肝细胞癌患者住院时的年龄,并发症负担和死亡风险
Lucia Calthorpe1, Jessica Rubin2, Catherine Lee3
1Department of Surgery, UCSF, San Francisco, CA, USA.
对于患有肝癌 (肝细胞癌) 的老年人来说,他们的整体健康 (并发症负担) 比预测医院生存的年龄更重要. 虚弱度得分比时间表年龄更好地预测结果.
科学领域:
- 肝胆道医学 肝胆道医学
- 老年瘤学 老年瘤学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 肝细胞癌 (HCC) 不成比例地影响着老年人,但时间性年龄与并发症负担对结果的相对影响仍然不清楚.
- 区分年龄和并发症对于优化老年HCC患者的治疗策略至关重要,防止治疗不足和过度治疗.
研究的目的:
- 调查慢性年龄或并发症负担是否是肝细胞癌 (HCC) 患者住院死亡率的更强有力的预测因素.
- 评估伴随性疾病调整对HCC患者年龄和死亡率之间的关联的影响.
主要方法:
- 利用了国家住院患者样本 (2016-2018) 的数据,用于诊断为HCC或肝硬化的成年患者.
- 使用医院虚弱风险评分 (HFRS) 评估并发病负担,并将年龄分类为以下组:<45,45-64,65-74和≥75岁.
- 采用嵌套多变量逻辑回归来分析年龄,HFRS和住院死亡率之间的关系,按HCC状态分层.
主要成果:
- 在426,633名患者中 (26,653人患有高血),住院死亡率为5.9%.
- 在HCC患者中,年龄最初与死亡率有关,但在对HFRS进行调整后,这种关联变得无意义.
- 每增加HFRS一个点,就显著增加了15%的住院死亡几率 (95%CI:1.14,1.16,p<0.001).
结论:
- 由HFRS测量的并发症负担是HCC患者住院死亡率的更重要的预测因素,而不是时间表年龄.
- 对HCC患者的临床决策应优先考虑评估生理储备和并发性疾病负担,而不是仅仅依赖时间学年龄.
- 这些发现强调了需要超越时间学年龄作为老年HCC患者结果的唯一预测因素.
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