Chaudhary Fahad, Albeiruti Ridwaan, Alqahtani Fahad, Alhajji Mohamed, Lerfald Nathan, Hutson William
Department of Medicine, West Virginia University, Morgantown, WV, USA.
They contributed equally to the manuscript.
Gastroenterology Res. 2020 Apr;13(2):58-65. doi: 10.14740/gr1272. Epub 2020 Apr 22.
Acute pancreatitis is the leading gastrointestinal cause of hospital admissions. Our study aims to determine the trends and predictors of discharge against medical advice (AMA).
We utilized the Nationwide Inpatient Sample (2003 - 2016) to identify patients admitted with pancreatitis. We compared in-hospital complications and determined predictors of discharge AMA using a multivariate logistic regression.
A total of 7,158,894 patients were admitted with pancreatitis. Of those, 199,351 left AMA. Discharge AMA increased over time from 2.3% to 3.2%. Patients who left AMA were more likely to be younger, male, black, and a lower socioeconomic status (SES). They had a greater prevalence of depression, cirrhosis, smoking, drug abuse, and human immunodeficiency virus (HIV) infection. Alcohol use was the most likely etiology of pancreatitis among those leaving AMA. In a multivariate regression, patients more likely to leave AMA included: age 18 - 44, male, and black. Patients with a history of depression, drug abuse, and HIV infection were also more likely to be discharged AMA.
Discharges AMA increased over time. Predictors of AMA include patients who are younger, male, black, lower socioeconomic status, and have a history of depression, HIV infection, alcohol and drug use. Future studies are necessary to examine the reasons for discharge AMA among this population.
急性胰腺炎是导致住院的主要胃肠道病因。我们的研究旨在确定违反医嘱出院（AMA）的趋势及预测因素。
我们利用全国住院患者样本（2003 - 2016年）来确定胰腺炎住院患者。我们比较了住院期间的并发症，并使用多因素逻辑回归确定AMA出院的预测因素。
共有7158894例患者因胰腺炎住院。其中，199351例违反医嘱出院。随着时间推移，AMA出院率从2.3%上升至3.2%。违反医嘱出院的患者更可能年轻、男性、黑人且社会经济地位较低（SES）。他们患抑郁症、肝硬化、吸烟、药物滥用和人类免疫缺陷病毒（HIV）感染的患病率更高。在违反医嘱出院的患者中，饮酒是胰腺炎最可能的病因。在多因素回归分析中，更可能违反医嘱出院的患者包括：年龄18 - 44岁、男性和黑人。有抑郁症、药物滥用和HIV感染病史的患者也更可能违反医嘱出院。
随着时间推移，AMA出院率上升。AMA的预测因素包括年轻、男性、黑人、社会经济地位较低以及有抑郁症、HIV感染、酗酒和药物使用病史的患者。有必要开展进一步研究以探究该人群中AMA出院的原因。
