肝硬化合并胸腔积液患者的长期预后

StephenW

Year : 2018  |  Volume : 24  |  Issue : 1  |  Page : 46-51

The long-term outcomes of cirrhotic patients with pleural effusion

Tsung-Hsing Hung1, Chih-Wei Tseng1, Chih-Chun Tsai2, Chen-Chi Tsai3, Kuo-Chih Tseng1, Yu-Hsi Hsieh1
1 Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi; School of Medicine, Tzu Chi University, Hualien, Taiwan
2 Department of Mathematics, Tamkang University, Tamsui, Taiwan
3 School of Medicine, Tzu Chi University, Hualien; Division of Infectious Disease, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan

Correspondence Address:
Dr. Chih-Wei Tseng
Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi
Taiwan
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DOI: 10.4103/sjg.SJG_336_17
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Background/Aim: A pleural effusion is an abnormal collection of fluid in the pleural space and may cause related morbidity or mortality in cirrhotic patients. Currently, there are insufficient data to support the long-term prognosis for cirrhotic patients with pleural effusion. In this study, we investigated the short- and long-term effects of pleural effusion on mortality in cirrhotic patients and evaluated the benefit of liver transplantation in these patients. Patients and Methods: The National Health Insurance Database, derived from the Taiwan National Health Insurance Program, was used to identify 3,487 cirrhotic patients with pleural effusion requiring drainage between January 1, 2007 and December 31, 2010. The proportional hazards Cox regression model was used to control for possible confounding factors. Results: The 30-day, 90-day, 1-year, and 3-year mortalities were 20.1%, 40.2%, 59.1%, and 75.9%, respectively, in the cirrhotic patients with pleural effusion. After Cox proportional hazard regression analysis adjusted by patient gender, age, complications of cirrhosis and comorbid disorders, old age, esophageal variceal bleeding, hepatocellular carcinoma, hepatic encephalopathy, pneumonia, renal function impairment, and without liver transplantation conferred higher risks for 3-year mortality in the cirrhotic patients with pleura effusion. Liver transplantation is the most important factor to determine the 3-year mortalities (HR: 0.17, 95% CI 0.11- 0.26, P < 0.001). The 30-day, 30 to 90-day, 90-day to 1-year, and 1 to 3-year mortalities were 5.7%, 13.4%, 20.4%, and 21.7% respectively, in the liver transplantation group, and 20.5%, 41.0%, 61.2%, and 77.5%, respectively, in the non-liver transplantation group. Conclusion: In cirrhotic patients, the presence of pleural effusion predicts poor long-term outcomes. Liver transplantation could dramatically improve the survival and should be suggested as soon as possible.

StephenW

年份：2018 |卷：24 |问题：1 |页码：46-51

肝硬化合并胸腔积液患者的长期预后

洪崇兴1，曾志伟1，蔡赤春2，陈志齐3，郭国志1，谢锡锡1
1济慈佛教慈济医学基金会大林慈济医院医学科消化内科;台湾花莲慈济大学医学院
2台湾淡水淡江大学数学系
3慈济大学医学院花莲;台湾嘉义佛教慈济医学基金会大林慈济医院传染病科

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Chih-Wei Wei博士
济慈佛教慈济医学基金会大林慈济医院消化内科
台湾
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DOI：10.4103 / sjg.SJG_336_17
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背景/目的：胸腔积液是胸膜腔积液的异常收集，可能导致肝硬化患者的相关发病率或死亡率。目前，没有足够的数据来支持肝硬化胸腔积液患者的长期预后。在本研究中，我们调查了胸腔积液对肝硬化患者死亡率的短期和长期影响，并评估了这些患者肝移植的益处。患者和方法：国民健康保险数据库，从台湾全民健康保险计划派生，被用来确定3,487肝硬化患者2007年1月1日至2010年12月31日之间需要引流胸水中使用的比例风险Cox回归模型以控制可能的混杂因素。结果：肝硬化合并胸腔积液患者的30天，90天，1年和3年死亡率分别为20.1％，40.2％，59.1％和75.9％。后患者的性别，年龄，肝硬化和共病的并发症，年老，食管静脉曲张破裂出血，肝癌，肝性脑病，肺炎，肾功能损害，且无肝移植调整Cox比例风险回归分析赋予更高的风险为3年肝硬化胸膜腔积液患者的死亡率。肝移植是决定3年死亡率的最重要因素（HR：0.17,95％CI 0.11-0.26，P <0.001）。在30天，30至90天，90天到1年，和1至3年的死亡率分别为5.7％，13.4％，20.4％，和21.7％，肝脏移植组，和20.5％ ，非肝移植组分别为41.0％，61.2％和77.5％。结论：在肝硬化患者中，胸腔积液的存在预示着长期的不良后果。肝移植可以显着提高生存率，应尽快提出建议。

StephenW

http://www.saudijgastro.com/arti ... page=51;aulast=Hung