Bodger Keith, Tench William, Mair Thomas, Schofield Pieta, Dodd Susanna, Silberberg Benjamin, Fleming Kate M, Hood Steve
Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
Gastroenterology Department, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
BMJ Open Gastroenterol. 2025 Aug 18;12(1):e001831. doi: 10.1136/bmjgast-2025-001831.
Deficiencies have been highlighted in acute hospital care for alcohol-related liver disease (ARLD). Such problems may be worse at weekends (WEs). Increased 30-day mortality for WE admissions has been reported for several acute conditions, but data for ARLD are limited. We aimed to compare patient and pathway characteristics between WE and weekday (WD) admissions and investigate the 'weekend effect' on mortality.
Retrospective cohort study (2008-2018) using linked electronic databases (Hospital Episode Statistics-Clinical Practice Research Datalink and death registration) including 17 575 first emergency admissions identified using the Liverpool ARLD algorithm.
WE admission (Saturday or Sunday).
all-cause death within 30 days. Covariates included socio-demographic characteristics, pathway characteristics (pre-admission contacts and admission method) and markers of severity (recorded stage of liver disease, ascites and varices, comorbidity). Alternative risk-adjustment methods were used, including standard regression and propensity-weighted analysis (Inverse Probability of Treatment Weighting).
3249 admissions (18.5%) were at WE. Unadjusted 30-day mortality was significantly higher for WE versus WD (17.1% vs 15.5%, p=0.018). All models demonstrated increased odds of death for WE admissions with adjusted ORs ranging from 1.15 to 1.23 (relative risk of 1.12-1.19). Causes of death did not vary by admission day and effect was consistent across subgroups. Findings were robust to sensitivity analyses restricting the cohort to patients admitted directly from Accident and Emergency department (A&E), or cirrhosis or ascites but not varices.
First ARLD admissions at the WE experienced a 12-19% increase in 30-day mortality risk compared with WD. Although residual confounding cannot be excluded, this suggests the possibility of avoidable mortality among those hospitalised at WEs. Services should be alert to risks of WE effects when planning care.
酒精性肝病（ARLD）的急性医院护理中存在的不足已受到关注。此类问题在周末可能更为严重。已有报道称，几种急性病症的周末入院患者30天死亡率有所上升，但ARLD的数据有限。我们旨在比较周末（WE）和工作日（WD）入院患者的特征及治疗路径，并研究“周末效应”对死亡率的影响。
采用回顾性队列研究（2008 - 2018年），使用关联电子数据库（医院事件统计 - 临床实践研究数据链和死亡登记），纳入17575例首次急诊入院患者，这些患者通过利物浦ARLD算法识别。
周末入院（周六或周日）。
30天内全因死亡。协变量包括社会人口统计学特征、治疗路径特征（入院前接触情况和入院方式）以及严重程度标志物（记录的肝病阶段、腹水和静脉曲张、合并症）。使用了替代风险调整方法，包括标准回归和倾向加权分析（逆概率治疗加权）。
3249例入院患者（18.5%）为周末入院。未经调整的情况下，周末入院患者的30天死亡率显著高于工作日入院患者（17.1%对15.5%，p = 0.018）。所有模型均显示周末入院患者死亡几率增加，调整后的比值比范围为1.15至1.23（相对风险为1.12 - 1.19）。死亡原因不因入院日期而异，且在各亚组中效应一致。对队列进行敏感性分析，将其限制为直接从急诊部（A&E）入院的患者，或患有肝硬化或腹水但无静脉曲张的患者，结果依然稳健。
与工作日相比，周末首次因ARLD入院的患者30天死亡风险增加了12% - 19%。尽管不能排除残余混杂因素，但这表明周末住院患者存在可避免死亡的可能性。在规划护理时，服务机构应警惕周末效应带来的风险。
