胃肠病学会诊对肝性脑病入院患者临床结局的影响。
Impact of Gastroenterology Consultation on the Clinical Outcomes of Patients Admitted With Hepatic Encephalopathy.
作者信息
Dutta Nirjhar, Kc Mandip, Wang Qi, Lim Nicholas
机构信息
Division of Hospital Medicine, University of Minnesota, Minneapolis, USA.
Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, USA.
出版信息
Cureus. 2023 Jul 9;15(7):e41610. doi: 10.7759/cureus.41610. eCollection 2023 Jul.
Introduction Hepatic encephalopathy (HE) is a common complication of cirrhosis and a common reason for hospital admission. We aimed to determine whether expert consultation from gastroenterology (GI) leads to better clinical outcomes for inpatients with HE. Methods A retrospective review was performed of all adult patients (age ≥ 18) admitted with HE to a tertiary care hospital between January 2013 and April 2018. Patients who received a GI consult were compared to patients who did not receive a GI consult (No consult group). The primary outcome was hospital length of stay (LOS); secondary outcomes were rates of 30-day hospital readmission and 90-day mortality. Multivariate analysis was conducted to adjust for known confounders. Results Four hundred and twenty-five patients (814 encounters) were included in the study; of these, 236 patients had received a GI consultation for HE. Patients in the GI consult group were younger (mean age 55 vs 58 years, p= 0.02) and had higher Model For End-Stage Liver Disease-sodium (MELD-Na) score (mean MELD-Na 23.5 vs 17.5, p<0.01) compared to patients who did not receive GI consultation. The precipitants of HE were significantly different between the groups: there was more spontaneous bacterial peritonitis (SBP) and GI bleeding (GIB) in the GI consult group and more lactulose non-adherence in the no consult group. There was no difference in the etiology of liver disease between the two groups. Median LOS for the GI consult group was six days vs three days in the no consult group (p<0.01); the incidence rate ratio was 1.79 (95%CI 1.59-2.02, p<0.01) on multivariate analysis. There was no difference in 30-day readmission or 90-day mortality between the two groups. Conclusion GI consultation for patients with HE admitted to a hospital medicine service may be associated with longer LOS. In selected patients admitted with HE, GI consultation may not be necessary to achieve good clinical outcomes.
引言 肝性脑病（HE）是肝硬化的常见并发症，也是住院的常见原因。我们旨在确定胃肠病学（GI）专家会诊是否能为HE住院患者带来更好的临床结局。方法 对2013年1月至2018年4月期间因HE入住三级医院的所有成年患者（年龄≥18岁）进行回顾性研究。将接受GI会诊的患者与未接受GI会诊的患者（无会诊组）进行比较。主要结局是住院时间（LOS）；次要结局是30天再入院率和90天死亡率。进行多变量分析以调整已知的混杂因素。结果 425例患者（814次就诊）纳入研究；其中，236例患者因HE接受了GI会诊。与未接受GI会诊的患者相比，GI会诊组患者更年轻（平均年龄55岁对58岁，p = 0.02），终末期肝病钠模型（MELD-Na）评分更高（平均MELD-Na 23.5对17.5，p<0.01）。两组之间HE的诱因有显著差异：GI会诊组自发性细菌性腹膜炎（SBP）和消化道出血（GIB）更多，无会诊组乳果糖不依从性更多。两组之间肝病病因无差异。GI会诊组的中位LOS为6天，无会诊组为3天（p<0.01）；多变量分析时发病率比为1.79（95%CI 1.59 - 2.02，p<0.01）。两组之间30天再入院率或90天死亡率无差异。结论 入住医院内科的HE患者接受GI会诊可能与更长的LOS相关。在部分因HE入院的患者中，可能无需GI会诊即可获得良好的临床结局。
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