非酒精性脂肪性肝病与因感染住院患者更严重的肠道并发症相关。
Nonalcoholic fatty liver disease is associated with worse intestinal complications in patients hospitalized for infection.
作者信息
Jiang Yi, Chowdhury Salil, Xu Bing-Hong, Meybodi Mohamad Aghaie, Damiris Konstantinos, Devalaraju Samanthika, Pyrsopoulos Nikolaos
机构信息
Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07101, United States.
Liver Center and Center for Asian Health, RWJBH-Saint Barnabas Medical Center, Florham Park, NJ 07932, United States.
出版信息
World J Hepatol. 2021 Nov 27;13(11):1777-1790. doi: 10.4254/wjh.v13.i11.1777.
BACKGROUND
Nonalcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease with increasing prevalence worldwide. infection (CDI) remains the most common cause of nosocomial diarrhea in developed countries.
AIM
To assess the impact of NAFLD on the outcomes of hospitalized patients with CDI.
METHODS
This study was a retrospective cohort study. The Nationwide Inpatient Sample database was used to identify a total of 7239 adults admitted as inpatients with a primary diagnosis of CDI and coexisting NAFLD diagnosis from 2010 to 2014 using ICD-9 codes. Patients with CDI and coexisting NAFLD were compared to those with CDI and coexisting alcoholic liver disease (ALD) and viral liver disease (VLD), individually. Primary outcomes included mortality, length of stay, and total hospitalization charges. Secondary outcomes were in-hospital complications. Multivariate regression was used for outcome analysis after adjusting for possible confounders.
RESULTS
CDI with NAFLD was independently associated with lower rates of acute respiratory failure (2.7% 4.2%, 0.01; 2.7% 4.2%, 0.05), shorter length of stay (days) (5.75 ± 0.16 6.77 ± 0.15, 0.001; 5.75 ± 0.16 6.84 ± 0.23, 0.001), and lower hospitalization charges (dollars) (38150.34 ± 1757.01 46326.72 ± 1809.82, 0.001; 38150.34 ± 1757.01 44641.74 ± 1660.66, 0.001) when compared to CDI with VLD and CDI with ALD, respectively. CDI with NAFLD was associated with a lower rate of acute kidney injury (13.0% 17.2%, 0.01), but a higher rate of intestinal perforation ( 0.01) when compared to VLD. A lower rate of mortality (0.8% 2.7%, 0.05) but a higher rate of intestinal obstruction (4.6% 2.2%, = 0.001) was also observed when comparing CDI with NAFLD to ALD.
CONCLUSION
Hospitalized CDI patients with NAFLD had more intestinal complications compared to CDI patients with VLD and ALD. Gut microbiota dysbiosis may contribute to the pathogenesis of intestinal complications.
背景
非酒精性脂肪性肝病（NAFLD）已成为全球范围内慢性肝病的主要病因，其患病率不断上升。艰难梭菌感染（CDI）仍是发达国家医院获得性腹泻的最常见病因。
目的
评估NAFLD对住院CDI患者预后的影响。
方法
本研究为回顾性队列研究。利用全国住院患者样本数据库，通过国际疾病分类第九版（ICD - 9）编码，识别出2010年至2014年期间共7239例以CDI为主诊断且并存NAFLD诊断的成年住院患者。将CDI合并NAFLD的患者分别与CDI合并酒精性肝病（ALD）和病毒性肝病（VLD）的患者进行比较。主要结局包括死亡率、住院时间和总住院费用。次要结局为住院并发症。在调整可能的混杂因素后，采用多变量回归进行结局分析。
结果
与CDI合并VLD和CDI合并ALD相比，CDI合并NAFLD分别独立与较低的急性呼吸衰竭发生率（2.7%对4.2%，P<0.01；2.7%对4.2%，P<0.05）、较短的住院时间（天）（5.75±0.16对6.77±0.15，P<0.001；5.75±0.16对6.84±0.23，P<0.001）以及较低的住院费用（美元）（38150.34±1757.01对46326.72±1809.82，P<0.001；38150.34±1757.01对44641.74±1660.66，P<0.001）相关。与VLD相比，CDI合并NAFLD与较低的急性肾损伤发生率（13.0%对17.2%，P<0.01）相关，但与较高的肠穿孔发生率相关（P<0.01）。与ALD相比，CDI合并NAFLD的死亡率较低（0.8%对2.7%，P<0.05），但肠梗阻发生率较高（4.6%对2.2%，P = 0.001）。
结论
与CDI合并VLD和ALD的患者相比，住院CDI合并NAFLD的患者肠道并发症更多。肠道微生物群失调可能有助于肠道并发症的发病机制。
Zotero 插件