Epidemiology and Outcomes of Hospitalizations With Invasive Aspergillosis in the United States, 2009-2013
Epidemiology and Outcomes of Hospitalizations With Invasive Aspergillosis in the United States, 2009-2013
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DOI：
10.1093/cid/ciy181
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发表时间：
2018-09-01
影响因子：
11.8
通讯作者：
Shorr, Andrew F.
中科院分区：
文献类型：
--
作者：
Zilberberg, Marya D.;Nathanson, Brian H.;Shorr, Andrew F.
背景。尽管侵袭性曲霉病（IA）使高达13%的免疫功能低下患者的护理复杂化，但对其在美国的发病率和死亡率负担知之甚少。我们分析了2009-2013年医疗保健研究和质量机构的医疗保健利用项目数据。在具有IA高危条件的受试者中，通过《国际疾病分类》第九版、临床修改代码117.3、117.9和484.6确定IA。我们比较了IA患者和非IA患者（非IA）的特征和结果。使用倾向评分匹配，我们计算了ia相关的超额死亡率和30天再入院率、住院时间和费用。在符合研究纳入标准的66 634 683例出院患者中，154 888例（0.2%）诊断为IA。非IA组最常见的高危条件是大手术（50.1%），IA组最常见的高危条件是危重症（41.0%）。倾向评分匹配后，IA组的死亡率（优势比为1.43；95%可信区间为1.36-1.51）和30天再入院率（1.39;1.34-1.45）均高于IA组。IA与每次住院额外花费15 542美元（13 869美元- 17 215美元）和6.0（95%可信区间，5.7-6.4）的住院天数相关。虽然在高危人群中也很少见，但IA与医院死亡率和30天再入院率增加、住院时间延长和费用增加有关。考虑到美国每年有近4万名IA患者，每年可归因于IA的总超额成本可能达到6亿美元。
Background. Though invasive aspergillosis (IA) complicates care of up to 13% of patients with immunocompromise, little is known about its morbidity and mortality burden in the United States.Methods. We analyzed the Health Care Utilization Project's data from the Agency for Healthcare Research and Quality for 2009-2013. Among subjects with high-risk conditions for IA, IA was identified via International Classification of Diseases, Ninth Revision, Clinical Modification codes 117.3, 117.9, and 484.6. We compared characteristics and outcomes between those with (IA) and without IA (non-IA). Using propensity score matching, we calculated the IA-associated excess mortality and 30-day readmission rates, length of stay, and costs.Results. Of the 66 634 683 discharged patients meeting study inclusion criteria, 154 888 (0.2%) had a diagnosis of IA. The most common high-risk conditions were major surgery (50.1%) in the non-IA and critical illness (41.0%) in the IA group. After propensity score matching, both mortality (odds ratio, 1.43; 95% confidence interval, 1.36-1.51) and 30-day readmission (1.39; 1.34-1.45) rates were higher in the IA group. IA was associated with 6.0 (95% confidence interval, 5.7-6.4) excess days in the hospital and $15 542 ($13 869-$17 215) in excess costs per hospitalization.Conclusions. Although rare even among high-risk groups, IA is associated with increased hospital mortality and 30-day readmission rates, excess duration of hospitalization, and costs. Given nearly 40 000 annual admissions for IA in the United States, the aggregate IA-attributable excess costs may reach $600 million annually.