A Population-Based Evaluation of Severity and Mortality Among Transferred Patients With Acute Pancreatitis
A Population-Based Evaluation of Severity and Mortality Among Transferred Patients With Acute Pancreatitis
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DOI：
10.1097/mpa.0000000000000179
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发表时间：
2014-10-01
期刊：
影响因子：
2.9
通讯作者：
Singh, Vikesh K.
中科院分区：
文献类型：
--
作者：
Anand, Gobind;Hutfless, Susan M.;Singh, Vikesh K.
目的：比较转院和未转院患者急性胰腺炎(AP)的严重程度和死亡率，并确定影响转院决定的因素。方法：对马里兰州行政数据库进行编码的回顾分析。根据器官衰竭(OF)、重症监护病房(ICU)、机械通气(MV)或血液透析的存在来定义严重程度。结果：AP出院71,035例，转院1657例(2.3%)。与非转移者相比，转移者多系统(5.6%比1.2%)、需要ICU(22.8%比4.3%)、机械通气(13.1%比1.4%)、血液透析(4.2%比2.7%)、死亡率(6.1%比1.1%)更高(P<；0.0001)。在调整疾病严重程度后，转移患者和未转移患者的死亡率相似(OR，1.37；95%可信区间，0.96-1.97)。年轻(OR，0.99)、非裔美国人(OR，0.55)和未参保(OR，0.46)患者转移的可能性较小，而多系统(OR，3.5)、需要重症监护室(OR，2.3)或MV(OR，2.1)患者转移的可能性更大(P<；0.0001)。在对疾病严重程度进行调整后，死亡率相似。疾病严重程度、保险状况、种族和年龄都会影响转移AP患者的决定。
Objectives: This study aimed to compare severity of acute pancreatitis (AP) and mortality rates between transferred and nontransferred patients and to determine the factors that influence the decision to transfer.Methods: A retrospective analysis coding a statewide administrative database in Maryland was conducted. Severity was defined by presence of organ failure (OF), need for intensive care unit (ICU), mechanical ventilation (MV), or hemodialysis.Results: There were 71,035 discharges for AP, with 1657 (2.3%) patient transfers. Transferred patients had more multisystem OF (5.6% vs 1.2%), need for ICU (22.8% vs 4.3%), MV (13.1% vs 1.4%), hemodialysis (4.2% vs 2.7%), and higher mortality (6.1% vs 1.1%) compared with nontransferred patients (P < 0.0001). After adjusting for disease severity, mortality was similar between the transferred patients and the nontransferred patients (OR, 1.37; 95% confidence interval, 0.96-1.97). Younger (OR, 0.99), African American (OR, 0.55), and uninsured (OR, 0.46) patients were less likely to be transferred, whereas patients with multisystem OF (OR, 3.5), need for ICU (OR, 2.3), or MV (OR, 2.1) were more likely to be transferred (P < 0.0001).Conclusions: Transferred patients with AP have more severe disease and higher overall mortality. Mortality is similar after adjusting for disease severity. Disease severity, insurance status, race, and age all influence the decision to transfer patients with AP.