美国成年噬血细胞性淋巴组织细胞增生症重症患者的预后——基于2007年至2015年行政数据库的分析
Outcomes of adult critically ill patients with hemophagocytic lymphohistiocytosis in united states-analysis from an administrative database from 2007 to 2015.
作者信息
Kumar Gagan, Hererra Martin, Patel Dhaval, Nanchal Rahul, Guddati Achuta K
机构信息
Department of Pulmonary & Critical Care, Northeast Georgia Health System Gainesville, GA 30501, USA.
Department of Internal Medicine, Northeast Georgia Health System Gainesville, GA 30501, USA.
出版信息
Am J Blood Res. 2020 Dec 15;10(6):330-338. eCollection 2020.
BACKGROUND
Severe infections caused by the novel coronavirus 2 display similarities to secondary hemophagocytic lymphohistiocytosis (HLH). However, HLH is a rare disease and has not been well described in critically ill patients.
METHODS
We used the Nationwide Inpatient Sample (NIS), the largest all-payer inpatient care database publicly available in the United States to identify all adult discharges with Hemophagocytic syndrome (ICD-9 CM code 288.4) between 2007 and 2015. Critical illness was considered present if patient had either ICD-9 CM code indicating the requirement of invasive mechanical ventilation or the presence of shock. We used ICD-9-CM codes to identify various infections (inf-HLH), malignancies (mal-HLH) and autoimmune diseases associated with HLH (MAS-HLH) and classified them in their respective groups. Primary outcome was in-hospital mortality in critically ill patients. We developed multivariable regression model to examine variables associated with mortality in critically ill HLH patients. value was kept at < 0.05.
RESULTS
Of the 7420 (95% CI 6959-7881) estimated discharges with HLH, 2313 (31%) were critically ill. Of the critically ill patients, 442 (34%) were mal-HLH, 422 (43.3%) were inf-HLH, 403 (30.7%) were MAS-HLH and 1046 (27.3%) were unable to be classified. In hospital mortality rates were 6.4% in non-critically ill and 48.4% in critically ill patients. Among the subtypes of HLH, in-hospital mortality was 53% in mal-HLH, 49.4% in inf-HLH, 26% in MAS-HLH and 54.6% in unclassified group. On multivariable regression analysis, development of acute renal failure requiring hemodialysis (OR 2.06, 95% CI 1.29-3.3, P=0.002) and acute hepatic failure (OR 2.21, 95% CI 1.38-3.52, P=0.001) were significantly associated with higher mortality.
CONCLUSION
Inpatient mortality of critically ill patients is remarkably high. Patients with MAS-HLH had better outcomes when compared to other groups of HLH.
背景
新型冠状病毒2引起的严重感染与继发性噬血细胞性淋巴组织细胞增生症（HLH）表现出相似性。然而，HLH是一种罕见疾病，在重症患者中尚未得到充分描述。
方法
我们使用了美国最大的公开可用的全付费住院护理数据库全国住院患者样本（NIS），以识别2007年至2015年间所有患有噬血细胞综合征（ICD-9 CM编码288.4）的成年出院患者。如果患者有表明需要有创机械通气的ICD-9 CM编码或存在休克，则认为存在重症。我们使用ICD-9-CM编码来识别与HLH相关的各种感染（inf-HLH）、恶性肿瘤（mal-HLH）和自身免疫性疾病（MAS-HLH），并将它们分类到各自的组中。主要结局是重症患者的住院死亡率。我们建立了多变量回归模型来检查与重症HLH患者死亡率相关的变量。P值保持在<0.05。
结果
在估计的7420例（95%CI 6959-7881）HLH出院患者中，2313例（31%）为重症。在重症患者中，442例（34%）为mal-HLH，422例（43.3%）为inf-HLH，403例（30.7%）为MAS-HLH，1046例（27.3%）无法分类。非重症患者的住院死亡率为6.4%，重症患者为48.4%。在HLH的亚型中，mal-HLH的住院死亡率为53%，inf-HLH为49.4%，MAS-HLH为26%，未分类组为54.6%。多变量回归分析显示，需要血液透析的急性肾衰竭（OR 2.06，95%CI 1.29-3.3，P=0.002）和急性肝衰竭（OR 2.21，95%CI 1.38-3.52，P=0.001）与较高的死亡率显著相关。
结论
重症患者的住院死亡率非常高。与其他HLH组相比，MAS-HLH患者的结局更好。
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