Katiyar Vatsala, Uprety Alok, Mendez-Hernandez Andres, Fuentes Harry E, Andrade Xavier A, Zia Maryam
Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States.
Department of Hematology and Oncology, Mayo Clinic, Rochester, Minnesota, United States.
TH Open. 2019 Jul 17;3(3):e203-e209. doi: 10.1055/s-0039-1692988. eCollection 2019 Jul.
Patients with Philadelphia-negative myeloproliferative neoplasms (MPNs), including polycythemia vera (PV), essential thrombocytosis (ET), and primary myelofibrosis (MF), have a significant risk of venous thromboembolism (VTE). We aim to determine the trends in annual rates of VTE-related admissions, associated cost, length of stay (LOS), and in-hospital mortality in patients with MPN. We identified patients with PV, ET, and MF from the Nationwide Inpatient Sample (NIS) database from 2006 to 2014 using ICD-9CM coding. Hospitalizations where VTE was among the top-three diagnoses were considered VTE-related. We compared in-hospital outcomes between VTE and non-VTE hospitalizations using chi-square and Mann-Whitney -test and used linear regression for trend analysis. We identified 1,046,666 admissions with a diagnosis of MPN. Patients were predominantly white (65.6%), females (52.7%), with a median age of 66 years (range: 18-108). The predominant MPN was ET (54%). There was no difference in in-hospital mortality between groups (VTE: 3.4% vs. non-VTE: 3.2%; = 0.12); however, VTE admissions had a longer LOS (median: 6 vs. 5 days; < 0.01) and higher cost (median: VTE US$32,239 vs. 28,403; ≤ 0.01). The annual rate of VTE admissions decreased over time (2006: 3.94% vs. 2014: 2.43%; ≤ 0.01), compared with non-VTE-related admissions. In our study, VTE-related admissions had similar in-hospital mortality as compared with non-VTE-related admissions. The rates of hospitalizations due to VTE have decreased over time but are associated with a higher cost and LOS. Newer risk assessment tools may assist in preventing VTE in high-risk patients and optimizing resource utilization.
伴有费城染色体阴性的骨髓增殖性肿瘤(MPN)患者,包括真性红细胞增多症(PV)、原发性血小板增多症(ET)和原发性骨髓纤维化(MF),有发生静脉血栓栓塞(VTE)的显著风险。我们旨在确定MPN患者VTE相关住院的年发生率、相关费用、住院时间(LOS)及院内死亡率的变化趋势。
我们使用ICD-9CM编码从2006年至2014年的全国住院患者样本(NIS)数据库中识别出PV、ET和MF患者。VTE位列前三诊断的住院被视为VTE相关住院。我们使用卡方检验和曼-惠特尼U检验比较VTE与非VTE住院的院内结局,并使用线性回归进行趋势分析。
我们识别出1,046,666例诊断为MPN的住院病例。患者主要为白人(65.6%)、女性(52.7%),中位年龄为66岁(范围:18 - 108岁)。主要的MPN类型为ET(54%)。两组间院内死亡率无差异(VTE:3.4% vs. 非VTE:3.2%;P = 0.12);然而,VTE住院的LOS更长(中位值:6天 vs. 5天;P < 0.01)且费用更高(中位值:VTE为32,239美元 vs. 28,403美元;P ≤ 0.01)。与非VTE相关住院相比,VTE住院的年发生率随时间下降(2006年:3.94% vs. 2014年:2.43%;P ≤ 0.01)。
在我们的研究中,VTE相关住院与非VTE相关住院的院内死亡率相似。VTE导致的住院率随时间下降,但与更高的费用和LOS相关。更新的风险评估工具可能有助于预防高危患者的VTE并优化资源利用。