Assistant Professor of Pediatrics, Pediatric Critical Care, Rainbow Babies and Children's Hospital, Cleveland, Ohio, United States of America.
Fellow, Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio, United States of America.
PLoS One. 2014 Apr 16;9(4):e94387. doi: 10.1371/journal.pone.0094387. eCollection 2014.
Adults with sickle cell disease(SCD) are a growing population. Recent national estimates of outcomes in acute chest syndrome(ACS) among adults with SCD are lacking. We describe the incidence, outcomes and predictors of mortality in ACS in adults. We hypothesize that any need for mechanical ventilation is an independent predictor of mortality.
We performed a retrospective analysis of the Nationwide Inpatient Sample(2004-2010),the largest all payer inpatient database in United States, to estimate the incidence and outcomes of ACS needing mechanical ventilation(MV) and exchange transfusion(ET) in patients >21 years. The effects of MV and ET on outcomes including length of stay(LOS) and in-hospital mortality(IHM) were examined using multivariable linear and logistic regression models respectively. The effects of age, sex, race, type of sickle cell crisis, race, co-morbid burden, insurance status, type of admission, and hospital characteristics were adjusted in the regression models.
Of the 24,699 hospitalizations, 4.6% needed MV(2.7% for <96 hours, 1.9% for ≥96 hours), 6% had ET, with a mean length of stay(LOS) of 7.8 days and an in-hospital mortality rate(IHM) of 1.6%. There was a gradual yearly increase in ACS hospitalizations that needed MV(2.6% in 2004 to 5.8% in 2010). Hb-SS disease was the phenotype in 84.3% of all hospitalizations. After adjusting for a multitude of patient and hospital related factors, patients who had MV for <96 hours(OR = 67.53,p<0.01) or those who had MV for ≥96 hours(OR = 8.73,p<0.01) were associated with a significantly higher odds for IHM when compared to their counterparts. Patients who had MV for ≥96 hours and those who had ET had a significantly longer LOS in-hospitals(p<0.001).
In this large cohort of hospitalized adults with SCD patients with ACS, the need for mechanical ventilation predicted higher mortality rates and increased hospital resource utilization. Identification of risk factors may enable optimization of outcomes.
患有镰状细胞病 (SCD) 的成年人是一个不断增长的群体。最近缺乏全国范围内成年人急性胸部综合征 (ACS) 结局的估计。我们描述了成年人 ACS 的发病率、结局和死亡率预测因素。我们假设任何需要机械通气的情况都是死亡率的独立预测因素。
我们对美国最大的全支付住院患者数据库——全国住院患者样本（2004-2010 年）进行了回顾性分析，以估计需要机械通气 (MV) 和换血 (ET) 的 21 岁以上 ACS 患者的发病率和结局。使用多变量线性和逻辑回归模型分别检查 MV 和 ET 对包括住院时间 (LOS) 和院内死亡率 (IHM) 在内的结局的影响。在回归模型中调整了 MV 和 ET 的年龄、性别、种族、镰状细胞危象类型、种族、合并症负担、保险状况、入院类型和医院特征的影响。
在 24699 例住院患者中，有 4.6%需要 MV（2.7%需要 <96 小时，1.9%需要 ≥96 小时），6%需要 ET，平均住院时间 (LOS) 为 7.8 天，院内死亡率 (IHM) 为 1.6%。需要 MV 的 ACS 住院患者人数逐年增加（2004 年为 2.6%，2010 年为 5.8%）。所有住院患者中 Hb-SS 疾病表型占 84.3%。在调整了大量患者和医院相关因素后，与对照组相比，MV 时间 <96 小时的患者（OR=67.53，p<0.01）或 MV 时间≥96 小时的患者（OR=8.73，p<0.01）发生 IHM 的可能性显著更高。MV 时间≥96 小时的患者和接受 ET 的患者住院时间明显更长（p<0.001）。
在这项对患有 ACS 的镰状细胞病成年住院患者的大型队列研究中，需要机械通气预测死亡率更高和增加医院资源利用。识别风险因素可能能够优化结局。
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