Taghizadeh Niloofar, Fortin Marc, Tremblay Alain
Division of Respiratory Medicine, University of Calgary and Alberta Thoracic Oncology Program, Calgary, AB, Canada.
Division of Respiratory Medicine, University of Calgary and Alberta Thoracic Oncology Program, Calgary, AB, Canada.
Chest. 2017 Apr;151(4):845-854. doi: 10.1016/j.chest.2016.11.010. Epub 2016 Nov 19.
Malignant pleural effusion (MPE) is a common complication of advanced malignancy, but little is known regarding its prevalence and overall burden on a population level.
We conducted a retrospective analysis of MPE-associated hospitalizations using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, Agency for Healthcare Research and Quality (HCUP-NIS 2012). Cases were included if MPE was coded as a primary or secondary diagnosis or if an unspecified pleural effusion was coded in addition to a diagnosis of cancer with either of these being the primary diagnosis.
A weighted sample of 126,825 admissions (0.35%) for MPE was identified among the 36,484,846 weighted admissions included in the database in 2012. Of these admissions, 70,750 (55.8%) were for female patients. The median age at admission was 68.0 years (interquartile range [IQR]), 58.4-77.2 years). Lung (37.8%), breast (15.2%), hematologic (11.2%), GI tract (11.0%), and gynecologic (9.0%) cancers were the most common primary malignancies associated with MPE. The median length of stay was 5.5 days (IQR, 2.7-10.1 days), and the inpatient mortality rate was 11.6%. Median hospitalization total charges were $42,376 (IQR, $21,618-$84,679). In the multivariate analyses, female sex, large fringe county residential area, Medicare insurance, and elective type of admission were independently associated with a lower risk of inpatient mortality.
There is a considerable inpatient burden and high inpatient mortality associated with MPE in the United States, with potential demographic, geographic, and socioeconomic disparities.
恶性胸腔积液（MPE）是晚期恶性肿瘤的常见并发症，但在人群层面上，对其患病率和总体负担知之甚少。
我们使用医疗保健成本和利用项目全国住院样本（医疗保健研究与质量局，HCUP-NIS 2012）对与MPE相关的住院情况进行了回顾性分析。如果MPE被编码为主要或次要诊断，或者除癌症诊断外还编码了未明确的胸腔积液，且这些情况中有任何一种是主要诊断，则纳入病例。
在2012年数据库中的36484846例加权住院病例中，确定了126825例MPE住院病例的加权样本（0.35%）。在这些住院病例中，70750例（55.8%）为女性患者。入院时的中位年龄为68.0岁（四分位间距[IQR]，58.4 - 77.2岁）。肺癌（37.8%）、乳腺癌（15.2%）、血液系统癌症（11.2%）、胃肠道癌症（11.0%）和妇科癌症（9.0%）是与MPE相关的最常见原发性恶性肿瘤。中位住院时间为5.5天（IQR，2.7 - 10.1天），住院死亡率为11.6%。住院总费用中位数为42376美元（IQR，21618 - 84679美元）。在多变量分析中，女性、大城市边缘县居住地区、医疗保险和择期入院类型与较低的住院死亡风险独立相关。
在美国，MPE与相当大的住院负担和高住院死亡率相关，存在潜在的人口统计学、地理和社会经济差异。
