Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, School of medicine, Virginia Commonwealth University, Richmond, VA 23298, USA.
Alcohol Clin Exp Res. 2011 Jul;35(7):1368-73. doi: 10.1111/j.1530-0277.2011.01475.x. Epub 2011 Apr 19.
Healthcare-associated infections (HAI) affect 1.7 million patients annually in the United States, and patients with alcohol use disorders (AUD) are at increased risk of developing HAI. HAI have been shown to substantially increase the hospital length of stay, mortality, and cost. In a cohort of patients with HAI, we sought to determine mortality, cost, and hospital length of stay attributable to AUD.
Using the Nationwide Inpatient Sample for the year 2007, the largest all-payer database of hospitalized patients comprising approximately 1,000 hospitals, we performed a retrospective cohort study of all patients who developed healthcare-associated pneumonia or sepsis. We excluded patients who were transferred from another healthcare facility, who were diagnosed with community-acquired infections, immunosuppression, or cancer. Logistic regression was computed to calculate attributable mortality. Linear regression analyses were computed to determine cost and hospital length of stay α = 10(-10) .
A total of 149,892 patients developed HAI, and 8,830 (5.9%) had a co-diagnosis of AUD. Patients with AUD were younger, more likely to be men, less likely to be Asian, and more likely to be Hispanic. Patients with AUD were more likely to have tobacco dependence, less likely to be electively admitted to the hospital, and less likely to undergo surgery. They also had lower severity of illness, lower income, and were more likely to be in academic medical centers. Logistic regression revealed that AUD was an independent predictor of increased mortality: Odds ratio = 1.71, 95% confidence interval (CI) [1.626; 1.799], p < 10(-10) . Linear regression demonstrated that AUD independently predicted increased hospital length of stay by 2 days: Patients with AUD had a length of stay of 13 days, 95% CI [12.4; 13.6] compared with 11 days, 95% CI [11.1; 11.4] for patients without AUD, p < 10(-10) . Linear regression also revealed that patients with AUD had a higher hospital cost: $34,826, 95% CI [32,415.71; 37,416.52] for patients with AUD compared with $27,167, 95% CI [25,703.18; 28,714.05] for patients without AUD, p < 10(-10) .
Patients with AUD who experience HAI have worse outcomes compared with patients without AUD. Patients with AUD have higher mortality, longer hospital length of stay, and higher costs. Studies aimed at decreasing the morbidity and mortality of HAI in patients with AUD are warranted.
在美国，每年有 170 万患者受到医疗保健相关感染（HAI）的影响，而患有酒精使用障碍（AUD）的患者发生 HAI 的风险增加。HAI 已被证明会大大延长住院时间、增加死亡率和增加医疗成本。在一组患有 HAI 的患者中，我们试图确定 AUD 导致的死亡率、成本和住院时间。
使用 2007 年全国住院患者样本（包含大约 1000 家医院的最大所有支付者住院患者数据库），我们对所有发生医疗保健相关性肺炎或败血症的患者进行了回顾性队列研究。我们排除了从其他医疗机构转来的患者、被诊断为社区获得性感染、免疫抑制或癌症的患者。使用逻辑回归计算归因死亡率。使用线性回归分析确定成本和住院时间α=10(-10)。
共有 149892 名患者发生 HAI，8830 名（5.9%）患者合并 AUD 诊断。患有 AUD 的患者更年轻，更可能是男性，不太可能是亚洲人，更可能是西班牙裔。患有 AUD 的患者更有可能患有烟草依赖，不太可能是择期入院，也不太可能接受手术。他们的疾病严重程度较低，收入较低，更有可能在学术医疗中心。逻辑回归显示 AUD 是死亡率增加的独立预测因素：优势比=1.71，95%置信区间（CI）[1.626; 1.799]，p<10(-10)。线性回归表明 AUD 独立预测住院时间延长 2 天：患有 AUD 的患者的住院时间为 13 天，95%CI[12.4; 13.6]，而没有 AUD 的患者的住院时间为 11 天，95%CI[11.1; 11.4]，p<10(-10)。线性回归还表明 AUD 患者的医疗费用更高：AUD 患者的住院费用为 34826 美元，95%CI[32，415.71；37，416.52]，而没有 AUD 的患者的住院费用为 27167 美元，95%CI[25，703.18；28，714.05]，p<10(-10)。
患有 AUD 并经历 HAI 的患者的预后比没有 AUD 的患者差。患有 AUD 的患者死亡率更高、住院时间更长、费用更高。需要开展研究来降低 AUD 患者 HAI 的发病率和死亡率。
