Kobayashi Takaaki, Salinas Jorge L, Ten Eyck Patrick, Chen Benjamin, Ando Tomo, Inagaki Kengo, Alsuhaibani Mohammed, Auwaerter Paul G, Molano Ilonka, Diekema Daniel J
Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA.
Palliat Med. 2021 Apr;35(4):785-792. doi: 10.1177/0269216321999574. Epub 2021 Mar 24.
Palliative care consultation has shown benefits across a wide spectrum of diseases, but the utility in patients with bacteremia remains unclear despite its high mortality.
To examine the frequency of palliative care consultation and factors associated with palliative care consult in bacteremia patients in the United States.
A population-based retrospective analysis using the Nationwide Inpatient Sample database in 2014, compiled by the Healthcare Costs and Utilization Project of the Agency for Healthcare Research and Quality.
SETTING/SUBJECTS: All inpatients with a discharge diagnosis of bacteremia (ICD-9-CM codes; 038.11 and 038.12).
Palliative care consultation was identified using ICD-9-CM code V66.7. Patients' baseline characteristics and outcomes were compared between those with and without palliative care consult.
A total of 111,320 bacteremia admissions were identified in 2014. Palliative care consult was observed in 8140 admissions (7.3%). Palliative care consultation was associated with advanced age, white race, comorbidities, higher income, teaching/urban hospitals, Midwest region, Methicillin-resistant bacteremia and the lack of echocardiogram. Palliative care consult was also associated with shorter but more expensive hospitalizations. Crude mortality was 53% (4314/8140) among admissions with palliative care consult and 8% (8357/10,3180) among those without palliative care consult ( < 0.001).
Palliative care consultation was infrequent during the management of bacteremia, and a substantial number of patients died during their hospitalizations without palliative care consult. Given the reported benefit in other medical conditions, palliative care consultation may have a role in bacteremia. Selecting patients who may benefit the most should be explored.
姑息治疗会诊已在多种疾病中显示出益处，但尽管菌血症患者死亡率很高，其在菌血症患者中的效用仍不明确。
研究美国菌血症患者姑息治疗会诊的频率以及与姑息治疗会诊相关的因素。
基于人群的回顾性分析，使用2014年全国住院患者样本数据库，该数据库由医疗保健研究与质量局的医疗保健成本和利用项目汇编而成。
设置/研究对象：所有出院诊断为菌血症（ICD-9-CM编码；038.11和038.12）的住院患者。
使用ICD-9-CM编码V66.7确定姑息治疗会诊。比较有和没有姑息治疗会诊患者的基线特征和结局。
2014年共确定111,320例菌血症入院病例。8140例入院病例（7.3%）接受了姑息治疗会诊。姑息治疗会诊与高龄、白人种族、合并症、高收入、教学/城市医院、中西部地区、耐甲氧西林菌血症以及未进行超声心动图检查有关。姑息治疗会诊还与住院时间较短但费用较高有关。接受姑息治疗会诊的入院病例中，粗死亡率为53%（4314/8140），未接受姑息治疗会诊的病例中为8%（8357/103180）（P<0.001）。
在菌血症治疗过程中，姑息治疗会诊并不常见，大量患者在住院期间未接受姑息治疗会诊而死亡。鉴于在其他医疗状况中已报道的益处，姑息治疗会诊可能在菌血症中发挥作用。应探索选择可能最受益的患者。
