Burden and correlates of readmissions related to pulmonary edema in US hemodialysis patients: a cohort study.
Burden and correlates of readmissions related to pulmonary edema in US hemodialysis patients: a cohort study.
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美国血液透析患者肺水肿相关的负担和再入院的相关性：一项队列研究。
DOI：
10.1093/ndt/gfx335
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Jaar,BernardG
中科院分区：
文献类型：
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作者：
Plantinga,LauraC;King,LauraM;Masud,Tahsin;Shafi,Tariq;Burkart,JohnM;Lea,JaniceP;Jaar,BernardG
背景肺水肿很普遍，可能是血液透析患者再入院的常见原因。我们的目的是估计血液透析患者中与肺水肿相关的再入院的国家负担，并确定其相关性。方法在这项使用国家登记数据的回顾性队列研究中，我们确定了 2011-13 年 Medicare 主要承保期间有指数入院的美国常见血液透析患者 (n= 215~251)。我们将再入院定义为指数出院后 30 天内发生的入院，将肺水肿相关再入院定义为出院诊断为液体超负荷、心力衰竭或肺水肿的再入院。使用多变量逻辑回归模型根据患者和指标入院特征确定肺水肿相关再入院的比值比 (OR)。结果 大约四分之一 (23%) 的指标入院后出现再入院，其中近一半 (44%) 的再入院与肺水肿相关。肺水肿相关再入院的最强独立相关性是肺水肿相关指数入院 [OR = 2.32；OR = 2.32； 95% 置信区间 (CI) 2.22–2.41]。透析年份<1年（OR = 1.18；95% CI 1.14–1.22）、慢性阻塞性肺疾病（OR = 1.34；95% CI 1.29–1.38）、透析不依从（OR = 1.53；95% CI 1.41–1.64）和充血性心力衰竭（OR = 1.85；95% CI 1.77-1.93），患者特征通常与肺水肿相关再入院风险较高无关。结论 与肺水肿相关的再入院在血液透析患者中很常见。旨在防止此类再入院的干预措施可能会对总体再入院产生重大影响，特别是针对既往有心力衰竭病史的血液透析患者和最初因肺水肿入院的患者。
BackgroundPulmonary edema is prevalent and may be a common cause of hospital readmissions in hemodialysis patients. We aimed to estimate the national burden of, and identify correlates of, readmissions related to pulmonary edema among hemodialysis patients.MethodsIn this retrospective cohort study using national registry data, we identified prevalent US hemodialysis patients (n= 215 251) with index admissions while under Medicare primary coverage in 2011–13. We defined readmissions as admissions occurring within 30 days of the index discharge and pulmonary edema-related readmissions as readmissions with discharge diagnoses of fluid overload, heart failure or pulmonary edema. Multivariable logistic regression models were used to determine odds ratios (ORs) for pulmonary edema-related readmissions by patient and index admission characteristics.ResultsAbout one-quarter (23%) of index hospital admissions were followed by a readmission, with nearly half (44%) of the readmissions being associated with pulmonary edema. The strongest independent correlate of pulmonary edema-related readmission was a pulmonary edema-related index admission [OR = 2.32; 95% confidence interval (CI) 2.22–2.41]. With the exception of dialysis vintage <1 year (OR = 1.18; 95% CI 1.14–1.22), chronic obstructive pulmonary disease (OR = 1.34; 95% CI 1.29–1.38), dialysis non-compliance (OR = 1.53; 95% CI 1.41–1.64) and congestive heart failure (OR = 1.85; 95% CI 1.77–1.93), patient characteristics were not generally associated with higher risk of pulmonary edema-related readmission.ConclusionsReadmissions related to pulmonary edema are common in hemodialysis patients. Interventions aimed at preventing such readmissions could have a substantial impact on readmissions overall, particularly targeted at incident hemodialysis patients with a prior history of heart failure and patients initially admitted for pulmonary edema.