Department of Emergency Medicine, Taichung Tzu Chi Hospital, Taichung City, Taiwan.
Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan.
BMJ Open. 2019 Nov 21;9(11):e030939. doi: 10.1136/bmjopen-2019-030939.
Studies on the association between clinical vertebral fractures (CVFs) and the subsequent risk of cardiopulmonary diseases, including aortic dissection (AD), congestive heart failure (CHF), pneumonia and acute respiratory distress syndrome (ARDS) are scarce. Therefore, we used the National Health Insurance Research Database to investigate whether patients with CVF have a heightened risk of subsequent AD, CHF, pneumonia and ARDS.
The National Health Insurance Research Database was used to investigate whether patients with CVFs have an increased risk of subsequent AD, CHF, pneumonia and ARDS.
This cohort study comprised patients aged ≥18 years with a diagnosis of CVF and were hospitalised at any point during 2000-2010 (n=1 08 935). Each CVF patient was frequency-matched to a no-CVF hospitalised patients based on age, sex, index year and comorbidities (n=1 08 935). The Cox proportional hazard regressions model was used to estimate the adjusted effect of CVF on AD, CHF, pneumonia and ARDS risk.
The overall incidence of AD, CHF, pneumonia and ARDS was higher in the CVF group than in the no-CVF group (4.85 vs 3.99, 119.1 vs 89.6, 283.3 vs 183.5 and 9.18 vs 4.18/10 000 person-years, respectively). After adjustment for age, sex, comorbidities and Charlson comorbidity index score, patients with CVF had a 1.23-fold higher risk of AD (95% CI=1.03-1.45), 1.35-fold higher risk of CHF (95% CI=1.30-1.40), 1.57-fold higher risk of pneumonia (95% CI=1.54-1.61) and 2.21-fold higher risk of ARDS (95% CI=1.91-2.57) than did those without CVF. Patients with cervical CVF and SCI were more likely to develop pneumonia and ARDS.
Our study demonstrates that CVFs are associated with an increased risk of subsequent cardiopulmonary diseases. Future investigations are encouraged to delineate the mechanisms underlying this association.
关于临床椎体骨折（CVF）与随后发生的心肺疾病（包括主动脉夹层（AD）、充血性心力衰竭（CHF）、肺炎和急性呼吸窘迫综合征（ARDS））之间的关联的研究很少。因此，我们使用国家健康保险研究数据库来调查 CVF 患者是否存在随后发生 AD、CHF、肺炎和 ARDS 的风险增加。
使用国家健康保险研究数据库调查 CVF 患者是否存在随后发生 AD、CHF、肺炎和 ARDS 的风险增加。
这项队列研究包括年龄≥18 岁且在 2000 年至 2010 年期间任何时间因 CVF 住院的患者（n=108935）。每例 CVF 患者均根据年龄、性别、索引年和合并症（n=108935）与无 CVF 住院患者进行频率匹配。使用 Cox 比例风险回归模型估计 CVF 对 AD、CHF、肺炎和 ARDS 风险的调整影响。
CVF 组的 AD、CHF、肺炎和 ARDS 的总发生率高于无 CVF 组（4.85 比 3.99、119.1 比 89.6、283.3 比 183.5 和 9.18 比 4.18/10000 人年，分别）。在调整年龄、性别、合并症和 Charlson 合并症指数评分后，CVF 患者发生 AD 的风险增加 1.23 倍（95%CI=1.03-1.45）、发生 CHF 的风险增加 1.35 倍（95%CI=1.30-1.40）、发生肺炎的风险增加 1.57 倍（95%CI=1.54-1.61）和发生 ARDS 的风险增加 2.21 倍（95%CI=1.91-2.57）。患有颈椎 CVF 和 SCI 的患者更易发生肺炎和 ARDS。
本研究表明 CVF 与随后发生的心肺疾病风险增加相关。鼓励未来的研究阐明这种关联的机制。
