美国 2004-2013 年因甲状腺毒症住院患者（伴与不伴甲状腺危象）的发病率、死亡率和临床结局的全国趋势。
National Trends in Incidence, Mortality, and Clinical Outcomes of Patients Hospitalized for Thyrotoxicosis With and Without Thyroid Storm in the United States, 2004-2013.
机构信息
1 Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, Georgia.
2 Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
出版信息
Thyroid. 2019 Jan;29(1):36-43. doi: 10.1089/thy.2018.0275. Epub 2018 Dec 18.
BACKGROUND
Current evidence on the incidence and outcomes of patients with thyroid storm in the United States is limited to single-center case series. This study determined the national incidence of thyrotoxicosis with and without thyroid storm and clinical outcomes among hospitalized patients during a 10-year period in the United States.
METHODS
Retrospective longitudinal analysis was conducted of clinical characteristics, mortality, hospital length of stay, and costs from 2004 to 2013. Adults (≥18 years of age) with a primary diagnosis of thyrotoxicosis with and without thyroid storm were included. To determine the incidence, outcomes, and cost of thyrotoxicosis with and without thyroid storm, the study used data from the National Inpatient Sample database, the largest public inpatient database, with a representative sample of all non-federal hospitals in the United States.
RESULTS
Among 121,384 discharges with thyrotoxicosis during the study period (M ± standard error = 48.7 ± 0.11 years; 51.9% Caucasian; 77.3% female), 19,723 (16.2%) were diagnosed with thyroid storm. During the past decade, the incidence of thyroid storm ranged between 0.57 and 0.76 cases/100,000 U.S. persons per year, and 4.8 and 5.6/100,000 hospitalized patients per year. Thyroid storm was associated with significantly higher hospital mortality (1.2-3.6% vs. 0.1-0.4%, p < 0.01) and longer length of stay (4.8-5.6 vs. 2.7-3.4 mean days, p < 0.001) compared to patients with thyrotoxicosis without storm. Inflation-adjusted hospitalization costs progressively increased in patients with thyroid storm from $9942 to $12,660 between 2004 and 2013 (p < 0.01).
CONCLUSIONS
One of every six discharges for thyrotoxicosis was diagnosed with thyroid storm. Thyroid storm is associated with a 12-fold higher mortality rate compared to thyrotoxicosis without storm. The incidence and mortality of thyroid storm has not substantially changed in the past decade. However, hospitalization costs have significantly increased.
背景
目前，美国有关甲状腺危象患者发病率和结局的证据仅限于单中心病例系列研究。本研究旨在确定美国在 10 年间甲状腺毒症伴或不伴甲状腺危象患者的住院患者的全国发病率、临床结局。
方法
采用回顾性纵向分析，纳入 2004 年至 2013 年临床特征、死亡率、住院时间和费用。研究纳入了有原发性甲状腺毒症伴或不伴甲状腺危象诊断的成年患者（≥18 岁）。为确定甲状腺毒症伴或不伴甲状腺危象的发病率、结局和成本，本研究使用了全美住院患者样本数据库（National Inpatient Sample database）的数据，该数据库是最大的公共住院患者数据库，包含了全美非联邦医院的代表性样本。
结果
在研究期间的 121384 例甲状腺毒症出院患者中（M ± 标准误差 = 48.7 ± 0.11 岁；51.9%为白种人；77.3%为女性），有 19723 例（16.2%）被诊断为甲状腺危象。在过去的十年中，甲状腺危象的发病率在 0.57 至 0.76 例/10 万美国人口/年之间，在每年住院患者中为 4.8 至 5.6 例/10 万。与无甲状腺危象的甲状腺毒症患者相比，甲状腺危象患者的院内死亡率显著更高（1.2%至 3.6% vs. 0.1%至 0.4%，p<0.01），住院时间更长（4.8 至 5.6 天 vs. 2.7 至 3.4 天，p<0.001）。与 2004 年相比，2013 年甲状腺危象患者的住院费用从 9942 美元增加到 12660 美元（p<0.01），呈递增趋势。
结论
每 6 例甲状腺毒症出院患者中就有 1 例被诊断为甲状腺危象。与无甲状腺危象的甲状腺毒症患者相比，甲状腺危象患者的死亡率高 12 倍。在过去的十年中，甲状腺危象的发病率和死亡率没有明显变化。然而，住院费用显著增加。
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