Outcomes of Acute Chest Syndrome in Adult Patients with Sickle Cell Disease: Predictors of Mortality
Outcomes of Acute Chest Syndrome in Adult Patients with Sickle Cell Disease: Predictors of Mortality
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DOI：
10.1371/journal.pone.0094387
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发表时间：
2014-04-16
期刊：
影响因子：
3.7
通讯作者：
Rotta, Alexandre T.
中科院分区：
文献类型：
--
作者：
Allareddy, Veerajalandhar;Roy, Aparna;Rotta, Alexandre T.
患有镰状细胞病（SCD）的成年人数量不断增加。目前缺乏对成人SCD患者急性胸部综合征（ACS）结局的国家评估。我们描述了成人ACS的发病率、结局和死亡率预测因素。我们假设任何需要机械通气是一个独立的mortals.Methods的预测：我们进行了一项回顾性分析的全国住院病人样本（2004-2010年），在美国最大的所有付款人住院数据库，估计ACS的发病率和结果需要机械通气（MV）和交换输血（ET）的患者>21岁。分别采用多变量线性和Logistic回归模型分析MV和ET对住院时间（LOS）和住院死亡率（IHM）的影响。在回归模型中调整了年龄、性别、种族、镰状细胞危象类型、种族、共病负担、保险状况、入院类型和医院特征的影响。在24，699例住院治疗中，4.6%需要MV（2.7% ≥ 96小时），6%有ET，平均住院时间（LOS）为7.8天，住院死亡率（IHM）为1.6%。需要MV的ACS住院率逐年递增（2004年为2.6%，2010年为5.8%）。Hb-SS疾病是84.3%的住院患者的表型。在调整了大量患者和医院相关因素后，
Adults with sickle cell disease(SCD) are a growing population. Recent national estimates of outcomes in acute chest syndrome(ACS) among adults with SCD are lacking. We describe the incidence, outcomes and predictors of mortality in ACS in adults. We hypothesize that any need for mechanical ventilation is an independent predictor of mortality.Methods: We performed a retrospective analysis of the Nationwide Inpatient Sample(2004-2010), the largest all payer inpatient database in United States, to estimate the incidence and outcomes of ACS needing mechanical ventilation(MV) and exchange transfusion(ET) in patients >21 years. The effects of MV and ET on outcomes including length of stay(LOS) and in-hospital mortality(IHM) were examined using multivariable linear and logistic regression models respectively. The effects of age, sex, race, type of sickle cell crisis, race, co-morbid burden, insurance status, type of admission, and hospital characteristics were adjusted in the regression models.Results: Of the 24,699 hospitalizations, 4.6% needed MV(2.7% for = 96 hours), 6% had ET, with a mean length of stay(LOS) of 7.8 days and an in-hospital mortality rate(IHM) of 1.6%. There was a gradual yearly increase in ACS hospitalizations that needed MV(2.6% in 2004 to 5.8% in 2010). Hb-SS disease was the phenotype in 84.3% of all hospitalizations. After adjusting for a multitude of patient and hospital related factors, patients who had MV for