德国全国住院患者样本中的晕厥 - 心房颤动/扑动中的晕厥与肺栓塞有关，并且伴有更高的住院死亡率。
Syncope in the German Nationwide inpatient sample - Syncope in atrial fibrillation/flutter is related to pulmonary embolism and is accompanied by higher in-hospital mortality.
机构信息
Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
出版信息
Eur J Intern Med. 2019 Apr;62:29-36. doi: 10.1016/j.ejim.2019.02.005. Epub 2019 Feb 13.
AIMS
Syncope is a common phenomenon in the general population. Although most of the causes are of benign origin, some comorbidities are accompanied by high mortality. We aimed to compare the in-hospital mortality of patients with syncope related to different comorbities and investigate the impact of syncope in patients with atrial fibrillation/flutter (AF).
METHODS
The nationwide inpatient sample of Germany of the years 2011-2014 was used for this analysis. Patients with syncope (ICD-code R55) were stratified by presence of selected comorbidities. Additionally, AF patients with and without syncope were compared. Incidence of syncope and in-hospital mortality were calculated. Syncope as a predictor of adverse outcome in AF patients was investigated.
RESULTS
In total, 1,628,859 hospitalizations of patients with syncope were identified; incidence was 504.6/100,000 citizens/year with case-fatality rate of 1.6%. Patients with syncope revealed frequently comorbidities as AF, heart failure and pneumonia. In-hospital mortality was high in syncope patients with pulmonary embolism (PE, 13.0%), pneumonia (12.8%), myocardial infarction (MI, 9.7%) and stroke (8.5%). We analysed 1,106,019 hospitalizations (52.9% females, 54.9% aged > 70 years) of patients with AF (2011-2014). Among these, 23,694 (2.1%) were coded with syncope and 0.7% died. Syncope had no significant impact on in-hospital mortality (OR 1.04, 95%CI 0.92-1.17, P = .503) independently of age, sex and comorbidities, but was associated with PE (OR 1.83, 95%CI 1.42-2.36, P < .001), MI (OR 1.68, 95%CI 1.48-1.90, P < .001), stroke (OR 1.66, 95%CI 1.42-1.94, P < .001) and pneumonia (OR 1.26, 95%CI 1.16-1.37, P < .001).
CONCLUSIONS
Syncope is a frequent cause for referrals in hospitals. While the overall in-hospital mortality rate is low (<2%), syncope in coprevalence with PE, pneumonia, MI and stroke showed a mortality rate > 8%. Syncope in AF patients had no independent impact on in-hospital mortality.
目的
晕厥是普通人群中的常见现象。尽管大多数病因是良性的，但一些合并症伴有较高的死亡率。我们旨在比较与不同合并症相关的晕厥患者的住院死亡率，并探讨晕厥对心房颤动/扑动（AF）患者的影响。
方法
本研究使用了 2011-2014 年德国全国住院患者样本进行分析。根据是否存在选定的合并症，将晕厥（ICD 编码 R55）患者分层。此外，还比较了伴有和不伴有晕厥的 AF 患者。计算晕厥的发生率和住院死亡率。研究了晕厥作为 AF 患者不良预后的预测因素。
结果
共确定了 1628859 例晕厥住院患者；发病率为 504.6/100000 名公民/年，病死率为 1.6%。晕厥患者常伴有 AF、心力衰竭和肺炎等合并症。伴有肺栓塞（PE）、肺炎、心肌梗死（MI）和中风的晕厥患者住院死亡率较高（PE 为 13.0%、肺炎为 12.8%、MI 为 9.7%和中风为 8.5%）。我们分析了 1106019 例（52.9%为女性，54.9%年龄>70 岁）AF 患者（2011-2014 年）的住院情况。其中，23694 例（2.1%）被编码为晕厥，0.7%死亡。晕厥对住院死亡率无显著影响（OR 1.04，95%CI 0.92-1.17，P=0.503），独立于年龄、性别和合并症，但与 PE（OR 1.83，95%CI 1.42-2.36，P<0.001）、MI（OR 1.68，95%CI 1.48-1.90，P<0.001）、中风（OR 1.66，95%CI 1.42-1.94，P<0.001）和肺炎（OR 1.26，95%CI 1.16-1.37，P<0.001）有关。
结论
晕厥是医院转介的常见原因。尽管总体住院死亡率较低（<2%），但伴有 PE、肺炎、MI 和中风的晕厥患者的死亡率>8%。AF 患者的晕厥对住院死亡率无独立影响。
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