Symptomatic Avascular Necrosis: An Understudied Risk Factor for Acute Care Utilization by Patients with SCD.
Symptomatic Avascular Necrosis: An Understudied Risk Factor for Acute Care Utilization by Patients with SCD.
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DOI：
10.14423/smj.0000000000000512
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发表时间：
2016-09
影响因子：
1.1
通讯作者：
Lanzkron S
中科院分区：
文献类型：
--
作者：
Yu T;Campbell T;Ciuffetelli I;Haywood C Jr;Carroll CP;Resar L;Strouse JJ;Lanzkron S
镰状细胞病（SCD）与一部分患者的高医疗利用率和不良预后相关，尽管预测这种表型的潜在因素尚不清楚。先前的研究表明，共病性缺血性坏死（AVN）有助于提高医疗保健利用率。我们试图澄清AVN是否独立预测成人SCD患者的急性护理利用，并确定AVN患者预测较高利用的特征。我们回顾了87例伴有症状性AVN的SCD患者的医疗记录，并比较了87例性别和年龄匹配的无症状性AVN的SCD患者的急性护理利用和临床特征。纳入随访≥2年的患者。结果采用双变量分析和多变量回归进行比较。我们的研究包括1381年的随访，每位患者的中位数为7年。AVN队列的急诊就诊中位数率（3.2/年vs 1.3/年，P = 0.0155）、入院率（1.3/年vs 0.4/年，P = 0.0002）和入院天数（5.1天/年vs 1.8天/年，P = 0.0007）更高。高使用率（比值比[OR] 4.28; P = 0.001）、急性胸综合征（比值比[OR] 3.12; P = 0.005）、肺炎（比值比[OR] 3.20; P = 0.023）、羟基脲治疗（比值比[OR] 2.23; P = 0.0136）和长期输血（比值比[OR] 2.33; P = 0.014）与AVN相关。在中位回归模型中，AVN、急性胸综合征和肺炎与急诊就诊和住院次数增加独立相关。发现症状性AVN是SCD患者急性护理使用的独立危险因素。因为这是一个潜在的可改变的因素，迫切需要进一步的研究来确定AVN预防/早期治疗干预是否会改变SCD患者的利用和改善预后。
Sickle cell disease (SCD) is associated with high healthcare utilization rates and poor outcomes in a subset of patients, although the underlying factors that predict this phenotype are poorly understood. Prior studies suggest that comorbid avascular necrosis (AVN) contributes to high healthcare utilization. We sought to clarify whether AVN independently predicts acute care utilization in adults with SCD and to identify characteristics of those with AVN that predict higher utilization. We reviewed the medical records of 87 patients with SCD with symptomatic AVN and compared acute care utilization and clinical characteristics with 87 sex- and age-matched patients with SCD without symptomatic AVN. Patients with ≥2 years of follow-up were included. Outcomes were compared using bivariate analysis and multivariate regression. Our study included 1381 follow-up years, with a median of 7 years per patient. The AVN cohort had greater median rates of urgent care visits (3.2/year vs 1.3/year; P = 0.0155), admissions (1.3/year vs 0.4/year; P = 0.0002), and admission days (5.1 days/year vs 1.8 days/year; P = 0.0007). History of high utilization (odds ratio [OR] 4.28; P = 0.001), acute chest syndrome (OR 3.12; P = 0.005), pneumonia (OR 3.20; P = 0.023), hydroxyurea therapy (OR 2.23; P = 0.0136), and long-term transfusion (OR 2.33; P = 0.014) were associated with AVN. In a median regression model, AVN, acute chest syndrome, and pneumonia were independently associated with greater urgent care visits and admissions. Symptomatic AVN was found to be an independent risk factor for acute care utilization in patients with SCD. Because this is a potentially modifiable factor, further studies are urgently needed to determine whether AVN prevention/early treatment interventions will alter utilization and improve outcomes for patients with SCD.