美国系统性红斑狼疮合并脓毒症患者院内死亡率的差异。
Interhospital variation in mortality among patients with systemic lupus erythematosus and sepsis in the USA.
机构信息
First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.
出版信息
Rheumatology (Oxford). 2019 Oct 1;58(10):1794-1801. doi: 10.1093/rheumatology/kez103.
OBJECTIVE
To determine whether the risk of mortality in patients with SLE hospitalized with sepsis varies among hospitals in the USA.
METHODS
We used the National Inpatient Sample (2002-2011) to obtain national population-based data on outcomes for adults with SLE admitted with sepsis, and compared it with that for patients without SLE admitted with sepsis at the same hospital. We computed expected mortality based on patient demographic characteristics, comorbidities and major organ dysfunction, and calculated observed/expected (O/E) mortality ratios separately for patients with SLE and without SLE for each hospital. We then computed the ratio of these O/E ratios within hospitals to assess relative SLE mortality. We considered hospitals with a risk ratio (RR) of ⩾2.0 as having high relative SLE mortality.
RESULTS
Among 424 hospitals that treated a total of 4024 patients with SLE and sepsis, the risk of in-hospital mortality varied from 0% to 60% (median 11.1%). The RR ranged from 0 to 9.75, with a median of 0.84, indicating that O/E mortality was similar in patients with and without SLE at the average hospital. Sixty-one hospitals (14.4%) had a RR of ⩾2.0, indicating higher mortality among patients with SLE. Hospitals that on average treated ⩾3.9 patients with SLE and sepsis annually were less likely to have a RR of ⩾2.0 than hospitals that treated fewer patients (10% vs 17%; P = 0.004).
CONCLUSION
Mortality among patients with SLE and sepsis varied widely between hospitals, and was lower at hospitals that treated more of these patients.
目的
确定美国医院中，并发脓毒症的系统性红斑狼疮（SLE）患者的死亡率风险是否存在差异。
方法
我们使用国家住院患者样本（2002-2011 年）获取美国全国范围内关于成人 SLE 并发脓毒症住院患者结局的人群数据，并与同一家医院中未患有 SLE 的脓毒症患者进行比较。我们根据患者的人口统计学特征、合并症和主要器官功能障碍计算预期死亡率，并分别计算 SLE 患者和非 SLE 患者在每个医院的观察到/预期（O/E）死亡率比值。然后，我们计算医院内这些 O/E 比值的比值，以评估 SLE 死亡率的相对风险。我们将风险比（RR）≥2.0 的医院视为 SLE 死亡率相对较高的医院。
结果
在治疗 4024 例 SLE 并发脓毒症患者的 424 家医院中，住院死亡率的风险从 0%到 60%不等（中位数为 11.1%）。RR 范围从 0 到 9.75，中位数为 0.84，表明平均医院中 SLE 患者和非 SLE 患者的 O/E 死亡率相似。有 61 家医院（14.4%）的 RR≥2.0，表明 SLE 患者的死亡率更高。平均每年治疗 ⩾3.9 例 SLE 并发脓毒症患者的医院，RR≥2.0 的可能性低于治疗较少患者的医院（10%比 17%；P=0.004）。
结论
SLE 并发脓毒症患者的死亡率在医院之间差异很大，治疗这类患者较多的医院死亡率较低。
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