Risk of Cardiovascular Events after Infection-Related Hospitalizations in Older Patients on Dialysis
Risk of Cardiovascular Events after Infection-Related Hospitalizations in Older Patients on Dialysis
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DOI：
10.2215/cjn.10151110
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发表时间：
2011-07-01
影响因子：
9.8
通讯作者：
Nguyen, Danh V.
中科院分区：
文献类型：
--
作者：
Dalrymple, Lorien S.;Mohammed, Sandra M.;Nguyen, Danh V.
背景和目标 感染和心血管疾病是透析患者住院和死亡的主要原因。本研究的目的是确定感染相关的住院治疗是否会增加接受透析的老年患者发生心血管事件的短期风险。 设计、设置、参与者和测量使用美国肾脏数据系统，对 2000 年 1 月 1 日至 2002 年 12 月 31 日之间开始透析的 65 至 100 岁患者进行了检查。从研究开始直至移植、死亡或 2004 年 12 月 31 日，对所有住院情况进行了检查。对所有出院诊断进行了检查，以确定住院期间是否发生感染。仅检查主要出院诊断以确定感兴趣的心血管事件。我们使用自我对照病例系列方法来估计感染相关住院后 90 天内心血管事件的相对发生率，与非此类住院后 90 天内的其他时间相比。结果 共有 16,874 名患者至少发生过一次心血管事件，并被纳入自我对照病例系列分析。与对照期相比，感染后的前 30 天内，心血管事件的风险增加了 25%，感染相关住院后的 90 天内总体增加了 18%。结论 感染相关住院后的前 90 天，特别是前 30 天是心血管事件的高危期，可能是老年透析患者降低心血管风险、监测和干预的重要时间范围。 Clin J Am Soc Nephrol 6: 1708-1713, 2011.doi: 10.2215/CJN.10151110
Background and objectives Infection and cardiovascular disease are leading causes of hospitalization and death in patients on dialysis. The objective of this study was to determine whether an infection-related hospitalization increased the short-term risk of a cardiovascular event in older patients on dialysis.Design, setting, participants, & measurements With use of the United States Renal Data System, patients aged 65 to 100 years who started dialysis between January 1, 2000, and December 31, 2002, were examined. All hospitalizations were examined from study entry until time of transplant, death, or December 31, 2004. All discharge diagnoses were examined to determine if an infection occurred during hospitalization. Only principal discharge diagnoses were examined to ascertain cardiovascular events of interest. We used the self-controlled case-series method to estimate the relative incidence of a cardiovascular event within 90 days after an infection-related hospitalization as compared with other times not within 90 days of such a hospitalization.Results A total of 16,874 patients had at least one cardiovascular event and were included in the self-controlled case-series analysis. The risk of a cardiovascular event was increased by 25% in the first 30 days after an infection and was overall increased 18% in the 90 days after an infection-related hospitalization relative to control periods.Conclusions The first 90 days, and in particular the first 30 days, after an infection-related hospitalization is a high-risk period for cardiovascular events and may be an important timeframe for cardiovascular risk reduction, monitoring, and intervention in older patients on dialysis. Clin J Am Soc Nephrol 6: 1708-1713, 2011. doi: 10.2215/CJN.10151110