Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases.
Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases.
复制标题
确定急性胰腺炎患者进展为重症监护入院和死亡的危险因素：苏格兰医疗保健数据库的记录关联分析。
DOI：
10.1136/bmjopen-2016-011474
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发表时间：
2016-06-15
期刊：
影响因子：
2.9
通讯作者：
Donnan PT
中科院分区：
文献类型：
--
作者：
Mole DJ;Gungabissoon U;Johnston P;Cochrane L;Hopkins L;Wyper GM;Skouras C;Dibben C;Sullivan F;Morris A;Ward HJ;Lawton AM;Donnan PT
急性胰腺炎（AP）可引发需要重症监护（CC）支持的全身性并发症。我们的目标是使用统一的国家健康记录来定义AP在苏格兰的流行病学，特别关注AP中CC入院的确定性和预后因素。苏格兰卫生局（n=4）。我们纳入了2009年4月1日至2012年3月31日在苏格兰至少发生过一次AP（ICD 10代码K85）的回顾性观察队列中的所有个体。3340人被编码为AP。来自16个来源的数据，包括全科医学、社区处方、事故和急诊就诊、住院患者、CC和死亡登记，通过国家安全港中的唯一患者标识符联系起来。Logistic回归和伽马模型被用来定义需要CC入院或导致死亡的严重AP（sAP）的独立预测因素。2053例患者（61.5%（95% CI 59.8%至63.2%））符合真正AP（tAP）的定义。368例患者（17.9%的tAP（95% CI 16.2%-19.6%））入住CC。sAP的预测因素是预先存在的心绞痛或高血压、低钙血症和年龄30-39岁（如果存在2型糖尿病）。 有多次AP发作史的患者发生sAP的风险较低。总体tAP患者的住院死亡率为5.0%（95% CI 4.1%-5.9%），需要CC住院的tAP患者的住院死亡率为21.7%（95% CI 19.9%-23.5%）。常规收集的数据的国家记录关联分析构成了模拟CC入院和AP期间死亡的强大资源。需要CC入院的AP患者的死亡率仍然很高。
Acute pancreatitis (AP) can initiate systemic complications that require support in critical care (CC). Our objective was to use the unified national health record to define the epidemiology of AP in Scotland, with a specific focus on deterministic and prognostic factors for CC admission in AP. Health boards in Scotland (n=4). We included all individuals in a retrospective observational cohort with at least one episode of AP (ICD10 code K85) occurring in Scotland from 1 April 2009 to 31 March 2012. 3340 individuals were coded as AP. Data from 16 sources, spanning general practice, community prescribing, Accident and Emergency attendances, hospital in-patient, CC and mortality registries, were linked by a unique patient identifier in a national safe haven. Logistic regression and gamma models were used to define independent predictive factors for severe AP (sAP) requiring CC admission or leading to death. 2053 individuals (61.5% (95% CI 59.8% to 63.2%)) met the definition for true AP (tAP). 368 patients (17.9% of tAP (95% CI 16.2% to 19.6%)) were admitted to CC. Predictors of sAP were pre-existing angina or hypertension, hypocalcaemia and age 30–39 years, if type 2 diabetes mellitus was present. The risk of sAP was lower in patients with multiple previous episodes of AP. In-hospital mortality in tAP was 5.0% (95% CI 4.1% to 5.9%) overall and 21.7% (95% CI 19.9% to 23.5%) in those with tAP necessitating CC admission. National record-linkage analysis of routinely collected data constitutes a powerful resource to model CC admission and prognosticate death during AP. Mortality in patients with AP who require CC admission remains high.