Mahal Shanan, Datta Sorabh, Ravat Virendrasinh, Patel Priya, Saroha Bipin, Patel Rikinkumar S
Department of Internal Medicine, Providence Hospital, Washington DC, USA.
Department of Infectious Disease, Clinical Infectious Disease Specialist, Las Vegas, USA.
Cureus. 2018 Jun 8;10(6):e2766. doi: 10.7759/cureus.2766.
Objective This study aimed to determine the differences in hospitalization outcomes among patients admitted for congestive cardiac failure (CCF) with underlying subclinical hypothyroidism (SCH). Methods This retrospective case-control study used data from the nationwide inpatient sample (NIS) for the years 2012-2014. We identified cases with CCF as the primary diagnosis and SCH as the secondary diagnosis using validated ICD-9-CM codes and controls with CCF only. The differences in hospitalization outcomes and hospital characteristics were quantified using the multinomial logistic regression model (adjusted odds ratio (aOR)). Results A total of 143,735 CCF patients were enrolled in this study, and 73,440 cases had IH. About 31.8% of SCH patients were hospitalized for more than four days (median) compared to 44.7% patients without SCH (P < .001). The median hospitalization charges per admission for CCF was $20,312. CCF patients with SCH had lower odds of longer hospitalization (aOR = .709, 95% CI .660-.762, P < .001) and higher hospitalization charges (aOR = .783, 95% CI .728-.841, P < .001) compared to CCF patients without SCH. CCF patients with SCH had two times higher odds of minor morbidity (aOR = 2.276; 95% CI 2.105-2.462; P < .001) but lower odds of major morbidity (aOR = .783; 95% CI .728-.841; P < .001). Inpatient mortality with SCH patients (2%) compared to 3.6% patients without SCH (P < .001). CCF patients with SCH had lower odds of in-hospital mortality (aOR = .547; 95% CI .496-.604; P < .001). CCF patients with SCH had higher odds of being seen in rural non-teaching hospitals (aOR = 1.696; 95% CI 1.572-1.831; P < .001). Also, CCF patients with SCH had the highest likelihood of presence in the western region of the United States (aOR = 149.924; 95% CI 110.497-203.419; P < .001) followed by the southern region (aOR = 31.431; 95% CI 26.066-37.900; P < .001). Conclusions Among CCF with SCH patients during hospitalization, we observed a variation in hospitalization outcomes, including inpatient length of stay and cost, morbidity, and in-hospital mortality. We found no significant increase in mortality and major morbidity in CCF patients with SCH. There were differences in the hospital characteristics between CCF patients with and without SCH. Thus, hospital bed size, location, and teaching status act as predictors for a co-diagnosis of SCH in CCF. Further research is needed to guide the development of clinical care models for targeting early diagnosis and treatment to determine whether thyroid hormone replacement would be beneficial for CCF patients with SCH and improve quality of care in these patients.
目的 本研究旨在确定合并潜在亚临床甲状腺功能减退症（SCH）的充血性心力衰竭（CCF）患者的住院结局差异。方法 这项回顾性病例对照研究使用了2012 - 2014年全国住院患者样本（NIS）的数据。我们使用经过验证的ICD - 9 - CM编码确定以CCF为主要诊断且以SCH为次要诊断的病例以及仅患有CCF的对照。使用多项逻辑回归模型（调整比值比（aOR））对住院结局和医院特征的差异进行量化。结果 本研究共纳入143,735例CCF患者，其中73,440例患有SCH。约31.8%的SCH患者住院时间超过四天（中位数），而无SCH患者为44.7%（P <.001）。CCF每次住院的中位住院费用为20,312美元。与无SCH的CCF患者相比，患有SCH的CCF患者住院时间延长的几率较低（aOR =.709，95% CI.660 -.762，P <.001），但住院费用较高（aOR =.783，95% CI.728 -.841，P <.001）。患有SCH的CCF患者发生轻微并发症的几率高出两倍（aOR = 2.276；95% CI 2.105 - 2.462；P <.001），但发生严重并发症的几率较低（aOR =.783；95% CI.728 -.841；P <.001）。SCH患者的住院死亡率为2%相比无SCH患者的3.6%（P <.001）。患有SCH的CCF患者住院死亡率较低（aOR =.547；95% CI.496 -.604；P <.001）。患有SCH的CCF患者在农村非教学医院就诊的几率较高（aOR = 1.696；95% CI 1.572 - 1.831；P <.001）。此外，患有SCH的CCF患者在美国西部地区出现的可能性最高（aOR = 149.924；95% CI 110.497 - 203.419；P <.001），其次是南部地区（aOR = 31.431；95% CI 26.066 - 37.900；P <.001）。结论 在合并SCH的CCF患者住院期间，我们观察到住院结局存在差异，包括住院时间和费用以及并发症和住院死亡率。我们发现患有SCH的CCF患者死亡率和严重并发症没有显著增加。患有SCH和无SCH的CCF患者在医院特征方面存在差异。因此，医院床位规模、位置和教学状况可作为CCF患者合并SCH诊断的预测因素。需要进一步研究以指导针对早期诊断和治疗的临床护理模式的发展，以确定甲状腺激素替代疗法对患有SCH的CCF患者是否有益并改善这些患者的护理质量。
