research and Quality (AHRQ). Patients were included if they were 18 years or older and had a principal diagnosis of COPD based on International Classification of Diseases, Tenth Revision (ICD-10- CM) codes and had a secondary diagnosis of HC. A total of 505,004 patients were included in the study with a diagnosis of COPD, 6196 (1.23%) of whom had HC. HC was found to be more common amongst male patients between the ages of 50 and 65 years. Medicare beneficiaries with high comorbidity burden, lower socioeconomic status, and those who received treatment in a large urban teaching hospital also had higher rates of HC. Patients with HC and COPD correlated to an increase of in-hospital mortality (adjusted odds ratio (aOR: 2.21, p<0.001) and 30-day hospital readmission rate (aOR: 1.23, p<0.001) compared with patients without HC. The in-hospital mortality rate was higher during readmission compared with index admissions (5.01% versus 2.16%; p<0.001). In addition, HC was associated with higher morbidity including prolonged mechanical ventilation (aOR: 1.39, p<0.001), resource utilization with prolong length of stay (LOS) (adjusted mean difference (aMD: 0.51, p<0.001), higher total hospitalization charges (aMD: 4967, p<0.001), and costs (aMD: 1200, p<0.001). Both patient groups had similar odds of being intubated (aOR: 1.18, p-0.13), tracheostomy (aOR: 0.81, p-069) and bronchoscopy rates (aOR: 1.27, p-0.36). The most common causes of hospital readmission were found to be COPD with acute exacerbation (19.7%), sepsis, unspecified organism (6.0%, acute and chronic respiratory failure with hypoxia (4.2%), acute on chronic systolic heart failure (3.9%), and hepatic failure, unspecified coma (3.1%). Various autonomous prognosticators of readmission were sex (particularly female), alcohol dependence, LOS greater than 7 days, lower comorbidity burden, and discharge to short term hospital or against medical advice. On the other hand, males, patients without a history of alcohol dependence, greater comorbidity burden, and LOS fewer than 3 days, were less likely to be readmitted. We found that HC is related to higher in-hospital mortality, LOS, increased mechanical ventilation, resource utilization with prolonged LOS, hospital costs, odds of intubation, and tracheostomy and bronchoscopy rates. Our study aims to shed light on the impact of HC on COPD in hopes to improve future management.
我们旨在研究肝硬化（HC）对慢性阻塞性肺疾病（COPD）的影响。我们的研究是一项回顾性队列研究，使用了2016 - 2017年国家再入院数据库（NRD）。NRD是医疗保健成本与利用项目（HCUP）的一部分，由医疗保健研究与质量局（AHRQ）组织并提供支持。纳入的患者年龄在18岁及以上，根据国际疾病分类第十版（ICD - 10 - CM）编码，主要诊断为COPD，且次要诊断为HC。共有505,004例诊断为COPD的患者纳入研究，其中6196例（1.23%）患有HC。HC在50至65岁的男性患者中更为常见。合并症负担高、社会经济地位较低的医疗保险受益人和那些在大型城市教学医院接受治疗的患者HC发生率也较高。与无HC的患者相比，患有HC和COPD的患者住院死亡率增加（调整后的优势比（aOR）：2.21，p<0.001）以及30天再入院率增加（aOR：1.23，p<0.001）。与首次入院相比，再入院期间的住院死亡率更高（5.01%对2.16%；p<0.001）。此外，HC与更高的发病率相关，包括机械通气时间延长（aOR：1.39，p<0.001）、住院时间延长导致的资源利用增加（调整后的平均差异（aMD）：0.51，p<0.001）、更高的总住院费用（aMD：4967，p<0.001）以及成本（aMD：1200，p<0.001）。两组患者进行气管插管（aOR：1.18，p = 0.13）、气管切开术（aOR：0.81，p = 0.69）和支气管镜检查的几率相似（aOR：1.27，p = 0.36）。医院再入院的最常见原因是COPD急性加重（19.7%）、败血症（未明确病原体）（6.0%）、急性和慢性呼吸衰竭伴缺氧（4.2%）、慢性收缩性心力衰竭急性发作（3.9%）以及肝衰竭、未明确昏迷（3.1%）。再入院的各种独立预测因素包括性别（尤其是女性）、酒精依赖、住院时间大于7天、合并症负担较低以及出院至短期医院或违反医嘱出院。另一方面，男性、无酒精依赖史、合并症负担较重且住院时间少于3天的患者再入院的可能性较小。我们发现HC与更高的住院死亡率、住院时间、机械通气增加、住院时间延长导致的资源利用增加、医院成本、气管插管几率、气管切开术和支气管镜检查率相关。我们的研究旨在阐明HC对COPD的影响，以期改善未来的管理。
