Cirrhosis is a Crucial Factor in Mortality and Medical Costs of Acute Respiratory and Renal Failure Patients

肝硬化為急性呼吸衰竭及急性腎衰竭病人之死亡率及醫療成本之重要決定因素

陳碩爵(Shuo-Chueh Chen) ； 張仕妮(Shih-Ni Chang) ； 程味兒(Wei-Erh Cheng) ； 陳志毅(Chih-Yi Chen) ； 徐武輝(Wu-Huei Hsu) ； 林裕超(Yu-Chao Lin) ； 邱國梁(Kuo-Liang Chiu) ； 梁信杰(Shinn-Jye Liang) ； 魏裕峰(Yu-Feng Wei) ； 劉炯勳(Jiung-Hsiun Liu) ； 宋鴻樟(Fung-Chang Sung) ； 施純明(Chuen-Ming Shih)

《胸腔醫學》 27卷4期 (2012/08) Pp. 199-208

https://doi.org/10.29806/TM.201208.0001

摘要

Objective: Patients with cirrhosis are at high risk of mortality in Taiwan, especially those with other organ failures. This study focused on determining if cirrhosis is a crucial factor in the mortality and medical costs of acute renal and respiratory failure patients using claims data from the National Health Insurance (NHI) system of Taiwan.Methods: Using the 2000-2007 NHI claims data for patients with acute respiratory and renal failure, we identified 2,798 patients with liver cirrhosis and 11,192 with no cirrhosis diagnosis. These subjects were frequency matched by sex and age, and co-morbidities, length of stay (LOS) in the hospital, cost, discharge status and impact of cirrhosis on in hospital mortality were compared between the 2 groups.Results: Non-cirrhotic patients were more prevalent than patients with the co-morbidities of sepsis, pneumonia, chronic heart/lung disease and diabetes, but the negative impact of cirrhosis on in-hospital mortality was still significant higher after correcting for other factors (OR=2.42, 95% CI=2.17 to 2.70). The cirrhotic patients had higher mortality and against-advice discharge (AAD) rates (83.8%/68.0%, p＜0.0001), a shorter LOS (p＜0.0001), and a higher daily cost than those with more than 3 co-morbidities and younger age at hospitalization.Conclusion: Patients with acute renal and respiratory failure and a diagnosis of cirrhosis are at an elevated risk of in-hospital mortality, AAD, shorter LOS, and higher daily costs during admission.

關鍵字

肝硬化 ； 急性呼吸衰竭 ； 急性腎衰竭 ； 死亡率 ； 醫療成本

並列摘要

Objective: Patients with cirrhosis are at high risk of mortality in Taiwan, especially those with other organ failures. This study focused on determining if cirrhosis is a crucial factor in the mortality and medical costs of acute renal and respiratory failure patients using claims data from the National Health Insurance (NHI) system of Taiwan.Methods: Using the 2000-2007 NHI claims data for patients with acute respiratory and renal failure, we identified 2,798 patients with liver cirrhosis and 11,192 with no cirrhosis diagnosis. These subjects were frequency matched by sex and age, and co-morbidities, length of stay (LOS) in the hospital, cost, discharge status and impact of cirrhosis on in hospital mortality were compared between the 2 groups.Results: Non-cirrhotic patients were more prevalent than patients with the co-morbidities of sepsis, pneumonia, chronic heart/lung disease and diabetes, but the negative impact of cirrhosis on in-hospital mortality was still significant higher after correcting for other factors (OR=2.42, 95% CI=2.17 to 2.70). The cirrhotic patients had higher mortality and against-advice discharge (AAD) rates (83.8%/68.0%, p＜0.0001), a shorter LOS (p＜0.0001), and a higher daily cost than those with more than 3 co-morbidities and younger age at hospitalization.Conclusion: Patients with acute renal and respiratory failure and a diagnosis of cirrhosis are at an elevated risk of in-hospital mortality, AAD, shorter LOS, and higher daily costs during admission.

並列關鍵字

cirrhosis ； acute renal failure ； acute respiratory failure ； mortality ； medical cost