Division of Gastroenterology and Hepatology, Department of Medicine.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
J Clin Gastroenterol. 2023 Jan 1;57(1):48-56. doi: 10.1097/MCG.0000000000001624.
GOALS/BACKGROUND: Pain is common among cirrhosis patients, particularly those hospitalized with acute illness. Managing pain in this population is challenging due to concern for adverse events and lack of guidelines for analgesic use. We sought to characterize analgesic use among inpatients with cirrhosis compared with matched noncirrhosis controls, as well as hospital-level variation in prescribing patterns.
We utilized the Vizient Clinical Database, which includes clinical and billing data from hospitalizations at >500 US academic medical centers. We identified cirrhosis patients hospitalized in 2017-2018, and a matched cohort of noncirrhosis patients. Types of analgesic given-acetaminophen (APAP), nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and adjuvants (eg, gabapentinoids, antidepressants) were defined from inpatient prescription records. Conditional logistic regression was used to associate cirrhosis diagnosis with analgesic use.
Of 116,363 cirrhosis inpatients, 83% received at least 1 dose of an analgesic and 58% had regular inpatient analgesic use, rates that were clinically similar to noncirrhosis controls. Cirrhosis inpatients were half as likely to receive APAP (26% vs. 42%, P <0.01) or NSAIDs (3% vs. 7%, P <0.01), but were more likely to receive opioids (59% vs. 54%, P <0.01), particularly decompensated patients (60%). There was notable variation in analgesic prescribing patterns between hospitals, especially among cirrhosis patients.
Analgesic use was common among inpatients, with similar rates among patients with and without cirrhosis. Cirrhosis patients-particularly decompensated patients-were less likely to receive APAP and NSAIDs and more likely to receive opioid analgesics. Because of lack of evidence-based guidance for management of cirrhosis patients with pain, providers may avoid nonopioid analgesics due to perceived risks and consequently may overutilize opioids in this high-risk population.
目的/背景：疼痛在肝硬化患者中很常见，尤其是那些因急性疾病住院的患者。由于担心不良反应和缺乏镇痛药使用指南，管理这类人群的疼痛具有挑战性。我们旨在描述肝硬化住院患者与匹配的非肝硬化对照组相比的镇痛药使用情况，以及医院层面的处方模式差异。
我们利用了 Vizient 临床数据库，该数据库包含了来自 500 多家美国学术医疗中心住院患者的临床和计费数据。我们确定了 2017-2018 年住院的肝硬化患者和匹配的非肝硬化患者队列。从住院患者的处方记录中定义了给予的镇痛药类型-对乙酰氨基酚（APAP）、非甾体抗炎药（NSAIDs）、阿片类药物和辅助药物（如加巴喷丁类、抗抑郁药）。使用条件逻辑回归将肝硬化诊断与镇痛药使用相关联。
在 116363 例肝硬化住院患者中，83%至少接受了 1 剂镇痛药，58%有规律的住院镇痛药使用，这些比率与非肝硬化对照组临床相似。肝硬化患者接受 APAP（26%对 42%，P<0.01）或 NSAIDs（3%对 7%，P<0.01）的可能性减半，但更有可能接受阿片类药物（59%对 54%，P<0.01），尤其是失代偿期患者（60%）。医院之间的镇痛药处方模式存在明显差异，尤其是在肝硬化患者中。
镇痛药在住院患者中很常见，有肝硬化和无肝硬化患者的使用比率相似。肝硬化患者-特别是失代偿期患者-接受 APAP 和 NSAIDs 的可能性较低，而接受阿片类镇痛药的可能性较高。由于缺乏针对肝硬化疼痛患者管理的循证指南，由于担心潜在风险，提供者可能避免使用非阿片类镇痛药，因此在这个高风险人群中可能过度使用阿片类药物。
