Michet Clement John, Achenbach Sara J, Crowson Cynthia S, Matteson Eric L
Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester 55905, MN.
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Semin Arthritis Rheum. 2015 Aug;45(1):70-4. doi: 10.1016/j.semarthrit.2015.02.010. Epub 2015 Mar 3.
Patients with giant cell arteritis (GCA) may experience serious vascular and visual complications. It is unknown, however, to what extent the difficulties of the disease may lead to hospitalization. The goal of this study is to discern whether patients with GCA are at greater risk for all-cause hospitalizations when compared to the general population.
This retrospective, population-based cohort study utilized patients with large vessel or visual involvement who were diagnosed with GCA (as defined by the 1990 ACR criteria) between 1/1/1950 and 12/31/2009, and a reference cohort of patients without GCA matched on age, sex, and calendar year. Each patients' medical record was examined for hospitalizations from 1987 through 2012. For this analysis, follow-up began with the latter of index date or 1/1/1987 and ended at the earlier of death, emigration from Olmsted County, or 12/31/2012. Discharge diagnoses were grouped together using the Clinical Classifications Software (CCS) for ICD-9-CM from Healthcare Cost and Utilization Project (HCUP). Data were analyzed using person-year methods and rate ratios comparing GCA to non-GCA.
The GCA cohort consists of 199 patients with a mean age of 76.2 (79.9% female) and follow-up of 8.2 years. The non-GCA cohort is comprised of 194 patients with a mean age of 75.7 (78.9% female) and follow-up of 8.6 years. The patients with GCA had 816 hospitalizations and the non-GCA patients had 737 hospitalizations. GCA patients proved to be at a marginally greater risk for all causes of hospitalization [rate ratio (RR) = 1.13; 95% confidence interval (CI): 1.02-1.25]; however, the rate of hospitalization for patients with and without GCA decreased significantly from 1987 to 2012. Two specific discharge categories are of interest. First, transient cerebral ischemia is a greater risk of hospitalization for patients with GCA who had 16 hospitalizations compared to patients without GCA who only had 5 hospitalizations (RR = 3.06; 95% CI: 1.27-9.47). Second, patients with GCA (21 hospitalizations) are at greater risk of hospitalization for syncope than patients without GCA (5 hospitalizations) (RR = 3.98; 95% CI: 1.72-12.14).
In this first ever analysis of all-cause hospitalizations in a population-based cohort, patients with GCA appear to be at a marginally greater risk for hospitalization than patients without GCA, although the rate of hospitalization for GCA patients decreased from 1987 to 2012. Patients with GCA are at increased risk of hospitalization for both transient cerebral ischemia and syncope.
巨细胞动脉炎（GCA）患者可能会出现严重的血管和视力并发症。然而，目前尚不清楚该疾病的困难程度会在多大程度上导致住院治疗。本研究的目的是确定与普通人群相比，GCA患者全因住院的风险是否更高。
这项基于人群的回顾性队列研究纳入了1950年1月1日至2009年12月31日期间被诊断为GCA（根据1990年美国风湿病学会标准定义）且有大血管或视力受累的患者，以及一个在年龄、性别和日历年份上匹配的无GCA患者的对照队列。检查了每位患者从1987年到2012年的住院病历。对于本分析，随访从索引日期或1987年1月1日较晚者开始，至死亡、从奥尔姆斯特德县移民或2012年12月31日较早者结束。使用医疗保健成本和利用项目（HCUP）的ICD-9-CM临床分类软件（CCS）对出院诊断进行分组。使用人年方法和比较GCA与非GCA的率比进行数据分析。
GCA队列包括199例患者，平均年龄76.2岁（79.9%为女性），随访8.2年。非GCA队列由194例患者组成，平均年龄75.7岁（78.9%为女性），随访8.6年。GCA患者有816次住院，非GCA患者有737次住院。GCA患者全因住院的风险略高[率比（RR）=1.13；95%置信区间（CI）：1.02-1.25]；然而，1987年至2012年期间，有GCA和无GCA患者的住院率均显著下降。有两个特定的出院类别值得关注。首先，短暂性脑缺血在GCA患者中住院风险更高，GCA患者有16次住院，而无GCA患者仅有5次住院（RR=3.06；95%CI：1.27-9.47）。其次，GCA患者（21次住院）晕厥的住院风险高于无GCA患者（5次住院）（RR=3.98；95%CI：1.72-12.14）。
在这项基于人群队列的首次全因住院分析中，GCA患者住院风险似乎略高于无GCA患者，尽管1987年至2012年期间GCA患者的住院率有所下降。GCA患者短暂性脑缺血和晕厥的住院风险增加。
