From the Departments of Psychiatry (A.M.K., K.H.) and Neurology (K.C.R., N.J., J.Y.Y., M.S.D.), Icahn School of Medicine at Mount Sinai, New York, NY.
Neurology. 2018 Aug 28;91(9):e800-e810. doi: 10.1212/01.wnl.0000542492.00605.9d. Epub 2018 Aug 1.
To determine if epilepsy admissions, compared to admissions for other medical causes, are associated with a higher readmission risk for mood disorders.
The Nationwide Readmissions Database is a nationally representative dataset comprising 49% of US hospitalizations in 2013. In this retrospective cohort study, we used ICD-9-CM codes to identify medical conditions. Index admissions for epilepsy (n = 58,278) were compared against index admissions for stroke (n = 215,821) and common medical causes (n = 973,078). Readmission rates (per 100,000 index admissions) for depression or bipolar disorders within 90 days from discharge for index hospitalization were calculated. Cox regression was used to test for associations between admission type (defined in 3 categories as above) and readmission for depression or bipolar disorder up to 1 year after index admission, in univariate models and adjusted for age, sex, psychiatric history, drug abuse, income quartile of patient's zip code, and index hospitalization characteristics.
The adjusted hazard ratio (HR) for readmission for depression in the epilepsy group was elevated at 2.80 compared to the stroke group (95% confidence interval [CI] 2.39-3.27, < 2 × 10), and 2.09 compared to the medical group (95% CI 1.88-2.32, < 2 × 10). The adjusted HR for readmission for bipolar disorder in the epilepsy group was elevated at 5.84 compared to the stroke group (95% CI 4.56-7.48, < 2 × 10), and 2.46 compared to the medical group (95% CI 2.16-2.81, < 2 × 10).
Admission for epilepsy was independently associated with subsequent hospital readmission for mood disorders. The magnitude of elevated risk in this population suggests that patients admitted with epilepsy may warrant targeted psychiatric screening during their hospital admission.
确定癫痫发作入院与其他医疗原因入院相比，是否与情绪障碍的再入院风险更高有关。
全国再入院数据库是一个全国代表性数据集，包含 2013 年美国 49%的住院患者。在这项回顾性队列研究中，我们使用 ICD-9-CM 代码来识别医疗条件。将癫痫发作（n=58278）的入院与中风（n=215821）和常见医疗原因（n=973078）的入院进行比较。计算出院后 90 天内抑郁或双相情感障碍的再入院率（每 10 万例索引入院）。使用 Cox 回归测试入院类型（分为 3 类）与索引入院后 1 年内抑郁或双相情感障碍再入院之间的关联，采用单变量模型和年龄、性别、精神病史、药物滥用、患者邮政编码收入四分位数和索引住院特征进行调整。
与中风组相比，癫痫组抑郁再入院的调整后危险比（HR）为 2.80（95%置信区间[CI] 2.39-3.27，<2×10），与医疗组相比为 2.09（95% CI 1.88-2.32，<2×10）。与中风组相比，癫痫组双相情感障碍再入院的调整后 HR 为 5.84（95% CI 4.56-7.48，<2×10），与医疗组相比为 2.46（95% CI 2.16-2.81，<2×10）。
癫痫发作入院与随后的情绪障碍再入院独立相关。该人群的风险升高幅度表明，入院时患有癫痫的患者可能需要在住院期间进行有针对性的精神科筛查。
