Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2012;7(7):e34048. doi: 10.1371/journal.pone.0034048. Epub 2012 Jul 6.
Deep vein thrombosis and pulmonary embolism (PE) are responsible for substantial mortality, morbidity, and impaired health-related quality of life. The aim of this study was to evaluate the correlates of in-hospital deaths among hospitalizations with a diagnosis of PE in the United States.
By using data from the 2001-2008 National Hospital Discharge Survey, we assessed the correlates of in-hospital deaths among 14,721 hospitalizations with a diagnosis of PE and among subgroups stratified by age, sex, race, days of hospital stay, type of admission, cancer, pneumonia, and fractures. We produced adjusted rate ratios (aRR) and 95% confidence intervals using log-linear multivariate regression models.
Regardless of the listing position of diagnostic codes, we observed an increased likelihood of in-hospital death in subgroups of hospitalizations with ages 50 years and older (aRR = 1.82-8.48), less than 7 days of hospital stay (aRR = 1.43-1.57), cancer (aRR = 2.10-2.28), pneumonia (aRR = 1.79-2.20), or fractures (aRR = 2.18) (except for first-listed PE), when compared to the reference groups with ages 1-49 years, 7 days or more of hospital stay, without cancer, pneumonia, or fractures while adjusting for covariates. In addition, we observed an increased likelihood of in-hospital death for first-listed PE in hospitalizations of women, when compared to those of men (aRR = 1.45).
The results of this study provide support for identifying, developing, and implementing effective, evidence-based clinical assessment and management strategies to reduce PE-related morbidity and mortality among hospitalized PE patients who may have concurrent health conditions including cancer, pneumonia, and fractures.
深静脉血栓形成和肺栓塞（PE）是导致大量死亡、发病和健康相关生活质量受损的原因。本研究旨在评估美国 PE 住院患者院内死亡的相关因素。
我们利用 2001-2008 年全国医院出院调查的数据，评估了诊断为 PE 的 14721 例住院患者中院内死亡的相关因素，以及按年龄、性别、种族、住院天数、入院类型、癌症、肺炎和骨折分层的亚组中的相关因素。我们使用对数线性多变量回归模型计算了校正后的率比（aRR）和 95%置信区间。
无论诊断代码的列出位置如何，我们观察到年龄在 50 岁及以上（aRR=1.82-8.48）、住院时间少于 7 天（aRR=1.43-1.57）、癌症（aRR=2.10-2.28）、肺炎（aRR=1.79-2.20）或骨折（aRR=2.18）（首位诊断为 PE 除外）的住院患者中，院内死亡的可能性增加，与年龄在 1-49 岁、住院时间 7 天或以上、无癌症、肺炎或骨折的参考组相比，在校正了混杂因素后。此外，与男性相比，我们观察到首位诊断为 PE 的女性住院患者院内死亡的可能性增加（aRR=1.45）。
本研究结果为识别、制定和实施有效的、基于证据的临床评估和管理策略提供了支持，以减少可能同时患有癌症、肺炎和骨折等健康状况的 PE 住院患者的 PE 相关发病率和死亡率。
