Incidence and mortality rates of myasthenia gravis and myasthenic crisis in US hospitals
Incidence and mortality rates of myasthenia gravis and myasthenic crisis in US hospitals
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DOI：
10.1212/wnl.0b013e3181a41211
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发表时间：
2009-05-05
期刊：
影响因子：
9.9
通讯作者：
Kaminski, H. J.
中科院分区：
文献类型：
--
作者：
Alshekhlee, A.;Miles, J. D.;Kaminski, H. J.
目的：确定重症肌无力（MG）和MG危象的发病率和死亡率及死亡预测因素，在一个大型的美国coherent.Methods：我们的队列是从2000年至2005年使用ICD-9-CM代码的全国住院患者样本数据库中确定的。MG危象通过主要诊断代码或呼吸衰竭的存在来识别。MG的发病率按年龄、种族和性别分层。多因素Logistic回归分析用于确定MG死亡率的预测因素。对于免疫干预的趋势分析，我们使用Cochrane-Armitage检验。结果：经过数据清理，纳入了5，502例MG患者。在前50年中，女性的入院率高出2至3倍。在男性中，在第六、第七和第八个十年期间入院的发生率较高。与白色女性以及白色和黑人男性（0.009、0.008和0.007/1000人/年）相比，黑人女性的MG年发病率更高（0.01/1000人/年）。住院病死率为2.2%，重症肌无力危象病死率最高（4.47%）。高龄和呼吸衰竭是死亡的预测因素，校正后的比值比为9.28（95%置信区间[CI]，3.31，26.0）和3.58（95% CI，2.01，6.38）。结论：重症肌无力（MG）仍是一种年轻女性和老年男性的疾病，其住院率反映了这一点。重症肌无力住院死亡率低。与血浆置换和胸腺切除术相比，静脉注射免疫球蛋白的医院使用率显著增加。神经病学（R）2009;72：1548-1554
Objective: To determine the incidence and mortality rates and predictors of death in myasthenia gravis (MG) and MG crisis in a large US cohort.Methods: Our cohort was identified from the Nationwide Inpatient Sample database for the years 2000 through 2005 using ICD-9-CM codes. MG crisis was identified by the principal diagnosis code or by the presence of respiratory failure. The incidence of MG was stratified by age, ethnicity, and gender. Multivariate logistic regression analysis was used to identify predictors of mortality in MG. For trend analyses of immune intervention, we used the Cochrane-Armitage test.Results: After data cleansing, 5,502 patients with MG were included. In women, the incidence of admission was two to three times higher during the first 5 decades. In men, the incidence of admission was higher during the sixth, seventh, and eighth decades. The annual incidence rate of MG was higher in black women (0.01 per 1,000 persons/year) compared to white women and white and black men (0.009, 0.008, and 0.007 per 1,000 persons/year). The overall in-hospital mortality rate was 2.2%, being higher in MG crisis (4.47%). Older age and respiratory failure were the predictors of death, with adjusted odds ratios of 9.28 (95% confidence interval [CI], 3.31, 26.0) and 3.58 (95% CI, 2.01, 6.38). The trend of IV immunoglobulin utilization has increased compared to plasma exchange and thymectomy (p < 0.0001).Conclusion: Myasthenia gravis (MG) is still a disease of young women and old men, as reflected by the hospital admission rates. In-hospital mortality of MG is low. Hospital utilization of IV immunoglobulin has significantly increased compared to plasma exchange and thymectomy. Neurology (R) 2009;72:1548-1554