Predictors of inpatient mortality in patients with systemic sclerosis: a case control study
Predictors of inpatient mortality in patients with systemic sclerosis: a case control study
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DOI：
10.1007/s10067-016-3245-6
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发表时间：
2016-06-01
影响因子：
3.4
通讯作者：
Derk, Chris T.
中科院分区：
文献类型：
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作者：
Sehra, Shiv T.;Kelly, Andrew;Derk, Chris T.
关于系统性硬化症（SSc）患者住院死亡率预测因素的研究很少。了解这些预测因素对于早期识别住院死亡高危患者和识别可改变的因素非常重要。本研究的目的是确定与SSc患者住院死亡率较高相关的因素。对2001年至2011年宾夕法尼亚大学医院所有SSc（ICD-9-710.1）住院患者进行了审查。SSc的诊断得到证实，死亡通过病历审查确定。对于每例死亡，确定了年龄、性别和种族匹配的SSc对照（在住院期间未死亡）。我们假设SSc特征、非SSc共病和入院实验室检查的组间差异。使用Student t检验以及二分变量的Chi（2）检验分析组间差异。单变量分析中与死亡相关的暴露量用于形成最终的简约多变量logistic回归模型。在分析了658例SSc入院后，对29例病例和29例匹配对照进行了研究。与匹配的对照组相比，死亡受试者在非SSc肺病（p = 0.03）、吸入事件（p <0.01）、血尿素氮（BUN）（p < 0.01）和血红蛋白（p = 0.03）方面存在显著差异。血尿素氮高的患者死亡几率更高（OR = 1.06，CI = 1.02-1.11），非SSc肺部疾病（OR = 3.87，CI = 1.26-11.88），误吸事件发生率（OR = 30，CI = 3.58-250.80），血红蛋白水平较高的患者发生率较低（OR = 0.73，CI = 0.54-0.97）。发现高BUN、吸入事件史和低Hgb与死亡风险独立相关。肺疾病、贫血、肾功能不全和误吸事件史与SSc患者较高的住院死亡率相关。发生误吸事件的患者在医院死亡的几率高出30倍。应考虑采取严格措施，防止高危患者误吸。
There are few studies on predictors of inpatient mortality in patients with systemic sclerosis (SSc). Knowledge of these predictors is important for the early identification of patients at high risk of inpatient death and for the recognition of modifiable factors. The aim of this study was to define factors associated with greater inpatient mortality in SSc. All admissions coded for SSc (ICD-9-710.1) at the Hospital of University of Pennsylvania, between 2001 and 2011, were reviewed. The diagnosis of SSc was confirmed, and deaths were identified by chart review. For each death, an age, sex, and race matched control with SSc (who did not die during their hospitalization) was identified. We hypothesized group differences in SSc characteristics, non-SSc co-morbidities, and admission labs. Group differences were analyzed using Student's t test as well as Chi(2) tests for dichotomous variables. Exposures associated with death in univariate analyses were used to form a final parsimonious multivariable logistic regression model. After analysis of 658 SSc admissions, 29 cases and 29 matched controls were studied. A significant difference in non-SSc lung disease (p = 0.03), aspiration events (p < 0.01), blood urea nitrogen (BUN) (p < 0.01), and hemoglobin (p = 0.03) was noted between subjects that died compared to matched controls. Odds of death were higher in patients with a higher BUN (OR = 1.06, CI = 1.02-1.11), non-SSc lung disease (OR = 3.87, CI = 1.26-11.88), and aspiration events (OR = 30, CI = 3.58-250.80) and lower in patients with a higher hemoglobin (OR = 0.73, CI = 0.54-0.97). A high BUN, a history of aspiration events, and low Hgb were found to be independently associated with risk of death. A history of lung disease, anemia, renal dysfunction, and aspiration events is associated with higher in-hospital mortality in patients with SSc. The odds of dying in the hospital were 30 times higher among patients with an aspiration event. Stringent measures should be considered to prevent aspiration in at-risk patients.