Dar Sophia Haroon, Rahim Mehek, Hosseini Davood K, Sarfraz Khurram
Internal Medicine, Hackensack University Medical Center, Hackensack, NJ 07601, United States.
World J Hepatol. 2022 Apr 27;14(4):766-777. doi: 10.4254/wjh.v14.i4.766.
Critical care is rapidly evolving with significant innovations to decrease hospital stays and costs. To our knowledge, there is limited data on factors that affect the length of stay and hospital charges in cirrhotic patients who present with ST-elevation myocardial infarction-related cardiogenic shock (SRCS).
To identify the factors that increase inpatient mortality, length of stay, and total hospital charges in patients with liver cirrhosis (LC) compared to those without LC.
This study includes all adults over 18 from the National Inpatient Sample 2017 database. The study consists of two groups of patients, including SRCS with LC and without LC. Inpatient mortality, length of stay, and total hospital charges are the primary outcomes between the two groups. We used STATA 16 to perform statistical analysis. The Pearson's chi-square test compares the categorical variables. Propensity-matched scoring with univariate and multivariate logistic regression generated the odds ratios for inpatient mortality, length of stay, and resource utilization.
This study includes a total of 35798453 weighted hospitalized patients from the 2017 National Inpatient Sample. The two groups are SRCS without LC ( = 758809) and SRCS with LC ( = 11920). The majority of patients were Caucasian in both groups (67% 72%). The mean number of patients insured with Medicare was lower in the LC group (60% 56%) compared to the other group, and those who had at least three or more comorbidities (53% 90%) were significantly higher in the LC group compared to the non-LC group. Inpatient mortality was also considerably higher in the LC group (28.7% 10.63%). Length of Stay (LOS) is longer in the LC group compared to the non-LC group (9 5.6). Similarly, total hospital charges are higher in patients with LC ($147407.80 $113069.10, ≤ 0.05). Inpatient mortality is lower in the early percutaneous coronary intervention (PCI) group (OR: 0.79 < 0.11), however, it is not statistically significant. Both early Impella (OR: 1.73 < 0.05) and early extracorporeal membrane oxygenation (ECMO) (OR: 3.10 < 0.05) in the LC group were associated with increased mortality. Early PCI (-2.57 < 0.05) and Impella (-3.25 < 0.05) were also both associated with shorter LOS compared to those who did not. Early ECMO does not impact the LOS; however, it does increase total hospital charge (addition of $24717.85, < 0.05).
LC is associated with a significantly increased inpatient mortality, length of stay, and total hospital charges in patients who develop SRCS. Rural and Non-teaching hospitals have significantly increased odds of extended hospital stays and higher adjusted total hospital charges. The Association of LC with worse outcomes outlines the essential need to monitor these patients closely and treat them early on with higher acuity care. Patients with early PCI had both shorter LOS and reduced inpatient mortality, while early Impella was associated with increased mortality and shorter LOS. Early ECMO is associated with increased mortality and higher total hospital charges. This finding should affect the decision to follow through with interventional management in this cohort of patients as it is associated with poor outcomes and immense resource utilization.
重症监护领域正在迅速发展，出现了重大创新以缩短住院时间和降低成本。据我们所知，关于患有ST段抬高型心肌梗死相关心源性休克（SRCS）的肝硬化患者中影响住院时间和住院费用的因素的数据有限。
确定与无肝硬化患者相比，肝硬化（LC）患者住院死亡率、住院时间和总住院费用增加的因素。
本研究纳入了2017年全国住院患者样本数据库中所有18岁以上的成年人。该研究包括两组患者，即伴有LC的SRCS患者和不伴有LC的SRCS患者。两组之间的主要结局指标为住院死亡率、住院时间和总住院费用。我们使用STATA 16进行统计分析。Pearson卡方检验用于比较分类变量。倾向匹配评分结合单变量和多变量逻辑回归得出住院死亡率、住院时间和资源利用的比值比。
本研究共纳入了来自2017年全国住院患者样本的35798453例加权住院患者。两组分别为不伴有LC的SRCS患者（n = 758809）和伴有LC的SRCS患者（n = 11920）。两组中大多数患者为白种人（67%对72%）。与另一组相比，LC组中医疗保险参保患者的平均人数较低（60%对56%），且LC组中至少患有三种或更多合并症的患者比例（53%对90%）显著高于非LC组。LC组的住院死亡率也显著更高（28.7%对10.63%）。与非LC组相比，LC组的住院时间（LOS）更长（9天对5.6天）。同样，LC患者的总住院费用更高（147407.80美元对113069.10美元，P≤0.05）。早期经皮冠状动脉介入治疗（PCI）组的住院死亡率较低（OR：0.79，P<0.11），然而，差异无统计学意义。LC组中早期使用Impella（OR：1.73，P<0.05）和早期体外膜肺氧合（ECMO）（OR：3.10，P<0.05）均与死亡率增加相关。与未接受早期PCI和Impella的患者相比，早期PCI（-2.57，P<0.05）和Impella（-3.25，P<0.05）也均与较短的住院时间相关。早期ECMO对住院时间无影响；然而，它确实会增加总住院费用（增加24717.85美元，P<0.05）。
LC与发生SRCS患者的住院死亡率、住院时间和总住院费用显著增加相关。农村医院和非教学医院延长住院时间和调整后总住院费用增加的几率显著更高。LC与较差结局的关联表明，密切监测这些患者并尽早给予更高强度的治疗至关重要。早期接受PCI的患者住院时间较短且住院死亡率降低，而早期使用Impella与死亡率增加和住院时间缩短相关。早期ECMO与死亡率增加和总住院费用升高相关。这一发现应会影响对此类患者进行介入治疗的决策，因为其与不良结局和大量资源利用相关。
