Elghezewi Abdelwahap, Hammad Mohamad, El-Dallal Mohammed, Mohamed Mujtaba, Sherif Ahmed, Frandah Wesam
Department of Internal Medicine. Marshall University Hospital, Huntington, WV 25701, USA.
Department of Gastroenterology and Hepatology, Marshall University Hospital, Huntington, WV 25701, USA.
Gastroenterology Res. 2023 Jun;16(3):171-183. doi: 10.14740/gr1627. Epub 2023 Jun 11.
Prevalence of gastroesophageal varices is around 50% of patients with cirrhosis. In compensated cirrhosis they are present in 30-40%. Progression from small to large varices occurs at rate of 10-12% annually. That percentage increases significantly in decompensated liver cirrhosis with gastroesophageal varices found in 85% of patients. Variceal hemorrhage occurs at a rate around 10-15% per year. The outcome of variceal hemorrhage depends on the severity of liver disease, size of varices, and presence of stigmata of recent bleeding (red whale sign). Six-week mortality of variceal hemorrhage ranges between 15% and 25%. Without treatment, variceal hemorrhage tends to recur in 60% of patients within 1 - 2 years. The aim of the study was to assess demographics of esophageal varices with and without bleeding, geographic distribution, comorbidities, outcomes, main payers, and cost of hospitalizations.
The National Inpatient Sample (NIS) database from year 2011 to 2018 was used. Patients who had a primary diagnosis of esophageal varices with or without bleeding were identified using the International Classification of Diseases, Ninth Revision (ICD-9) codes (456.0 for esophageal varices with bleeding, and 456.1 for esophageal varices without bleeding), and International Classification of Diseases, 10th Revision (ICD-10) codes (I85.01 for esophageal varices with bleeding, and I85.00 for esophageal varices without bleeding) in the first two discharge diagnoses. The propensity score to calculate the inverse probability treatment weighting (IPTW) to adjust between the differences of the compared groups was implemented. Two groups were compared in terms of their hospitalization outcomes, including LOS, hospital charges, hospital mortality, and disposition.
A total of 322,761 patients were admitted with esophageal varices between 2011 and 2018, with 236,802 (73.6%) had bleeding esophageal varices and 85,959 (26.4%) had nonbleeding esophageal varices. The majority of the patients from both groups were white (66%), covered with Medicare (38% in the esophageal varices with bleeding vs. 41% in the nonbleeding group). There was a steady increase of patients admitted with nonbleeding esophageal varices. Most common comorbidities were liver diseases, alcohol abuse, uncomplicated hypertension and depression in both groups. There were no significant changes in OLS over the years in both groups, but there was a significant increase in hospital charges, especially in the patients with bleeding esophageal varices starting in 2015, and no change in mortality throughout the years. Regarding hospital disposition, there was a notable decline in rehab discharge in the bleeding esophageal varices group.
Esophageal varices with and without bleeding have been steadily increasing since the beginning of this century. This may result in a substantial impact on increasing health care costs and utilization due to acute variceal hemorrhage. Odds of death, transfer to urban hospital, and transfer to visiting nursing assistance remained unchanged.
胃食管静脉曲张在肝硬化患者中的患病率约为50%。在代偿期肝硬化患者中，其发生率为30% - 40%。小静脉曲张每年以10% - 12%的速度发展为大静脉曲张。在失代偿期肝硬化患者中，这一比例显著增加，85%的患者存在胃食管静脉曲张。静脉曲张出血的发生率约为每年10% - 15%。静脉曲张出血的结局取决于肝病的严重程度、静脉曲张的大小以及近期出血的征象（红色征）。静脉曲张出血的六周死亡率在15%至25%之间。未经治疗，60%的患者在1 - 2年内静脉曲张出血倾向于复发。本研究的目的是评估有出血和无出血的食管静脉曲张的人口统计学特征、地理分布、合并症、结局、主要支付方以及住院费用。
使用2011年至2018年的国家住院样本（NIS）数据库。通过国际疾病分类第九版（ICD - 9）编码（456.0表示有出血的食管静脉曲张，456.1表示无出血的食管静脉曲张）以及国际疾病分类第十版（ICD - 10）编码（I85.01表示有出血的食管静脉曲张，I85.00表示无出血的食管静脉曲张）在前两个出院诊断中确定有食管静脉曲张伴或不伴出血的主要诊断患者。实施倾向评分以计算逆概率治疗权重（IPTW），以调整比较组之间的差异。比较两组的住院结局，包括住院时间、住院费用、医院死亡率和出院情况。
2011年至2018年期间，共有322,761例患者因食管静脉曲张入院，其中236,802例（73.6%）有出血性食管静脉曲张，85,959例（26.4%）有无出血性食管静脉曲张。两组中的大多数患者为白人（66%），由医疗保险覆盖（有出血的食管静脉曲张组为38%，无出血组为41%）。无出血性食管静脉曲张入院患者数量稳步增加。两组中最常见的合并症是肝病、酒精滥用、单纯性高血压和抑郁症。两组多年来住院时间无显著变化，但住院费用显著增加，尤其是从2015年开始有出血性食管静脉曲张的患者，且多年来死亡率无变化。关于出院情况，有出血性食管静脉曲张组康复出院显著下降。
自本世纪初以来，有出血和无出血的食管静脉曲张一直在稳步增加。这可能会对因急性静脉曲张出血导致的医疗保健成本增加和利用率产生重大影响。死亡、转至城市医院以及转至访视护理援助的几率保持不变。
