德国急性静脉曲张出血--对 65,357 例住院病例的全国性研究:德国静脉曲张性出血。

IF 2.7 4区 医学 Q2 Medicine Canadian Journal of Gastroenterology and Hepatology Pub Date : 2024-10-24 eCollection Date: 2024-01-01 DOI:10.1155/2024/5453294
Alexander Mertens, Tobias Essing, Anselm Kunstein, Christian Weigel, Johannes Bode, Christoph Roderburg, Tom Luedde, Jennis Kandler, Sven H Loosen
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引用次数: 0

摘要

背景:急性静脉曲张出血(AVH)是肝硬化患者上消化道出血(UGIB)的常见原因。由于可能危及生命,大多数病例需要紧急内镜介入治疗。根据出血侧(食管、胃底和胃)的不同,可采用不同的内镜止血技术,特别是内镜下静脉曲张结扎术(EVL)和内镜下硬化剂注射疗法(EST),以及放射学干预(如栓塞术和经颈静脉肝内门体分流术[TIPS])。本研究旨在调查德国的发病率、治疗方式和结果参数(如院内死亡率和不良事件)的趋势。方法:我们根据德国联邦统计局提供的 2010 年至 2019 年标准化出院数据,评估了德国 AVH 目前的流行病学趋势、治疗策略和院内死亡率。结果:共有 65357 例 AVH 病例纳入分析,其中男性占多数(68.3%)。年发病率(每 10 万人中的住院病例数)为 8.9。住院死亡率为 18.6%。最常见的基础疾病是酒精相关性肝硬化(60.6%)。最常见的临床并发症是出血性贫血(60.1%),而低血容量性休克(12.8%)则较少见。在食管静脉曲张出血(EVH)中,EVL是最常用的内镜疗法,而在胃静脉曲张出血(GVH)中,EST和纤维蛋白胶注射是最常用的疗法。在EVH患者中,EVL的院内死亡率最低(12.3%),而在GVH患者中,EST的效果良好(院内死亡率为14%)。总体而言,联合疗法的院内死亡率较高,在GVH中更为常见。出现低血容量性休克、AKI、脓毒症、人工通气、ARDS、出血性贫血、肝性脑病和男性时,预后明显较差。结论我们的研究详细揭示了德国大规模 AVH 群体的发病率、患者相关风险因素、内镜治疗和院内死亡率。这些数据可能有助于改进 AVH 患者的风险分层和治疗策略。
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Acute Variceal Hemorrhage in Germany-A Nationwide Study of 65,357 Hospitalized Cases: Variceal Hemorrhage in Germany.

Background: Acute variceal hemorrhage (AVH) is a frequent cause of upper gastrointestinal bleeding (UGIB) in liver cirrhosis. Most cases require urgent endoscopic intervention due to potentially life-threatening courses. Different endoscopic hemostasis techniques can be used, in particular endoscopic variceal ligation (EVL) and endoscopic sclerotherapy (EST), depending on the bleeding side (esophageal, fundal, and gastric) as well as radiological interventions (e.g., embolization and transjugular intrahepatic portosystemic shunt [TIPS]). This study aimed to investigate trends in incidence, treatment modalities, and outcome parameters, such as in-hospital mortality and adverse events in Germany. Methods: We evaluated the current epidemiological trends, therapeutic strategies, and in-hospital mortality of AVH in Germany based on the standardized hospital discharge data provided by the German Federal Statistical Office from 2010 to 2019. Results: A total of 65,357 AVH cases, predominately males (68.3%), were included in the analysis. The annual incidence rate (hospitalization cases per 100,000 persons) was 8.9. The in-hospital mortality was 18.6%. The most common underlying disease was alcohol-related liver cirrhosis (60.6%). The most common clinical complication was bleeding anemia (60.1%), whereas hypovolemic shock (12.8%) was the less frequent. In esophageal variceal hemorrhage (EVH), EVL was the most frequently performed endoscopic therapy, while in gastric variceal hemorrhage (GVH), EST and fibrin glue injection were the most commonly performed therapies. EVL showed the lowest in-hospital mortality (12.3%) in EVH, while EST showed favorable results (14% in-hospital mortality) in GVH. Combination therapies overall showed a higher in-hospital mortality and were more frequent in GVH. The presence of hypovolemic shock, AKI, sepsis, artificial ventilation, ARDS, bleeding anemia, hepatic encephalopathy, and male sex was associated with a significantly worse outcome. Conclusion: Our study provides detailed insight into the incidence, patient-related risk factors, endoscopic treatment, and in-hospital mortality in a sizeable AVH collective in Germany. These data might help improve risk stratification and treatment strategies for AVH patients in the future.

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来源期刊
CiteScore
4.80
自引率
0.00%
发文量
0
审稿时长
37 weeks
期刊介绍: Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery. The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
期刊最新文献
Acute Variceal Hemorrhage in Germany-A Nationwide Study of 65,357 Hospitalized Cases: Variceal Hemorrhage in Germany. The Predictive Value of Time-Varying Noninvasive Scores on Long-Term Prognosis of NAFLD in South Korea. Feasibility and Acceptability of Antenatal Hepatitis C Screening: A Pilot Study. Primary Care Support Tools for Digestive Health Care: A Mixed Method Study. Long-Term Treatment with Bulevirtide in Patients with Chronic Hepatitis D and Advanced Chronic Liver Disease.
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