胃窦血管扩张症（GAVE）患者输血及院内结局的预测因素：一项基于全国人群的分析
Predictors of blood transfusion and in-hospital outcomes in patients with gastric antral vascular ectasia (GAVE): a nationwide population-based analysis.
作者信息
Patel Upenkumar, Desai Rupak, Desai Jiten, Damarlapally Nanush, Zalavadia Dipen, Yousef Mohamad, Coman Roxana, Bansal Pardeep, Goyal Hemant
机构信息
Division of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA.
Atlanta VA Medical Center, Decatur, GA, USA.
出版信息
Ann Transl Med. 2019 Feb;7(3):46. doi: 10.21037/atm.2019.01.11.
BACKGROUND
Gastric antral vascular ectasia (GAVE) is a rare cause of chronic non-variceal upper gastrointestinal (GI) bleeding and can turn into life-threatening bleed in some patients. Packed red blood cell (PRBC) transfusions are often required in these patients during hospitalization. We aimed to investigate the hospitalization outcomes and predictors of PRBC transfusions in patients with GAVE lesions.
METHODS
Using the ICD-9-CM codes (537.82, 537.83), we queried the National Inpatient Sample (NIS) [2010-2014] to recognize hospitalized GAVE patients. A 1:2 random sample was obtained from the non-GAVE cohort and these groups were compared (GAVE non-GAVE). The predictors of PRBC transfusion in GAVE cohort were analyzed with multivariate analysis by using SPSS Statistics 22.0.
RESULTS
We included weighted 89,081 GAVE and 178,550 non-GAVE hospitalized patients. The GAVE patients were tended to be older, female and white. Significantly higher proportions of comorbidities such as congestive heart failure, diabetes, hypertension, hypothyroidism, liver disease, renal failure, Sjogren syndrome, systemic sclerosis and portal hypertension, etc. were present in these patients. The all-cause inpatient mortality was found to be 1.4%. The mean hospital charges and length of stay (LOS) per GAVE hospitalization were $36,059 and 4.63±5.3 days, respectively. A total of 6,276 (weighted 31,102) (34.9%) of these patients received at least one PRBC transfusion during hospitalization. Advanced age, multiple comorbidities, non-elective admissions, male gender, and African American race were the independent factors associated with higher chances of receiving PRBC transfusion.
CONCLUSIONS
Our analysis showed that hospitalized patients with GAVE lesions had lower overall mortality rate despite having multiple comorbidities. There was no difference in the LOS and hospital charges between the two cohorts. Nearly 35% of the GAVE patients received at least one PRBC transfusion.
背景
胃窦血管扩张症（GAVE）是慢性非静脉曲张性上消化道（GI）出血的罕见病因，在某些患者中可转变为危及生命的出血。这些患者住院期间常需要输注浓缩红细胞（PRBC）。我们旨在研究GAVE病变患者的住院结局及PRBC输血的预测因素。
方法
使用国际疾病分类第九版临床修订本（ICD-9-CM）编码（537.82、537.83），我们查询了国家住院患者样本（NIS）[2010 - 2014年]以识别住院的GAVE患者。从非GAVE队列中获取1:2的随机样本，并对这些组进行比较（GAVE组与非GAVE组）。使用SPSS Statistics 22.0通过多变量分析对GAVE队列中PRBC输血的预测因素进行分析。
结果
我们纳入了加权后的89,081例GAVE住院患者和178,550例非GAVE住院患者。GAVE患者倾向于年龄较大、为女性且为白人。这些患者中充血性心力衰竭、糖尿病、高血压、甲状腺功能减退、肝病、肾衰竭、干燥综合征、系统性硬化症和门静脉高压等合并症的比例显著更高。全因住院死亡率为1.4%。每次GAVE住院的平均住院费用和住院时间（LOS）分别为36,059美元和4.63±5.3天。这些患者中共有6,276例（加权后为31,102例）（34.9%）在住院期间接受了至少一次PRBC输血。高龄、多种合并症、非择期入院、男性性别和非裔美国人种族是与接受PRBC输血几率较高相关的独立因素。
结论
我们的分析表明，患有GAVE病变的住院患者尽管有多种合并症，但总体死亡率较低。两个队列之间的住院时间和住院费用没有差异。近35%的GAVE患者接受了至少一次PRBC输血。
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