Akanbi Olalekan, Adejumo Adeyinka C, Saleem Nasir, Francisque Frantz, Soliman Mohanad, Ogunbayo Gbolahan O
Department of Internal Medicine, Division of Hospital Medicine, University of Kentucky College of Medicine.
Department of Medicine, North Shore Medical Center, Salem, Massachusetts, USA.
Eur J Gastroenterol Hepatol. 2018 Sep;30(9):1027-1032. doi: 10.1097/MEG.0000000000001181.
Sickle cell disease (SCD) is the most common inheritable hematologic disorder in the USA and is associated with ischemic organ diseases. SCD-associated ischemic bowel disease is increasing being recognized, and studies on the hospitalization outcomes of such patients are limited.
This study aimed to compare the inpatient outcomes of ischemic bowel disease among patients with SCD compared with patients without SCD.
This is a case-control study using data from the National Inpatient Sample Database (2007-2014). We analyzed and compared outcomes between cases (ischemic bowel disease with SCD) and controls (ischemic bowel disease without SCD), matched in a 1 : 5 ratio. The primary outcome was in-hospital mortality, and the secondary outcomes were healthcare resource utilization including mechanical ventilation, hemodialysis, transfusion, length of stay, and hospital charges.
Of the 194 262 patients admitted with ischemic bowel disease, 98 had a diagnosis of SCD and were matched successfully to the controls. In multivariate analysis, patients with SCD had twice the mortality odds of those without (adjusted odds ratio=2.06, 95% confidence intervals: 1.13-3.74). They were more likely to require mechanical ventilation and blood transfusion, and to be discharged to secondary health facilities [1.68 (1.02-2.76), 3.32 (2.15-5.12), and 1.84 (1.02-3.35)]. Patients with SCD also had a higher frequency of pneumonia, acute respiratory failure, and hemodialysis for acute renal failure. There was no significant difference in the length of stay or the total hospital charge between the two groups.
In patients hospitalized with ischemic bowel disease, SCD is associated with significantly increased mortality and healthcare burden.
镰状细胞病（SCD）是美国最常见的遗传性血液系统疾病，与缺血性器官疾病相关。SCD相关的缺血性肠病越来越受到关注，而关于此类患者住院结局的研究有限。
本研究旨在比较SCD患者与非SCD患者缺血性肠病的住院结局。
这是一项病例对照研究，使用了国家住院样本数据库（2007 - 2014年）的数据。我们分析并比较了病例组（患有SCD的缺血性肠病患者）和对照组（不患有SCD的缺血性肠病患者）的结局，两组按1∶5的比例匹配。主要结局是住院死亡率，次要结局是医疗资源利用情况，包括机械通气、血液透析、输血、住院时间和住院费用。
在194262例因缺血性肠病入院的患者中，98例被诊断为SCD，并成功与对照组匹配。在多变量分析中，SCD患者的死亡几率是非SCD患者的两倍（调整后的优势比 = 2.06，95%置信区间：1.13 - 3.74）。他们更有可能需要机械通气和输血，并且更有可能被转至二级医疗机构[1.68（1.02 - 2.76），3.32（2.15 - 5.12），以及1.84（1.02 - 3.35）]。SCD患者肺炎、急性呼吸衰竭以及急性肾衰竭血液透析的发生率也更高。两组之间的住院时间或总住院费用没有显著差异。
在因缺血性肠病住院的患者中，SCD与死亡率显著增加和医疗负担加重相关。
