Hamedani Ali G, Pauly Meredith, Thibault Dylan P, Gonzalez-Alegre Pedro, Willis Allison W
Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, PA, United States of America.
Clin Park Relat Disord. 2020 Jan 24;3:100041. doi: 10.1016/j.prdoa.2020.100041. eCollection 2020.
Huntington's disease (HD) causes dysphagia and dementia, both of which are risk factors for malnutrition. Gastrostomy is used to sustain enteral intake in neurodegenerative diseases and specifically improves outcomes in ALS, but its indications and outcomes in HD are understudied.
To explore the indications and outcomes for gastrostomy for HD.
We performed a retrospective cross-sectional analysis of all HD admissions in the National Inpatient Sample. Logistic regression models compared the patient- and hospital-level characteristics associated with gastrostomy placement in HD and the prevalence of associated diagnoses in HD vs. ALS gastrostomy patients. We also examined in-hospital mortality, length of stay (LOS), and discharge status.
Between 2000 and 2010, 5.12% (n = 1614) of HD admissions included gastrostomy tube placement. Gastrostomy patients were more likely to be Black (adjusted odds ratio [AOR] 1.55, 95% CI: 1.09-2.21) and have Medicare coverage (AOR 1.43, 95% CI: 1.0-2.05). The most common comorbidities were aspiration pneumonia (34.1%), dementia (31.3%), malnutrition (30.3%), and dysphagia (29.5%). Dementia and delirium were associated with discharge type but not LOS. Aspiration pneumonia, sepsis, and Elixhauser comorbidity index were associated with LOS but not discharge type. Compared to 7908 ALS gastrostomy patients, those with HD more frequently had aspiration pneumonia (34.1% vs. 20.5%, p < 0.0001), sepsis (28.1% vs. 13.7%, p < 0.0001), prolonged LOS (OR 1.14, 95% CI: 1.02-1.28), and skilled nursing facility discharge (p < 0.0001, Wald chi square test).
Gastrostomy is frequently performed in HD patients with dementia and aspiration pneumonia who are at increased risk for negative hospitalization outcomes.
亨廷顿舞蹈症（HD）会导致吞咽困难和痴呆，这两者都是营养不良的风险因素。胃造口术用于维持神经退行性疾病患者的肠内营养摄入，尤其能改善肌萎缩侧索硬化症（ALS）患者的预后，但HD患者接受胃造口术的适应症及预后情况尚未得到充分研究。
探讨HD患者接受胃造口术的适应症及预后情况。
我们对国家住院患者样本中所有HD入院患者进行了回顾性横断面分析。逻辑回归模型比较了HD患者接受胃造口术相关的患者及医院层面特征，以及HD与ALS胃造口术患者相关诊断的患病率。我们还研究了住院死亡率、住院时间（LOS）和出院状态。
2000年至2010年间，5.12%（n = 1614）的HD入院患者接受了胃造口管置入术。接受胃造口术的患者更可能是黑人（调整优势比[AOR] 1.55，95%置信区间：1.09 - 2.21）且有医疗保险覆盖（AOR 1.43，95%置信区间：1.0 - 2.05）。最常见的合并症是吸入性肺炎（34.1%）、痴呆（31.3%）、营养不良（30.3%）和吞咽困难（29.5%）。痴呆和谵妄与出院类型相关，但与住院时间无关。吸入性肺炎、败血症和埃利克斯豪泽合并症指数与住院时间相关，但与出院类型无关。与7908例ALS胃造口术患者相比，HD患者更常出现吸入性肺炎（34.1%对20.5%，p < 0.0001）、败血症（28.1%对13.7%，p < 0.0001）、住院时间延长（OR 1.14，95%置信区间：1.02 - 1.28）以及转至专业护理机构出院（p < 0.0001，Wald卡方检验）。
对于痴呆和吸入性肺炎且住院不良结局风险增加的HD患者，胃造口术经常被实施。
