使用国家住院患者样本(2015 - 2018年)对经导管主动脉瓣移植术后大出血预测因素的分析

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015-2018).

作者信息

Khan Henna, Gilani Asma, Qayum Ihtisham, Khattak Taif, Haq Furqan, Zahid Anwar Muhammad, Khan Muhammad Atif, Asjad Sayyed Jalawan, Abbas Sakina, Inayat Arslan

机构信息

Medicine, Khyber Girls Medical College, Peshawar, PAK.

Internal Medicine, Khyber Teaching Hospital Peshawar, Peshawar, PAK.

出版信息

Cureus. 2021 Jun 29;13(6):e16022. doi: 10.7759/cureus.16022. eCollection 2021 Jun.

Abstract

Background Transcatheter aortic valve replacement (TAVR) is now a common procedure to treat and improve quality of life, clinical outcomes, and self-sufficiency in high-risk patients with aortic stenosis, and its use has been expanding rapidly in younger and low-risk populations. The aim of this study was to evaluate the outcomes, trends, and predictors of major bleeding in patients undergoing TAVR. Methodology We utilized the National Inpatient Sample (NIS) data from the year 2015 to 2018. International Classification of Disease 10 codes were utilized to extract data. Baseline characteristics were compared using Pearson's chi-square test for categorical variables and independent samples t-test for continuous variables. A multivariable logistic regression model was used to evaluate the predictors of major bleeding. Propensity matching was done for adjusted analysis to compare outcomes in TAVR with and without major bleeding. The outcomes of interest in this study were (1) predictors of major bleeding after TAVR; (2) in-hospital mortality; and (3) resource utilization in terms of cost and length of stay. Results A total of 34,752 weighted hospitalizations for TAVR were included in the analysis. Of the patients undergoing the procedure, 2,294 (6.6%) had a major bleed while 32,458 (93.3%) did not. At baseline, patients with coagulopathy (odds ratio [OR]: 2.03; 95% confidence interval [CI]: 1.82-2.27), congestive heart failure (OR: 1.26; 95% CI: 1.13-1.40), chronic obstructive pulmonary disease (OR: 1.41; 95% CI: 1.29-1.55), liver disease (OR: 1.96; 95% CI: 1.61-2.39), peripheral vascular disease (OR: 1.29; 95% CI: 1.17-1.43), cerebrovascular disease (OR: 1.22; 95% CI: 1.07-1.38), end-stage renal disease (ESRD) (OR: 2.17; 95% CI: 1.82-2.59), and coronary artery disease (OR: 1.17; 95% Cl: 1.06-1.30) had higher adjusted rates of odds of major bleeding. Patients who had major bleeding had a higher median cost of stay (US$60,326 vs. US$45490) and length of stay (seven vs. three days). Conclusions Mortality is higher in patients with major bleeding, and at baseline, coagulopathy and ESRD are significant predictors of a major bleed in patients undergoing TAVR.

摘要

背景 经导管主动脉瓣置换术(TAVR)目前是治疗和改善高危主动脉瓣狭窄患者生活质量、临床结局及自理能力的常见手术,且其在年轻和低风险人群中的应用迅速扩大。本研究旨在评估接受TAVR患者大出血的结局、趋势及预测因素。

方法 我们利用了2015年至2018年的全国住院患者样本(NIS)数据。使用国际疾病分类第10版编码提取数据。分类变量采用Pearson卡方检验比较基线特征,连续变量采用独立样本t检验。采用多变量逻辑回归模型评估大出血的预测因素。进行倾向匹配以进行调整分析,比较有和无大出血的TAVR患者的结局。本研究关注的结局为:(1)TAVR术后大出血的预测因素;(2)住院死亡率;(3)成本和住院时间方面的资源利用情况。

结果 分析共纳入34752例加权TAVR住院病例。接受该手术的患者中,2294例(6.6%)发生大出血,32458例(93.3%)未发生大出血。基线时,患有凝血病(比值比[OR]:2.03;95%置信区间[CI]:1.82 - 2.27)、充血性心力衰竭(OR:1.26;95% CI:1.13 - 1.40)、慢性阻塞性肺疾病(OR:1.41;95% CI:1.29 - 1.55)、肝病(OR:1.96;95% CI:1.61 - 2.39)、外周血管疾病(OR:1.29;95% CI:1.17 - 1.43)、脑血管疾病(OR:1.22;95% CI:1.07 - 1.38)、终末期肾病(ESRD)(OR:2.17;95% CI:1.82 - 2.59)和冠状动脉疾病(OR:1.17;95% Cl:1.06 - 1.30)的患者大出血调整后的比值比更高。发生大出血的患者住院费用中位数更高(60326美元对45490美元),住院时间更长(7天对3天)。

结论 大出血患者死亡率更高,且基线时,凝血病和ESRD是接受TAVR患者大出血的重要预测因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7454/8319189/5f832c7e3752/cureus-0013-00000016022-i01.jpg

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