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癌症患者静脉血栓栓塞症的急性住院死亡率:来自登记数据。

Acute Hospital Mortality of Venous Thromboembolism in Patients With Cancer From Registry Data.

机构信息

Department of Cardiovascular Medicine Tokushima University Hospital Tokushima Japan.

Clinical Trial Center for Developmental Therapeutics Tokushima University Hospital Tokushima Japan.

出版信息

J Am Heart Assoc. 2021 Jun;10(11):e019373. doi: 10.1161/JAHA.120.019373. Epub 2021 May 22.

Abstract

Background The prognosis of patients with cancer-venous thromboembolism (VTE) is not well known because of a lack of registry data. Moreover, there is also no knowledge on how specific types are related to prognosis. We sought to evaluate the clinical characteristics and outcomes of patients with cancer-associated VTE, compared with a matched cohort without cancer using real-world registry data of VTE. Methods and Results This study was based on the Diagnosis Procedure Combination database in the JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination). Of 5 106 151 total patients included in JROAD-DPC, we identified 49 580 patients who were first hospitalized with VTE from April 2012 to March 2017. Propensity score was estimated with a logistic regression model, with cancer as the dependent variable and 18 clinically relevant covariates. After propensity matching, there were 25 148 patients with VTE with or without cancer. On propensity score-matched analysis with 25 148 patients with VTE, patients with cancer had higher total in-hospital mortality within 7 days (1.3% versus 1.1%, odds ratio [OR], 1.66; 95% CI, 1.31-2.11; <0.0001), 14 days (2.5% versus 1.5%, OR, 2.07; 95% CI, 1.72-2.49; <0.0001), and 30 days (4.8% versus 2.0%, OR, 2.85; 95% CI, 2.45-3.31; <0.0001). On analysis for each type of cancer, in-hospital mortality in 11 types of cancer was significantly high, especially pancreas (OR, 12.96; 95% CI, 6.41-26.20), biliary tract (OR, 8.67; 95% CI, 3.00-25.03), and liver (OR, 7.31; 95% CI, 3.05-17.50). Conclusions Patients with cancer had a higher in-hospital acute mortality for VTE than those without cancer, especially in pancreatic, biliary tract, and liver cancers.

摘要

背景

由于缺乏登记数据,癌症-静脉血栓栓塞症(VTE)患者的预后尚不清楚。此外,也不知道特定类型的 VTE 与预后的关系。我们试图使用 VTE 的真实世界登记数据,评估癌症相关 VTE 患者与无癌症患者的临床特征和结局。

方法

本研究基于 JROAD-DPC(日本所有心脏和血管疾病及诊断程序组合登记)中的诊断程序组合数据库。在 JROAD-DPC 中,共纳入 5106151 例患者,我们从中识别出 49580 例 2012 年 4 月至 2017 年 3 月首次因 VTE 住院的患者。采用逻辑回归模型估计倾向评分,以癌症为因变量,18 个临床相关协变量。在倾向评分匹配后,有 25148 例 VTE 患者有或无癌症。在对 25148 例 VTE 患者进行倾向评分匹配分析后,癌症患者在 7 天内(1.3%比 1.1%,比值比[OR],1.66;95%置信区间[CI],1.31-2.11;<0.0001)、14 天内(2.5%比 1.5%,OR,2.07;95%CI,1.72-2.49;<0.0001)和 30 天内(4.8%比 2.0%,OR,2.85;95%CI,2.45-3.31;<0.0001)的全因院内死亡率更高。对每一种癌症类型进行分析后,11 种癌症的院内死亡率明显较高,尤其是胰腺(OR,12.96;95%CI,6.41-26.20)、胆道(OR,8.67;95%CI,3.00-25.03)和肝脏(OR,7.31;95%CI,3.05-17.50)。

结论

癌症患者的 VTE 院内急性死亡率高于无癌症患者,尤其是胰腺癌、胆道癌和肝癌。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f185/8483529/4da58b7ff372/JAH3-10-e019373-g003.jpg

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