High readmission rates are associated with a significant economic burden and poor outcome in patients with grade III/IV acute GvHD
High readmission rates are associated with a significant economic burden and poor outcome in patients with grade III/IV acute GvHD
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DOI：
10.1111/ctr.12065
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发表时间：
2013-01-01
影响因子：
2.1
通讯作者：
Shaw, Bronwen E.
中科院分区：
文献类型：
--
作者：
Dignan, Fiona L.;Potter, Mike N.;Shaw, Bronwen E.
移植物抗宿主病(GvHD)是造血干细胞移植后的一种常见并发症，但关于这种情况对医院再住院率的影响的报道很少。我们报告了187例连续的异基因移植患者的再住院率和相关费用的回顾分析，以评估GvHD的影响。移植物抗宿主病患者的总再住院率较高(86%对59%，p<；0.001)。再住院率在移植后的前100d(p=0.02)和移植后的第一年(p<；0.001)都较高。151/455(33%)的再入院事件发生在移植后100d内。III/IV级急性移植物抗宿主病患者的平均住院天数(101d)明显高于I/II级移植物抗宿主病(70d；p=0.003)。移植物抗宿主病患者的平均再住院费用(28/860)高于非移植物抗宿主病患者(13/405；p=0.002)和III/IV级移植物抗宿主病患者(40/012)与I/II移植物抗宿主病患者(24/560；p=0.038)。I/II级移植物抗宿主病患者的存活率(55%)高于III/IV级移植物抗宿主病患者(14%；P<；0.001)。这项研究表明，与III/IV级GvHD相关的经济负担高，总体存活率低。
Graft-versus-host disease (GvHD) is a common complication following haematopoietic stem cell transplant but little is published about the impact of this condition on hospital readmission rates. We report a retrospective analysis of readmission rates and associated costs in 187 consecutive allogeneic transplant patients to assess the impact of GvHD. The overall readmission rate was higher in patients with GvHD (86% (101/118) vs. 59% (41/69), p < 0.001). The readmission rate was higher both in the first 100 d from transplant (p = 0.02) and in the first year following transplant (p < 0.001). 151/455 (33%) of all readmission episodes occurred within 100 d of transplant. The mean number of inpatient days was significantly higher in patients with grade III/IV acute GvHD (101 d) compared with those with grade I/II GvHD (70 d; p = 0.003). The mean cost of readmission was higher in patients with GvHD (28 pound 860) than in non-GvHD patients (13 pound 405; p = 0.002) and in patients with grade III/IV GvHD (40 pound 012) compared with those patients with grade I/II GvHD (24 pound 560; p = 0.038). Survival was higher in those with grade I/II GvHD (55%) compared to grade III/IV GvHD (14%; p < 0.001). This study shows the high economic burden and poor overall survival associated with grade III/IV GvHD.