Case fatality and population mortality associated with anaphylaxis in the United States
Case fatality and population mortality associated with anaphylaxis in the United States
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DOI：
10.1016/j.jaci.2013.10.029
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发表时间：
2014-04-01
影响因子：
14.2
通讯作者：
Borish, Larry
中科院分区：
文献类型：
--
作者：
Ma, Larry;Danoff, Theodore M.;Borish, Larry
背景：过敏反应是一种可导致死亡的严重过敏反应，然而，死亡的实际风险尚不清楚。目的：我们试图估计住院或急诊科(ED)报告的过敏反应的病死率和普通人群中与过敏反应相关的死亡率。方法：这是一项基于人群的流行病学研究，使用了3个国家数据库：全国住院患者样本(NIS；1999-2009)、全国急诊科样本(NDS；2006-2009)和多原因死亡数据(MCDD；1999-2009)。这些数据库的来源分别是医院和急诊室出院记录和死亡证明。结果：在以过敏反应为主要诊断的住院或急诊室就诊中，病死率在0.25%至0.33%之间(NIS+NeDS，2006-2009年)。在美国，这些死亡率相当于每年63至99例死亡，其中约77%发生在住院患者中。1999年至2009年期间，与过敏反应相关的住院率从每百万人口21.0人增加到25.1人(年百分比变化，2.23%；95%可信区间，1.52%至2.94%)，而住院病例死亡率下降(年百分比变化，-2.35%；95%可信区间，-4.98%至0.34%)。总死亡率为0.63-0.76/百万人口(每年186-225例死亡，MCDD)，近十年来保持稳定(年变化百分比为-0.31%；95%可信区间为-1.54%-0.93%)。结论：2006-2009年因过敏反应住院或急诊室就诊的绝大多数患者均未死亡，平均病死率为0.3%。过去十年(1999-2009年)，与过敏反应有关的住院人数稳步增加，但住院者病死率下降抵消了这一增长；与过敏反应有关的住院死亡率和总死亡率似乎都很稳定，远低于每百万人口1人。虽然过敏反应可能危及生命，但实际上死亡的概率很低。随着过敏反应发生率的增加，从业者需要保持警惕，并遵循治疗指南，以进一步减少与过敏反应相关的死亡。
Background: Anaphylaxis is a serious allergic reaction that can cause death; however, the actual risk of death is unclear.Objective: We sought to estimate the case fatality rate among hospitalizations or emergency department (ED) presentations for anaphylaxis and the mortality rate associated with anaphylaxis for the general population.Methods: This was a population-based epidemiologic study using 3 national databases: the Nationwide Inpatient Sample (NIS; 1999-2009), the Nationwide Emergency Department Sample (NEDS; 2006-2009), and Multiple Cause of Death Data (MCDD; 1999-2009). Sources for these databases are hospital and ED discharge records and death certificates, respectively.Results: Case fatality rates were between 0.25% and 0.33% among hospitalizations or ED presentations with anaphylaxis as the principal diagnosis (NIS+NEDS, 2006-2009). These rates represent 63 to 99 deaths per year in the United States, approximately 77% of which occurred in hospitalized patients. The rate of anaphylaxis-related hospitalizations increased from 21.0 to 25.1 per million population between 1999 and 2009 (annual percentage change, 2.23%; 95% CI, 1.52% to 2.94%), contrasting with a decreasing case fatality rate among hospitalizations (annual percentage change, -2.35%; 95% CI, -4.98% to 0.34%). Overall mortality rates ranged from 0.63 to 0.76 per million population (186-225 deaths per year, MCDD) and appeared stable in the last decade (annual percentage change, -0.31%; 95% CI, -1.54% to 0.93%).Conclusion: From 2006 to 2009, the overwhelming majority of hospitalizations or ED presentations for anaphylaxis did not result in death, with an average case fatality rate of 0.3%. Anaphylaxis-related hospitalizations increased steadily in the last decade (1999-2009), but this increase was offset by the decreasing case fatality rate among those hospitalized; both inpatient and overall mortality rates associated with anaphylaxis appeared stable and were well under 1 per million population. Although anaphylactic reactions are potentially life-threatening, the probability of dying is actually very low. With the prevalence of anaphylaxis on the increase, practitioners need to stay vigilant and follow the treatment guidelines to further reduce anaphylaxis-related deaths.