Department of Medicine, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, Virginia.
Department of Medicine, University of California, San Francisco, California.
Clin Gastroenterol Hepatol. 2023 Jul;21(7):1864-1872.e2. doi: 10.1016/j.cgh.2022.10.023. Epub 2022 Nov 1.
BACKGROUND & AIMS: Hospitalizations are a sentinel event in cirrhosis; however, the changing demographics in patients with cirrhosis require updated hospitalization prediction models. Periodontitis is a risk factor for liver disease and potentially progression. The aim of this study was to determine factors, including poor oral health, associated with 3-month hospitalizations in a multi-center cohort of outpatients with cirrhosis.
North American Consortium for Study of End-stage Liver Disease (NACSELD-3), a new study cohort, recruits outpatients with cirrhosis. Cirrhosis details, demographics, minimal hepatic encephalopathy (MHE), frailty, and comorbid conditions including oral health were collected. All patients were followed for 3 months for nonelective hospitalizations. Multi-variable models were created for this outcome using demographics, cirrhosis details, oral health, MHE, frailty, and comorbid conditions with K-fold internal validation using 25%/75% split.
A total of 442 outpatients (70% men; 37% compensated; Model for End-stage Liver Disease-Sodium, 12; 42% ascites; and 33% prior HE) were included. MHE was found in 70%, frailty in 10%; and both in 8%. In terms of oral health, 15% were edentulous and 10% had prior periodontitis. Regarding 3-month hospitalizations, 14% were admitted for mostly liver-related reasons. These patients were more likely to be decompensated with higher cirrhosis complications, MHE, frailty and periodontitis history. Multi-variable analysis showed prior periodontitis (P = .026), composite MHE + frailty score (P = .0016), ascites (P = .004), prior HE (P = .008), and hydrothorax (P = .004) were associated with admissions using the training and validation subsets.
In a contemporaneous, prospective, multi-center cohort study in outpatients with cirrhosis, poor oral health is significantly associated with 3-month hospitalizations independent of portal hypertensive complications, MHE, and frailty. Potential strategies to reduce hospitalizations should consider oral evaluation in addition to MHE and frailty assessment in practice pathways.
住院是肝硬化的一个警戒事件；然而，肝硬化患者的人口统计学变化需要更新的住院预测模型。牙周炎是肝病和潜在进展的危险因素。本研究的目的是确定与多中心肝硬化门诊患者队列中 3 个月住院相关的因素，包括口腔健康状况不佳。
北美终末期肝病研究联盟（NACSELD-3），一项新的研究队列，招募肝硬化门诊患者。收集肝硬化详细信息、人口统计学、轻微肝性脑病（MHE）、脆弱性和包括口腔健康在内的合并症。所有患者均在 3 个月内进行非选择性住院治疗。使用 25%/75%的拆分进行 K 折内部验证，使用人口统计学、肝硬化详细信息、口腔健康、MHE、脆弱性和合并症创建该结果的多变量模型。
共纳入 442 名门诊患者（70%为男性；37%代偿；钠模型终末期肝病，12；42%腹水；33%既往肝性脑病）。发现 70%的患者存在 MHE，10%的患者存在脆弱性，8%的患者同时存在 MHE 和脆弱性。就口腔健康而言，15%的患者无牙，10%的患者有既往牙周炎。在 3 个月住院治疗方面，14%的患者因主要与肝脏相关的原因住院。这些患者更有可能出现失代偿，伴有更高的肝硬化并发症、MHE、脆弱性和牙周炎病史。多变量分析显示，既往牙周炎（P =.026）、MHE 复合脆弱性评分（P =.0016）、腹水（P =.004）、既往肝性脑病（P =.008）和胸水（P =.004）与培训和验证子集的入院相关。
在一项同期、前瞻性、多中心肝硬化门诊患者队列研究中，口腔健康状况不佳与 3 个月住院独立相关，与门静脉高压并发症、MHE 和脆弱性无关。潜在的减少住院的策略应考虑在实践途径中进行口腔评估，除了 MHE 和脆弱性评估之外。
