Ting-An Hsu, Shih-Ching Kang, Yu-San Tee, Faran Bokhari, Chih-Yuan Fu
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引用次数: 0
摘要
目的 在创伤质量改进计划(TQIP)数据库中评估原有肝硬化对非手术治疗的钝性肝损伤结果的影响。方法 对2016年至2019年非手术治疗的钝性肝损伤患者进行研究。倾向评分匹配分析了有肝硬化和无肝硬化患者的死亡率、并发症和住院时间(LOS)。结果 在63946名患者中,有767人(1.2%)患有肝硬化。经过 1:1 匹配后,肝硬化患者经历了更多的出血(TAE 需求:5.7% 对 2.7%;输血量:639.1 对 259.3 毫升)、并发症(急性肾损伤:5.1% vs. 2.8%;败血症:2.4% vs. 1.0%)、并发症(急性肾损伤:5.1% vs. 2.8%;败血症:2.4% vs. 1.0%)和较差的预后(死亡率:19.5% vs. 10.2%;住院时间:11.6 天 vs. 8.4 天;重症监护室住院时间:12.1 天 vs. 7.4 天;呼吸机天数:7.6 天 vs. 1.6 天):7.6 对 1.6)。值得注意的是,TAE 与肝硬化患者死亡率的增加有关(几率比:4.093),但对无肝硬化患者的死亡率无显著影响。接受 TAE 止血的肝硬化患者比非肝硬化患者面临更大的死亡风险。
The negative effect of preexisting cirrhosis on blunt liver trauma patients: a multifaceted approach from the trauma quality improvement program database
Purpose
To assess the impact of pre-existing cirrhosis on the outcomes of non-operatively managed blunt liver trauma within the Trauma Quality Improvement Program (TQIP) database.
Methods
A study of non-operatively managed blunt liver injury patients from 2016 to 2019 was conducted. Propensity score matching analyzed mortality, complications, and hospital length of stay (LOS) for patients with and without cirrhosis. The effect of transcatheter arterial embolization (TAE) was determined using multivariate logistic regression.
Results
Out of 63,946 patients, 767 (1.2%) had pre-existing cirrhosis. Following 1:1 matching, those with cirrhosis experienced more hemorrhage (TAE need: 5.7% vs. 2.7%; transfusion volume: 639.1 vs. 259.3 ml), complications (acute kidney injury: 5.1% vs. 2.8%; sepsis: 2.4% vs. 1.0%), and poorer outcomes (mortality: 19.5% vs. 10.2%; hospital LOS: 11.6 vs. 8.4 days; ICU LOS: 12.1 vs. 7.4 days; ventilator days: 7.6 vs. 1.6). Notably, TAE was associated with increased mortality in cirrhotic patients (odds ratio: 4.093) but did not significantly affect mortality in patients without cirrhosis.
Conclusions
Within TQIP, pre-existing cirrhosis is a significant negative determinant for outcomes in blunt liver trauma. Cirrhotic patients undergoing TAE for hemostasis face greater mortality risk than non-cirrhotic counterparts.
期刊介绍:
The European Journal of Trauma and Emergency Surgery aims to open an interdisciplinary forum that allows for the scientific exchange between basic and clinical science related to pathophysiology, diagnostics and treatment of traumatized patients. The journal covers all aspects of clinical management, operative treatment and related research of traumatic injuries.
Clinical and experimental papers on issues relevant for the improvement of trauma care are published. Reviews, original articles, short communications and letters allow the appropriate presentation of major and minor topics.