Service d'urologie, CHU Rennes, Rennes, France; Centre de référence spina bifida, CHU Rennes, Rennes, France; Equipe thématique INPHY CIC 1414 et INSERM UMR 1241, Rennes, France.
EHESP Rennes, Sorbonne Paris Cité, Paris, France.
Urology. 2020 Mar;137:200-204. doi: 10.1016/j.urology.2019.11.006. Epub 2019 Nov 14.
To assess and analyze the contemporary causes of in-hospital deaths of spina bifida patients.
It was a cross-sectional observational study of the longitudinal national cohort of all patients hospitalized in French public and private hospitals. We analyzed the data from the French hospital discharge database (Programme de Médicalisation des Systemes d'Information, PMSI) from 2009 to 2014. The number of in-hospital deaths was extracted using the combination of the ICD-10 codes "Q05" or "Q760" and a discharge code = 9.
There were 138 in-hospital deaths of spina bifida patients over the 6-year study period. The median age at death was 41 years (IQR: 25-52). The median age at death was significantly lower in patients with vs without hydrocephalus (26.6 vs 45.5 years; P <.0001). The leading cause of in-hospital death was urologic disorders (n = 24; 17.3%). Other main causes of death were pulmonary disorders (n = 23; 16.7%), neurologic disorders (n = 19; 13.8%), and bowel disorders (n = 15; 10.9%). Upper urinary tract damage accounted for most of the urologic causes of death: 8 patients died from urinary tract infections (33.3%), 7 patients died from renal failure (29.2%), 4 died from bladder cancer (16.7%), and 5 from other urologic causes. The only variable significantly associated with a death from urologic causes was the absence of hydrocephalus (OR = 0.26; P = .009).
Urologic disorders remain the leading cause of in-hospital death in spina bifida patients in France. The present study highlights that efforts to improve the urologic management of the spina bifida population are still greatly needed.
评估和分析脊髓脊膜膨出患者住院死亡的当代原因。
这是一项对法国公立和私立医院住院患者的纵向全国队列进行的横断面观察性研究。我们分析了 2009 年至 2014 年法国医院出院数据库（Programme de Médicalisation des Systemes d'Information，PMSI）的数据。使用国际疾病分类第 10 版（ICD-10）代码“Q05”或“Q760”和出院代码=9 组合提取住院死亡人数。
在 6 年的研究期间，有 138 例脊髓脊膜膨出患者住院死亡。死亡时的中位年龄为 41 岁（IQR：25-52）。有脑积水和无脑积水的患者死亡时的中位年龄有显著差异（26.6 岁 vs 45.5 岁；P<.0001）。住院死亡的主要原因是泌尿系统疾病（n=24；17.3%）。其他主要死亡原因是肺部疾病（n=23；16.7%）、神经系统疾病（n=19；13.8%）和肠道疾病（n=15；10.9%）。上尿路损伤占泌尿系统死亡原因的大部分：8 例死于尿路感染（33.3%），7 例死于肾衰竭（29.2%），4 例死于膀胱癌（16.7%），5 例死于其他泌尿系统疾病。唯一与泌尿系统原因死亡显著相关的变量是无脑积水（OR=0.26；P=0.009）。
泌尿系统疾病仍然是法国脊髓脊膜膨出患者住院死亡的主要原因。本研究强调，仍需要努力改善脊髓脊膜膨出患者的泌尿系统管理。
