美国急性痛风 30 天内再入院情况：全国再入院数据库分析。
Thirty-Day Hospital Readmissions for Acute Gout in the United States: Analysis of the Nationwide Readmission Database.
机构信息
Department of Internal Medicine, John H. Stronger, Jr. Hospital of Cook County, Chicago, IL.
From the Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, MI.
出版信息
J Clin Rheumatol. 2022 Mar 1;28(2):e467-e472. doi: 10.1097/RHU.0000000000001761.
BACKGROUND/OBJECTIVE: The aims of this study were to describe the rates and characteristics of nonelective 30-day readmission among adult patients hospitalized for acute gout and to assess predictors of readmission.
METHODS
We analyzed the 2017 Nationwide Readmission Database. Gout hospitalizations were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification code. Hospitalizations for adult patients were included. We excluded planned or elective readmissions. We utilized χ2 tests to compare baseline characteristics between readmissions and index hospitalizations. We used multivariate Cox regression to identify independent predictors of readmissions.
RESULTS
A total of 11,727 index adult hospitalizations with acute gout listed as the principal diagnosis were discharged alive and included. One thousand five hundred ninety-four (13.6%) readmissions occurred within 30 days. Acute gout was the most common reason for readmission. Readmissions had higher inpatient mortality (2.4% vs 0.1%, p < 0.0001), greater mean age (68.1 vs 67.0 years, p = 0.021), and longer hospital length of stay (5.9 vs 3.8 days, p < 0.0001) compared with index hospitalizations. Charlson Comorbidity Index scores of ≥2 (score 2: adjusted hazards ratio [AHR], 1.67; p = 0.001; score ≥3: AHR, 2.08; p < 0.0001), APR-DRG (All Patients Refined Diagnosis Related Groups) severity levels ≥2 (level 2: AHR, 1.43; p = 0.044; level 3: AHR, 1.83; p = 0.002; level 4: AHR, 2.38; p = 0.002), admission to metropolitan hospital (AHR, 1.83; p = 0.012), atrial fibrillation (AHR, 1.31; p = 0.004), and anemia (AHR, 1.30; p = 0.001) were significantly associated with 30-day readmissions.
CONCLUSIONS
Acute gout readmissions were associated with worse outcomes compared with index hospitalizations. Charlson Comorbidity Index scores ≥2, APR-DRG severity levels ≥2, admission to metropolitan hospital, atrial fibrillation, and anemia were significant predictors of readmission.
背景/目的：本研究旨在描述成年急性痛风住院患者非选择性 30 天再入院率及其特征，并评估再入院的预测因素。
方法
我们分析了 2017 年全国再入院数据库。使用国际疾病分类，第十次修订版，临床修正码来确定痛风住院。纳入成年患者的住院治疗。我们排除了计划性或选择性再入院。我们使用 χ2 检验比较再入院和指数住院之间的基线特征。我们使用多变量 Cox 回归来确定再入院的独立预测因素。
结果
共有 11727 例主要诊断为急性痛风的成年指数住院患者出院并存活。1594 例（13.6%）在 30 天内再入院。急性痛风是再入院的最常见原因。与指数住院相比，再入院的住院病死率更高（2.4% vs 0.1%，p < 0.0001），平均年龄更大（68.1 岁 vs 67.0 岁，p = 0.021），住院时间更长（5.9 天 vs 3.8 天，p < 0.0001）。Charlson 合并症指数评分≥2（评分 2：调整后的危险比 [AHR]，1.67；p = 0.001；评分≥3：AHR，2.08；p < 0.0001）、APR-DRG（All Patients Refined Diagnosis Related Groups）严重程度等级≥2（等级 2：AHR，1.43；p = 0.044；等级 3：AHR，1.83；p = 0.002；等级 4：AHR，2.38；p = 0.002）、入住大都市医院（AHR，1.83；p = 0.012）、心房颤动（AHR，1.31；p = 0.004）和贫血（AHR，1.30；p = 0.001）与 30 天再入院显著相关。
结论
与指数住院相比，急性痛风再入院与更差的结局相关。Charlson 合并症指数评分≥2、APR-DRG 严重程度等级≥2、入住大都市医院、心房颤动和贫血是再入院的显著预测因素。
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