美国中暑住院病例中的急性心肌梗死
Acute Myocardial Infarction among Hospitalizations for Heat Stroke in the United States.
作者信息
Bathini Tarun, Thongprayoon Charat, Chewcharat Api, Petnak Tananchai, Cheungpasitporn Wisit, Boonpheng Boonphiphop, Prasitlumkum Narut, Chokesuwattanaskul Ronpichai, Vallabhajosyula Saraschandra, Kaewput Wisit
机构信息
Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA.
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
出版信息
J Clin Med. 2020 May 6;9(5):1357. doi: 10.3390/jcm9051357.
BACKGROUND
This study aimed to assess the risk factors and impact of acute myocardial infarction on in-hospital treatments, complications, outcomes, and resource utilization in hospitalized patients for heat stroke in the United States.
METHODS
Hospitalized patients with a principal diagnosis of heat stroke were identified in the National Inpatient Sample dataset from the years 2003 to 2014. Acute myocardial infarction was identified using the hospital International Classification of Diseases, Ninth Revision (ICD-9), diagnosis of 410.xx. Clinical characteristics, in-hospital treatment, complications, outcomes, and resource utilization between patients with and without acute myocardial infarction were compared.
RESULTS
A total of 3372 heat stroke patients were included in the analysis. Of these, acute myocardial infarction occurred in 225 (7%) admissions. Acute myocardial infarction occurred more commonly in obese female patients with a history of chronic kidney disease, but less often in male patients aged <20 years with a history of hypothyroidism. The need for mechanical ventilation, blood transfusion, and renal replacement therapy were higher in patients with acute myocardial infarction. Acute myocardial infarction was associated with rhabdomyolysis, metabolic acidosis, sepsis, gastrointestinal bleeding, ventricular arrhythmia or cardiac arrest, renal failure, respiratory failure, circulatory failure, liver failure, neurological failure, and hematologic failure. Patients with acute myocardial infarction had 5.2-times greater odds of in-hospital mortality than those without myocardial infarction. The length of hospital stay and hospitalization cost were also higher when an acute myocardial infarction occurred while hospitalized.
CONCLUSION
Acute myocardial infarction was associated with worse outcomes and higher economic burden among patients hospitalized for heat stroke. Obesity and chronic kidney disease were associated with increased risk of acute myocardial infarction, while young male patients and hypothyroidism were associated with decreased risk.
背景
本研究旨在评估美国中暑住院患者急性心肌梗死的危险因素及其对住院治疗、并发症、结局和资源利用的影响。
方法
在2003年至2014年的国家住院患者样本数据集中识别出以中暑为主要诊断的住院患者。使用医院国际国际国际国际疾病分类第九版（ICD-9）编码410.xx来识别急性心肌梗死。比较了发生和未发生急性心肌梗死患者的临床特征、住院治疗、并发症、结局及资源利用情况。
结果
共有3372例中暑患者纳入分析。其中，225例（7%）住院期间发生急性心肌梗死。急性心肌梗死更常见于有慢性肾病病史的肥胖女性患者，而在年龄<20岁且有甲状腺功能减退病史的男性患者中较少见。急性心肌梗死患者对机械通气、输血和肾脏替代治疗的需求更高。急性心肌梗死与横纹肌溶解、代谢性酸中毒、脓毒症、胃肠道出血、室性心律失常或心脏骤停、肾衰竭、呼吸衰竭、循环衰竭、肝衰竭、神经功能衰竭及血液系统衰竭相关。发生急性心肌梗死的患者院内死亡几率比未发生心肌梗死的患者高5.2倍。住院期间发生急性心肌梗死时，住院时间和住院费用也更高。
结论
中暑住院患者发生急性心肌梗死与更差的结局及更高的经济负担相关。肥胖和慢性肾病与急性心肌梗死风险增加相关，而年轻男性患者和甲状腺功能减退与风险降低相关。
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