我院近10年肝衰竭患者预后变化趋势分析*

doi:10.3969/j.issn.1672-5069.2024.06.019

实用肝脏病杂志 ›› 2024, Vol. 27 ›› Issue (6): 874-877.doi: 10.3969/j.issn.1672-5069.2024.06.019

我院近10年肝衰竭患者预后变化趋势分析^*

徐曼曼, 杨颜榕, 李珊珊, 武羽, 杨雪, 段钟平, 陈煜

100069 北京市首都医科大学附属北京佑安医院肝病中心四科肝衰竭与人工肝治疗研究北京市重点实验室

收稿日期:2023-11-03 出版日期:2024-11-10 发布日期:2024-11-07
通讯作者: 陈煜,E-mail:chybeyond1071@ccmu.edu.cn
作者简介:徐曼曼,女,34岁,博士研究生,主治医师。E-mail:xmm1903@ccmu.edu.cn;共同第一作者:杨颜榕:女,25岁,硕士研究生,E-mail:yanrongyang2021@163.com
基金资助:
^*北京市高层次公共卫生技术人才建设基金资助项目(编号:学科带头人-01-12);北京市医院管理中心“登峰”计划专项经费资助项目(编号:DFL20221501)

Trends in outcomes of patients with liver failure in our hospital over the past ten years

Xu Manman, Yang Yanrong, Li Shanshan, et al

Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, You’an Hospital, Capital Medical University, Beijing 100069, China

Received:2023-11-03 Online:2024-11-10 Published:2024-11-07

摘要/Abstract

摘要： 目的分析近10年来我院住院的肝衰竭患者离院方式变化趋势。方法回顾性分析我院2012年～2021年收治的肝衰竭住院患者的病历资料,应用趋势检验分析急性肝衰竭(ALF)、亚急性肝衰竭(SALF)、慢加急性肝衰竭(ACLF)和慢性肝衰竭(CLF)患者的离院方式逐年变化趋势。结果在研究期间,共收治8512例肝衰竭住院患者,经过排除标准排除,有5789例患者被纳入分析,女性占28.7%,平均年龄为(50.31±13.49)岁,平均住院日为19.46 ±15.19 d;ACLF患者2702例(47.3%),CLF 患者2415例(42.0%),SALF患者 492例(7.9%)和ALF患者180例(2.9%);在离院方式方面,57.6%总体患者医嘱离院,27.5%非医嘱离院,15.0%在院死亡;ALF患者在院病死率为52.2%,CLF为14.2%,ACLF为13.7%,SALF为11.4%;纵向分析显示,ALF患者非肝移植医嘱离院率无显著变化趋势,住院病死率持续呈高水平状态,波动在31.2%～70.0%,趋势检验未见显著性统计学变化;SALF非肝移植医嘱离院率逐年升高,自55.6%升至70.8%,住院病死率逐年下降,自25.9%降至8.3%(P＜0.001);ACLF患者非肝移植医嘱离院率逐年升高,自47.9%升高至59.7%,经趋势检验显示差异显著(z=1.9677,P=0.049),而非医嘱离院率和在院病死率逐年下降(P＜0.001);CLF患者非肝移植医嘱离院率同样逐年升高,自55.8%升高至75.2% (P＜0.05),而住院病死率呈逐年下降趋势,自20.9%降至9.3%(P＜0.05)。结论我国肝衰竭患者预后较前改善,尤其是SALF、ACLF和CLF患者医嘱离院率较前显著升高,但ALF患者住院病死率仍处于较高水平,需进一步探索新的诊疗策略。

关键词: 急性肝衰竭, 亚急性肝衰竭, 慢加急性肝衰竭, 慢性肝衰竭, 预后, 变化趋势

Abstract: Objective The aim of this study was to analyze the change trends of discharge mode of hospitalized patients with liver failure over the last ten years. Methods The clinical materials of patients with liver failure, including acute liver failure (ALF), subacute liver failure (SALF), and acute-on-chronic liver failure (ACLF) and chronic liver failure (CLF), admitted to Beijing You'an Hospital between 2012 and 2021 was retrospectively collected, and analyzed. Results A total of 8512 patients with liver failure were hospitalized, of them, 5789 patients were enrolled as 2723 patients were ruled out based on exlusion criteria, with the mean age of (50.31 ± 13.49) year old, 28.7% of female, and mean hospital stay of 19.46 ± 15.19 days; the ACLF accounted for 47.3%, CLF for 42.0%, SALF for 7.9% and ALF for 2.9%; in terms of the way of discharging, the ordered accounted for 57.6%, non-ordered for 27.5%, and dead for 15.0%; the in-hospital mortality of ALF, CLF, ACLF and SALF were 52.2%, 14.2%,13.7% and 11.4%; the longitudinal analysis showed that in ALF patients, the percentage of doctor's order for discharge did not significantly changed, with in-hospital mortality fluctuating between 31.2% and 70.0%; in SALF, the percentage of discharge by medical advice increased from 55.6% to 70.8% year by year, and the in-hospital mortality decreased from 25.9% to 8.3% (P<0.001); in patients with ACLF, the proportion of discharge by medical orders increased from 47.9% to 59.7% (z=1.9677, P=0.049); in CLF patients, the proportion of patients discharged by medical order also increased from 55.8% to 75.2% (P<0.05), while the in-hospital mortality rate showed a downward trend from 20.9% to 9.3% (P<0.05) year by year. Conclusion The prognosis of patients with liver failure in our hospital has improved greatly over the past ten years, especially the discharging way by medical advice in patients with SALF, ACLF and CLF has increased year by year, but the in-hospital mortality of patients with ALF is still at a high level, so new diagnosis and treatment strategies need to be further explored.

Key words: Acute liver failure, Subacute liver failure, Acute-on-chronic liver failure, Chronic liver failure, Outcome, Trend

徐曼曼, 杨颜榕, 李珊珊, 武羽, 杨雪, 段钟平, 陈煜. 我院近10年肝衰竭患者预后变化趋势分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 874-877.

Xu Manman, Yang Yanrong, Li Shanshan, et al. Trends in outcomes of patients with liver failure in our hospital over the past ten years[J]. Journal of Practical Hepatology, 2024, 27(6): 874-877.

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我院近10年肝衰竭患者预后变化趋势分析^*

Trends in outcomes of patients with liver failure in our hospital over the past ten years

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