Soni Aakriti, Yekula Anuroop, Singh Yuvaraj, Sood Nitish, Dahiya Dushyant Singh, Bansal Kannu, Abraham G M
Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States.
Department of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, United States.
World J Hepatol. 2023 Jan 27;15(1):79-88. doi: 10.4254/wjh.v15.i1.79.
Non-alcoholic fatty liver disease (NAFLD) is the leading cause of liver disease globally with an estimated prevalence of 25%, with the clinical and economic burden expected to continue to increase. In the United States, non-variceal upper gastrointestinal bleeding (NVUGIB) has an estimated incidence of 61-78 cases per 100000 people with a mortality rate of 2%-15% based on co-morbidity burden.
To identify the outcomes of NVUGIB in NAFLD hospitalizations in the United States.
We utilized the National Inpatient Sample from 2016-2019 to identify all NVUGIB hospitalizations in the United States. This population was divided based on the presence and absence of NAFLD. Hospitalization characteristics, outcomes and complications were compared.
The total number of hospitalizations for NVUGIB was 799785, of which 6% were found to have NAFLD. NAFLD and GIB was, on average, more common in younger patients, females, and Hispanics than GIB without NAFLD. Interestingly, GIB was less common amongst blacks with NAFLD. Multivariate logistic regression analysis was conducted, controlling for the multiple covariates. The primary outcome of interest, mortality, was found to be significantly higher in patients with NAFLD and GIB [adjusted odds ratio (aOR) = 1.018 (1.013-1.022)]. Secondary outcomes of interest, shock [aOR = 1.015 (1.008-1.022)], acute respiratory failure [aOR = 1.01 (1.005-1.015)] and acute liver failure [aOR = 1.016 (1.013-1.019)] were all more likely to occur in this cohort. Patients with NAFLD were also more likely to incur higher total hospital charges (THC) [$2148 ($1677-$2618)]; however, were less likely to have a longer length of stay [0.27 d (0.17-0.38)]. Interestingly, in our study, the patients with NAFLD were less likely to suffer from acute myocardial infarction [aOR = 0.992 (0.989-0.995)]. Patients with NAFLD were not more likely to suffer acute kidney injury, sepsis, blood transfusion, intubation, or dialysis.
NVUGIB in NAFLD hospitalizations had higher inpatient mortality, THC, and complications such as shock, acute respiratory failure, and acute liver failure compared to those without NAFLD.
非酒精性脂肪性肝病（NAFLD）是全球肝病的主要病因，估计患病率为25%，临床和经济负担预计将持续增加。在美国，非静脉曲张性上消化道出血（NVUGIB）的估计发病率为每10万人61 - 78例，基于合并症负担，死亡率为2% - 15%。
确定美国NAFLD住院患者中NVUGIB的结局。
我们利用2016 - 2019年的全国住院患者样本，确定美国所有NVUGIB住院患者。该人群根据是否存在NAFLD进行划分。比较住院特征、结局和并发症。
NVUGIB住院患者总数为799785例，其中6%被发现患有NAFLD。与无NAFLD的GIB相比，NAFLD合并GIB在年轻患者、女性和西班牙裔中平均更为常见。有趣的是，NAFLD合并GIB在黑人中较少见。进行多因素逻辑回归分析，控制多个协变量。感兴趣的主要结局，即死亡率，在NAFLD合并GIB患者中显著更高[调整优势比（aOR）= 1.018（1.013 - 1.022）]。感兴趣的次要结局，休克[aOR = 1.015（1.008 - 1.022）]、急性呼吸衰竭[aOR = 1.01（1.005 - 1.015）]和急性肝衰竭[aOR = 1.016（1.013 - 1.019）]在该队列中都更有可能发生。NAFLD患者也更有可能产生更高的总住院费用（THC）[2148美元（1677 - 2618美元）]；然而，住院时间较短的可能性较小[0.27天（0.17 - 0.38）]。有趣的是，在我们的研究中，NAFLD患者患急性心肌梗死的可能性较小[aOR = 0.992（0.989 - 0.995）]。NAFLD患者发生急性肾损伤、脓毒症、输血、插管或透析的可能性并不更高。
与无NAFLD的患者相比，NAFLD住院患者中的NVUGIB住院死亡率、THC以及休克、急性呼吸衰竭和急性肝衰竭等并发症更高。
