Li Moying, Itzel Timo, Montagut Nathally Espinosa, Falconer Thomas, Daza Jimmy, Park Jimyung, Cheong Jae Youn, Park Rae Woong, Wiest Isabella, Ebert Matthias Philip, Hripcsak George, Teufel Andreas
Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Department of Medicine II, Division of Hepatology, Division of Bioinformatics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Scand J Gastroenterol. 2023 Jul-Dec;58(12):1505-1513. doi: 10.1080/00365521.2023.2239974. Epub 2023 Aug 22.
Liver cirrhosis is the end-stage liver disease associated with poor prognosis and cardiovascular comorbidity could significantly impact mortality of cirrhotic patients. We conducted a large, retrospective study to investigate the survival impact of cardiovascular co-medications in patients with liver cirrhosis.
A study-specific R package was processed on the local databases of partner institutions within the Observational Health Data Sciences and Informatics consortium, namely Columbia University, New York City (NYC), USA and Ajou University School of Medicine (AUSOM), South Korea. Patients with cirrhosis diagnosed between 2000 and 2020 were included. Final analysis of the anonymous survival data was performed at Medical Faculty Mannheim, Heidelberg University.
We investigated a total of 32,366 patients with liver cirrhosis. Our data showed that administration of antiarrhythmics amiodarone or digoxin presented as a negative prognostic indicator ( = 0.000 in both cohorts). Improved survival was associated with angiotensin-converting enzyme inhibitor ramipril ( = 0.005 in NYC cohort, = 0.075 in AUSOM cohort) and angiotensin II receptor blocker losartan ( = 0.000 in NYC cohort, = 0.005 in AUSOM cohort). Non-selective beta blocker carvedilol was associated with a survival advantage in the NYC ( = 0.000) cohort but not in the AUSOM cohort ( = 0.142). Patients who took platelet inhibitor clopidogrel had a prolonged overall survival compared to those without ( = 0.000 in NYC cohort, = 0.003 in AUSOM cohort).
Concomitant cardiovascular medications are associated with distinct survival difference in cirrhotic patients. Multidisciplinary management is needed for a judicious choice of proper cardiovascular co-medications in cirrhotic patients.
肝硬化是终末期肝病，预后较差，心血管合并症会显著影响肝硬化患者的死亡率。我们开展了一项大型回顾性研究，以调查心血管联合用药对肝硬化患者生存的影响。
在观察性健康数据科学与信息学联盟（OHDSI）的合作机构（即美国纽约市哥伦比亚大学和韩国庆熙大学医学院）的本地数据库上运行一个特定研究的R包。纳入2000年至2020年间诊断为肝硬化的患者。对匿名生存数据的最终分析在海德堡大学曼海姆医学院进行。
我们共调查了32366例肝硬化患者。我们的数据显示，使用抗心律失常药物胺碘酮或地高辛是不良预后指标（两个队列中均为P = 0.000）。血管紧张素转换酶抑制剂雷米普利与生存率提高相关（纽约队列中P = 0.005，庆熙大学医学院队列中P = 0.075），血管紧张素II受体阻滞剂氯沙坦也如此（纽约队列中P = 0.000，庆熙大学医学院队列中P = 0.005）。非选择性β受体阻滞剂卡维地洛在纽约队列中与生存优势相关（P = 0.000），但在庆熙大学医学院队列中并非如此（P = 0.142）。服用血小板抑制剂氯吡格雷的患者与未服用者相比，总生存期延长（纽约队列中P = 0.000，庆熙大学医学院队列中P = 0.003）。
心血管联合用药与肝硬化患者的生存差异显著相关。需要多学科管理，以便为肝硬化患者明智地选择合适的心血管联合用药。
