Cheung Kyle, Mailman Jonathan F, Crawford Jennifer J, Karvellas Constantine J, Sy Eric
University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Department of Critical Care, Regina General Hospital, Regina, Saskatchewan, Canada.
J Intensive Care Soc. 2022 May;23(2):139-149. doi: 10.1177/1751143720985293. Epub 2021 Jan 7.
Cirrhotic patients in organ failure are frequently admitted to intensive care units (ICUs) to receive invasive mechanical ventilation (IMV). We evaluated the trends of hospitalizations, in-hospital mortality, hospital costs, and hospital length of stay (LOS) of IMV patients with cirrhosis.
We analyzed the United States National Inpatient Sample from 2005-2014. We selected discharges of IMV adult (≥18 years) patients with cirrhosis using the , 9th Edition. Trends were assessed using linear regression and joinpoint regression.
Between 2005 and 2014, there were approximately 9,441,605 hospitalizations of IMV adult patients, of which 4.7% had cirrhosis. There was an increasing trend in the total number of IMV cirrhotic patient hospitalizations (annual percent change [APC] 7.0%, 95% confidence interval [CI] 6.4%; 7.6%, < 0.001). The in-hospital case-fatality ratio declined between 2005-2011 (APC -2.9%, 95% CI, -3.4%; -2.4%, < 0.001); however, it remained similar between 2011-2014 ( = 0.58). The total annual hospital costs of all IMV cirrhotic patients increased from approximately $1.2 billion USD in 2005 to $2.7 billion USD in 2014 ( < 0.001). The mean hospital costs per patient and mean LOS declined between 2005 and 2014 ( < 0.001 and = 0.01 respectively).
The total number of hospitalizations and total annual costs of IMV patients with cirrhosis have been increasing over time. However, past hesitancy around admitting cirrhotic patients to the ICU may need to be tempered by the improving mortality trends in this patient population.
器官衰竭的肝硬化患者常被收入重症监护病房（ICU）接受有创机械通气（IMV）。我们评估了肝硬化IMV患者的住院趋势、院内死亡率、住院费用和住院时长（LOS）。
我们分析了2005年至2014年美国国家住院样本。我们使用国际疾病分类第9版选择了成年（≥18岁）肝硬化IMV患者的出院病例。使用线性回归和连接点回归评估趋势。
2005年至2014年期间，成年IMV患者约有9441605次住院，其中4.7%患有肝硬化。肝硬化IMV患者的住院总数呈上升趋势（年变化百分比[APC]7.0%，95%置信区间[CI]6.4%；7.6%，P<0.001）。2005年至2011年期间院内病死率下降（APC -2.9%，95%CI，-3.4%；-2.4%，P<0.001）；然而，2011年至2014年期间病死率保持相似（P = 0.58）。所有肝硬化IMV患者的年度住院总费用从2005年的约12亿美元增加到2014年的27亿美元（P<0.001）。2005年至2014年期间，每位患者的平均住院费用和平均住院时长下降（分别为P<0.001和P = 0.01）。
随着时间的推移，肝硬化IMV患者的住院总数和年度总费用一直在增加。然而，过去对将肝硬化患者收入ICU的犹豫可能需要因该患者群体死亡率趋势的改善而有所缓和。
