Mujib Marjan, Khanna Neel, Mazumder Nabila K, Aronow Wilbert S, Kolte Dhaval, Khera Sahil, Palaniswamy Chandrasekar, Jain Diwakar, Lanier Gregg M, Sule Sachin, Ahmed Ali, Levy Wayne C, Prabhu Sumanth D, Cooper Howard A, Panza Julio A, Gass Alan L, Fonarow Gregg C
Department of Medicine, New York Medical College, Valhalla, New York.
Division of Cardiology, New York Medical College, Valhalla, New York.
Clin Cardiol. 2015 May;38(5):300-8. doi: 10.1002/clc.22391. Epub 2015 Feb 13.
The prevalence and contemporary trends of pre-heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database.
Pre-HT coagulopathy is associated with increased in-hospital mortality.
Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre-HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes). We used propensity scores for coagulopathy to assemble a matched cohort of 664 pairs of patients with and without coagulopathy balanced in 54 baseline characteristics.
The prevalence of pre-HT coagulopathy increased from 17% in 2003 to 44% in 2010 (P for trend <0.001). In-hospital mortality occurred in 8.6% and 4.7% of matched HT recipients with and without coagulopathy, respectively (hazard ratio: 1.81; 95% confidence interval [CI]: 1.17-2.80; P = 0.008). Coagulopathy was not significantly associated with post-HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95-1.52; P = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54-2.41; P < 0.001). Coagulopathy and no-coagulopathy groups had no difference in median length of stay (22 days in each group, P = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; P = 0.008).
In this national study of HT recipients, pretransplant coagulopathy was common, increased over time, and was not significantly associated with post-HT graft complications or increased hospital stay. However, it was associated with increased bleeding risk, in-hospital mortality, and total hospital charges. These findings may have implications for the selection of patients for HT.
尚未从全国性数据库中研究心脏移植（HT）前凝血病的患病率、当代趋势及相关临床结局。
HT前凝血病与住院死亡率增加相关。
在2003年至2010年全国住院患者样本数据库中的2454例成年HT受者中，707例（29%）有HT前凝血病（根据国际疾病分类第九版临床修订本和诊断相关组代码定义为一种合并症变量）。我们使用凝血病倾向评分来组建一个匹配队列，其中664对有凝血病和无凝血病的患者在54项基线特征上达到平衡。
HT前凝血病的患病率从2003年的17%增至2010年的44%（趋势P<0.001）。在匹配的有凝血病和无凝血病的HT受者中，住院死亡率分别为8.6%和4.7%（风险比：1.81；95%置信区间[CI]：1.17 - 2.80；P = 0.008）。凝血病与HT后移植物并发症无显著相关性（比值比[OR]：1.20；95% CI：0.95 - 1.52；P = 0.131），但与输血增加相关（OR：1.92；95% CI，1.54 - 2.41；P < 0.001）。凝血病组和无凝血病组的中位住院时间无差异（每组均为22天，P = 0.746），但凝血病患者的中位总住院费用高于无凝血病患者（425643美元对389656美元；P = 0.008）。
在这项针对HT受者的全国性研究中，移植前凝血病很常见，且随时间增加，与HT后移植物并发症或住院时间延长无显著相关性。然而，它与出血风险增加、住院死亡率及总住院费用相关。这些发现可能对HT患者的选择有影响。
