炎症性肠病患者的血清学、遗传学和临床特征与医疗资源利用增加的相关性。
Serological, genetic and clinical associations with increased health-care resource utilization in inflammatory bowel disease.
机构信息
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
出版信息
J Dig Dis. 2018 Jan;19(1):15-23. doi: 10.1111/1751-2980.12566.
OBJECTIVE
Inflammatory bowel diseases (IBD) are associated with significant morbidity and economic burden. The variable course of IBD creates a need for predictors of clinical outcomes and health resource utilization (HRU) to guide treatment decisions. We aimed to identify clinical, serological or genetic markers associated with inpatient resource utilization in patients with ulcerative colitis (UC) and Crohn's disease (CD).
METHODS
Patients with IBD with available genetic and serological data who had at least one emergency department visit or hospitalization in a 3-year period were included. The primary outcome measure was HRU, as measured by the All Patient Refined Diagnosis Related Group classification system. Univariate and multivariate linear and logistic regression models were used to identify the associations with HRU.
RESULTS
Altogether 858 (562 CD and 296 UC) patients were included. Anti-CBir1 seropositivity (P = 0.002, effect size [ES]: 0.762, 95% confidence interval [CI] 0.512-1.012) and low socioeconomic status (P = 0.005, ES: 1.620 [95% CI 1.091-2.149]) were independently associated with a high HRU. CD diagnosis (P = 0.006, ES: -0.701 [95% CI -0.959 to -0.443]) was independently associated with a low inpatient HRU.
CONCLUSION
In patients with IBD who required at least one emergency department visit or hospitalization, anti-CBir1 antibody status may be a useful biomarker of HRU when formulating management strategies to reduce disease complications and resource utilization.
目的
炎症性肠病(IBD)与显著的发病率和经济负担有关。IBD 的多变病程需要预测临床结果和卫生资源利用(HRU)的指标来指导治疗决策。我们旨在确定与溃疡性结肠炎(UC)和克罗恩病(CD)患者住院资源利用相关的临床、血清学或遗传标志物。
方法
纳入了在 3 年内至少有一次急诊就诊或住院治疗且有可用遗传和血清学数据的 IBD 患者。主要观察指标是 HRU,通过全患者精炼诊断相关分组(APR-DRG)分类系统进行衡量。使用单变量和多变量线性和逻辑回归模型来确定与 HRU 的关联。
结果
共纳入 858 名(562 名 CD 和 296 名 UC)患者。抗 CBir1 血清阳性(P = 0.002,效应大小 [ES]:0.762,95%置信区间 [CI]:0.512-1.012)和低社会经济地位(P = 0.005,ES:1.620 [95% CI:1.091-2.149])与高 HRU 独立相关。CD 诊断(P = 0.006,ES:-0.701 [95% CI:-0.959 至 -0.443])与低住院 HRU 独立相关。
结论
在需要至少一次急诊就诊或住院治疗的 IBD 患者中,抗 CBir1 抗体状态可能是制定管理策略以减少疾病并发症和资源利用的有用 HRU 生物标志物。