Nationwide linkage analysis in Scotland to assess mortality following hospital admission for Crohn's disease: 1998-2000
Nationwide linkage analysis in Scotland to assess mortality following hospital admission for Crohn's disease: 1998-2000
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DOI：
10.1111/j.1365-2036.2011.04906.x
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发表时间：
2012-01-01
影响因子：
7.6
通讯作者：
Satsangi, J.
中科院分区：
文献类型：
--
作者：
Kennedy, N. A.;Clark, D. N.;Satsangi, J.
背景：虽然基于人群的克罗恩病（CD）患者的研究表明，死亡率仅略有增加，但最近的数据引起了对需要住院治疗的CD患者结局的关注。目的确定1998年至2000年间苏格兰1595例CD住院患者的死亡率及其影响因素。方法采用苏格兰发病率记录数据库和相关数据集评估患者的纵向预后，并探讨3年死亡率与年龄、性别、合并症、入院类型和社会剥夺之间的关系。入院后3年的标准化死亡率（SMR）参照苏格兰人口计算。结果SMR为3.31（95%可信区间2.803.89）。除50例患者外，所有患者的死亡率均有所增加，入院类型、合并症、社会剥夺和入院时间与死亡率显著相关。除年龄外，入院类型是预测死亡的最重要因素。择期手术的三年粗死亡率为0.3%，急诊手术为8.7%，非手术为8.3%，急诊非手术入院为12.7% （P < 0.001）。结论：研究表明1998 - 2000年期间因乳糜病住院的患者死亡率很高，尤其是50岁以上的患者。选择性手术的死亡率低于紧急手术或药物治疗。需要进一步的研究来确定这些模式是否在引入生物治疗后发生了变化。
Background Although population-based studies of patients with Crohns disease (CD) suggest only a modestly increased mortality, recent data have raised concerns regarding the outcome of CD patients requiring hospitalisation. Aim To determine the mortality and contributory factors in 1595 patients hospitalised for CD in Scotland between 1998 and 2000. Methods The Scottish Morbidity Records database and linked datasets were used to assess longitudinal patient outcome, and to explore associations between 3-year mortality and age, sex, comorbidity, admission type and social deprivation. The standardised mortality ratio (SMR) at 3 years from admission was calculated with reference to the Scottish population. Results The SMR was 3.31 (95% confidence interval 2.803.89). This was increased in all patients, other than those 50, admission type, comorbidity, social deprivation and length of admission were significantly associated with mortality. Other than age, admission type was the strongest factor predictive of death. Three-year crude mortality was 0.3% for elective surgical, 8.7% for emergency surgical, 8.3% for elective nonsurgical and 12.7% for emergency nonsurgical admission (P < 0.001). Conclusions The study demonstrates high mortality rates in patients hospitalised during 19982000 for CD, especially in patients over 50. Elective surgery is associated with lower mortality than emergency surgery or medical therapy. Further study is needed to determine whether these patterns have changed following the introduction of biological treatment.