在急症医院中评估神经性厌食症的死亡率和风险：全国性行政数据库分析。
Mortality and risk assessment for anorexia nervosa in acute-care hospitals: a nationwide administrative database analysis.
机构信息
Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, S1560/S1568 M&D Tower 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
出版信息
BMC Psychiatry. 2020 Jan 13;20(1):19. doi: 10.1186/s12888-020-2433-8.
BACKGROUND
Anorexia nervosa (AN) is a common eating disorder with the highest mortality rate of all psychiatric diseases. However, few studies have examined inpatient characteristics and treatment for AN. This study aimed to characterise the association between mortality and risk factors in patients with AN in acute-care hospitals.
METHODS
We conducted a nationwide, retrospective analysis of the Japanese Diagnosis and Procedure Combination inpatient database. Data extraction occurred from April 2010 to March 2016. We estimated in-hospital mortality and identified independent risk factors, using multivariate logistic regression analysis to examine patient characteristics and physical and psychological comorbidities.
RESULTS
We identified 6937 patients with AN aged ≥12 years in 885 acute-care hospitals. Of these, 361 (5.2%) were male. Male and female participants' median ages at first admission were 34 (17-65) and 28 (17-41) years, respectively. In total, 195 in-hospital patient deaths, including 22 (6.1%) men and 173 (2.6%) women, it was observed that the unadjusted odds ratio of mortality for male patients was more than twice that for female patients (OR: 2.40, 95% CI: 1.45-3.81). Multivariate logistic regression analysis demonstrated an adjusted odds ratio of 2.19 (95% CI: 1.29-3.73). Age at first hospital admission, percentage of ideal body weight, comorbidities, and hypotension were significantly associated with increased mortality risk, but the frequency of hospitalization, bradycardia, and other psychiatric disorders were not. Treatment in a university hospital was associated with lower mortality risk (odds ratio: 0.45, 95% CI: 0.30-0.67).
CONCLUSION
The results highlighted sex differences in mortality rates. Potential risk factors could contribute to improved treatment and outcomes. These retrospective findings indicate a need for further longitudinal examination of these patients.
背景
神经性厌食症（AN）是一种常见的饮食障碍，其死亡率在所有精神疾病中最高。然而，很少有研究检查过急性护理医院中 AN 患者的住院特征和治疗方法。本研究旨在描述急性护理医院中 AN 患者的死亡率与危险因素之间的关系。
方法
我们对日本诊断和程序组合住院数据库进行了全国性的回顾性分析。数据提取时间为 2010 年 4 月至 2016 年 3 月。我们使用多变量逻辑回归分析来评估患者特征和身体及心理合并症，以估计住院死亡率并确定独立的危险因素。
结果
我们在 885 家急性护理医院中确定了 6937 名年龄≥12 岁的 AN 患者。其中，361 名（5.2%）为男性。男性和女性首次入院的中位年龄分别为 34 岁（17-65 岁）和 28 岁（17-41 岁）。共有 195 名住院患者死亡，其中 22 名（6.1%）为男性，173 名（2.6%）为女性。观察到男性患者的死亡率未调整比值比是女性患者的两倍多（OR：2.40，95%CI：1.45-3.81）。多变量逻辑回归分析表明，调整后的比值比为 2.19（95%CI：1.29-3.73）。首次住院年龄、理想体重百分比、合并症和低血压与死亡率增加显著相关，但住院频率、心动过缓和其他精神障碍则不然。在大学医院治疗与死亡率降低相关（比值比：0.45，95%CI：0.30-0.67）。
结论
研究结果强调了死亡率的性别差异。潜在的危险因素可能有助于改善治疗效果和预后。这些回顾性发现表明，需要进一步对这些患者进行纵向检查。
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