A Population-Based Study of Perforated Diverticular Disease Incidence and Associated Mortality
A Population-Based Study of Perforated Diverticular Disease Incidence and Associated Mortality
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DOI：
10.1053/j.gastro.2008.12.054
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发表时间：
2009-04-01
期刊：
影响因子：
29.4
通讯作者：
West, Joe
中科院分区：
文献类型：
--
作者：
Humes, David J.;Solaymani-Dodaran, Masoud;West, Joe
背景和目标：穿孔性憩室病是憩室病最严重的并发症，但对其发生率和死亡率知之甚少。我们的目的是确定憩室穿孔的发病率和死亡率以及合并症的影响。研究方法：我们使用了一项基于人群的队列研究，使用了1990年至2005年全科医学研究数据库（GPRD）中确定的穿孔性憩室病患者和人群对照。使用Poisson和考克斯回归对发病率和死亡率进行建模。使用Charlson指数对合并症进行量化。结果：我们确定了953例事件患者。总发生率为2.66（95%置信区间[CI]：2.49-2.83）/100，000人-年。1990年至2005年，经年龄和性别校正后，发病率增加了2.28倍（95% CI：1.79-2.95）。第一年死亡风险最高，增加了6倍（风险比[HR]，5.63; 95% CI：4.68 - 6.77）。经年龄和性别调整后，合并症最低的患者第一年的死亡风险最高（HR，11.11; 95%CI：8.06-15.31），但合并症最高的患者绝对死亡率最高（263.1/1000人-年）。结论：穿孔性憩室病的发病率在研究期间增加了一倍。憩室穿孔患者在穿孔后的第一年内死亡的可能性是普通人群的6倍。合并症最多的人死亡的可能性最大;然而，合并症最少的人在第一年的死亡率增加了11倍。
Background & Aims: Perforated diverticular disease represents the most serious complication of diverticular disease, but little is known regarding its occurrence and mortality. We aimed to determine the incidence and mortality associated with diverticular perforation and the influence of comorbidity. Methods: We used a population-based cohort study using patients with perforated diverticular disease and population controls identified from 1990 to 2005 in the General Practice Research Database (GPRD). Incidence and mortality rates were modelled using Poisson and Cox regression. Comorbidity was quantified using the Charlson index. Results: We identified 953 incident patients. The overall incidence was 2.66 (95% confidence interval [CI]: 2.49-2.83) per 100,000 person-years. The incidence rates increased 2.28-fold (95% CI: 1.79-2.95) when corrected for age and sex between 1990 and 2005. The risk of death was highest in the first year with a 6-fold increase (hazard ratio [HR], 5.63; 95% CI: 4.68 - 6.77). Adjusted for age and sex, the risk of death in the first year was highest in those with lowest comorbidity (HR, 11.11; 95% CI: 8.06-15.31), but the absolute mortality rates were greatest in those with the highest comorbidity (263.1 per 1000 person-years). Conclusions: The incidence of perforated diverticular disease has doubled over the period of the study. Patients presenting with a perforated diverticulum are 6 times more likely to die than the general population during the first year following perforation. Those who have the greatest comorbidity are the most likely to die; however, those with least comorbidity have an 11-fold increase in mortality in the first year.