Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland.
University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland.
J Clin Endocrinol Metab. 2020 Nov 1;105(11). doi: 10.1210/clinem/dgaa517.
Patients with hypopituitarism face excess mortality in the long-term outpatient setting. However, associations of pituitary dysfunction with outcomes in acutely hospitalized patients are lacking.
The objective of this work is to assess clinical outcomes of hospitalized patients with hypopituitarism with or without diabetes insipidus (DI).
DESIGN, SETTING, AND PATIENTS: In this population-based, matched-cohort study from 2012 to 2017, hospitalized adult patients with a history of hypopituitarism were 1:1 propensity score-matched with a general medical inpatient cohort.
The primary outcome was in-hospital mortality. Secondary outcomes included all-cause readmission rates within 30 days and 1 year, intensive care unit (ICU) admission rates, and length of hospital stay.
After matching, 6764 cases were included in the study. In total, 3382 patients had hypopituitarism and of those 807 (24%) suffered from DI. All-cause in-hospital mortality occurred in 198 (5.9%) of patients with hypopituitarism and in 164 (4.9%) of matched controls (odds ratio [OR] 1.32, [95% CI, 1.06-1.65], P = .013). Increased mortality was primarily observed in patients with DI (OR 3.69 [95% CI, 2.44-5.58], P < .001). Patients with hypopituitarism had higher ICU admissions (OR 1.50 [95% CI, 1.30-1.74], P < .001), and faced a 2.4-day prolonged length of hospitalization (95% CI, 1.94-2.95, P < .001) compared to matched controls. Risk of 30-day (OR 1.31 [95% CI, 1.13-1.51], P < .001) and 1-year readmission (OR 1.29 [95% CI, 1.17-1.42], P < .001) was higher among patients with hypopituitarism as compared with medical controls.
Patients with hypopituitarism are highly vulnerable once hospitalized for acute medical conditions with increased risk of mortality and adverse clinical outcomes. This was most pronounced among those with DI.
患有垂体功能减退症的患者在长期门诊治疗中面临过高的死亡率。然而，在急性住院患者中，垂体功能障碍与结局的相关性尚不清楚。
本研究旨在评估患有垂体功能减退症合并或不合并尿崩症（DI）的住院患者的临床结局。
设计、地点和患者：本研究为 2012 年至 2017 年期间基于人群的匹配队列研究，将有垂体功能减退症病史的住院成年患者与一般内科住院患者进行 1:1 倾向评分匹配。
主要结局为院内死亡率。次要结局包括 30 天和 1 年内的全因再入院率、重症监护病房（ICU）入住率和住院时间。
匹配后，共纳入 6764 例患者。共有 3382 例患者患有垂体功能减退症，其中 807 例（24%）患有 DI。垂体功能减退症患者的全因院内死亡率为 198 例（5.9%），匹配对照组为 164 例（4.9%）（比值比[OR]1.32，[95%CI，1.06-1.65]，P=0.013）。死亡率的增加主要见于患有 DI 的患者（OR 3.69 [95%CI，2.44-5.58]，P<0.001）。与匹配对照组相比，垂体功能减退症患者 ICU 入住率更高（OR 1.50 [95%CI，1.30-1.74]，P<0.001），且住院时间延长 2.4 天（95%CI，1.94-2.95，P<0.001）。与医学对照组相比，垂体功能减退症患者 30 天（OR 1.31 [95%CI，1.13-1.51]，P<0.001）和 1 年再入院（OR 1.29 [95%CI，1.17-1.42]，P<0.001）的风险更高。
患有垂体功能减退症的患者一旦因急性医疗状况住院，死亡率和不良临床结局的风险就会大大增加。在患有 DI 的患者中，这种情况最为明显。
