Weekend Hospital Admission, Acute Kidney Injury, and Mortality
Weekend Hospital Admission, Acute Kidney Injury, and Mortality
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DOI：
10.1681/asn.2009070682
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发表时间：
2010-05-01
影响因子：
13.6
通讯作者：
Chertow, Glenn M.
中科院分区：
文献类型：
--
作者：
James, Matthew T.;Wald, Ron;Chertow, Glenn M.
周末入院与几种急性疾病的死亡率增加有关。我们调查了周末入院的急性肾损伤（阿基）患者是否比工作日入院的患者更容易死亡。使用全国住院病人样本，一个大型的数据库，急诊入院，在美国的非联邦医院，我们确定了963,730入院诊断为阿基在2003年和2006年之间。其中，214，962例（22%）将阿基指定为入院的主要原因（周末45，203例，工作日169，759例）。我们使用逻辑回归模型来检查与周末与工作日入院相关的住院死亡率的调整几率。与在工作日入院相比，在周末入院的主要诊断为阿基的患者的死亡几率更高[校正的比值比（OR）1.07，95%置信区间（CI）1.02至1.12]。与大型医院（调整后的OR 1.07，95%CI 1.01至1.13）相比，小型医院（调整后的OR 1.17，95%CI 1.03至1.33）周末因阿基入院的死亡风险更明显。在一系列并存的医学诊断中，作为次要诊断的阿基患者的死亡率增加也与周末入院有关。总之，在因阿基住院的患者中，与工作日入院相比，周末入院与更高的死亡风险相关。
Admission to the hospital on weekends is associated with increased mortality for several acute illnesses. We investigated whether patients admitted on a weekend with acute kidney injury (AKI) were more likely to die than those admitted on a weekday. Using the Nationwide Inpatient Sample, a large database of admissions to acute care, nonfederal hospitals in the United States, we identified 963,730 admissions with a diagnosis of AKI between 2003 and 2006. Of these, 214,962 admissions (22%) designated AKI as the primary reason for admission (45,203 on a weekend and 169,759 on a weekday). We used logistic regression models to examine the adjusted odds of in-hospital mortality associated with weekend versus weekday admission. Compared with admission on a weekday, patients admitted with a primary diagnosis of AKI on a weekend had a higher odds of death [adjusted odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02 to 1.12]. The risk for death with admission on a weekend for AKI was more pronounced in smaller hospitals (adjusted OR 1.17, 95% CI 1.03 to 1.33) compared with larger hospitals (adjusted OR 1.07, 95% CI 1.01 to 1.13). Increased mortality was also associated with weekend admission among patients with AKI as a secondary diagnosis across a spectrum of co-existing medical diagnoses. In conclusion, among patients hospitalized with AKI, weekend admission is associated with a higher risk for death compared with admission on a weekday.