Department of Statistics, Harvard University, Cambridge, MA, USA.
Colorado School of Public Health, Department of Epidemiology, University of Colorado | Aschutz Medical Center, Aurora, CO, USA.
Cardiol Young. 2021 Oct;31(10):1667-1674. doi: 10.1017/S1047951121000858. Epub 2021 Mar 19.
To evaluate outcomes in patients with Turner Syndrome, especially those with cardiac conditions, compared to those without Turner syndrome.
Retrospective cohort study utilising hospitalisation data from 2006 to 2012. Conditional logistic regression models are used to analyse outcomes of interest: all-cause mortality, increased length of stay, and discharge to home.
We identified 2978 women with Turner syndrome, matched to 11,912 controls by primary diagnosis.
Patients with Turner syndrome were more likely to experience inpatient mortality (odds ratio 1.44, 95% confidence interval 1.02-2.02, p = 0.04) and increased length of stay (OR 1.31, CI 1.18-1.46, p = 0.03) than primary diagnosis matched controls, after adjusting for age, race, insurance status, and Charlson comorbidity index. Patients with Turner syndrome were 32% less likely to be discharged to home (OR 0.68, CI 0.60-0.78, p < 0.001). When restricting the sample of patients to those admitted with a cardiac diagnosis, the likelihood of mortality (OR 3.10, CI 1.27-7.57, p = 0.01) and prolonged length of stay (OR 1.42, CI 1.03-1.95, p = 0.03) further increased, while the likelihood of discharge to home further decreased (OR 0.55, CI 0.38-0.80, p = 0.001) in Turner syndrome compared to primary diagnosis matched controls. Specifically, patients with congenital heart disease were more likely to have prolonged length of stay (OR: 1.53, CI 1.18-2.00, p = 0.002), but not increased mortality or decreased discharge to home.
Hospitalised women with Turner syndrome carry a higher risk of adverse outcomes even when presenting otherwise similarly as controls, an important consideration for those treating them in these settings.
评估特纳综合征患者的结局，尤其是伴有心脏疾病患者的结局，并与无特纳综合征的患者进行比较。
利用 2006 年至 2012 年的住院数据进行回顾性队列研究。采用条件逻辑回归模型分析感兴趣的结局：全因死亡率、住院时间延长和出院回家。
我们共确定了 2978 名特纳综合征患者，并按主要诊断与 11912 名对照者进行匹配。
校正年龄、种族、保险状况和 Charlson 合并症指数后，与主要诊断匹配的对照者相比，特纳综合征患者更有可能发生院内死亡（优势比 1.44，95%置信区间 1.02-2.02，p=0.04）和住院时间延长（优势比 1.31，95%置信区间 1.18-1.46，p=0.03）。特纳综合征患者出院回家的可能性降低 32%（优势比 0.68，95%置信区间 0.60-0.78，p<0.001）。将患者样本限制为因心脏疾病入院的患者时，死亡率（优势比 3.10，95%置信区间 1.27-7.57，p=0.01）和住院时间延长（优势比 1.42，95%置信区间 1.03-1.95，p=0.03）的可能性进一步增加，而与主要诊断匹配的对照者相比，出院回家的可能性进一步降低（优势比 0.55，95%置信区间 0.38-0.80，p=0.001）。具体而言，患有先天性心脏病的患者住院时间延长的可能性更高（优势比：1.53，95%置信区间 1.18-2.00，p=0.002），但死亡率未增加，也未减少出院回家的可能性。
即使特纳综合征患者的表现与对照者相似，住院的女性也有更高的不良结局风险，这对在这些环境中治疗她们的人来说是一个重要的考虑因素。
