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甲状腺功能亢进症 30 天再入院的结局和预测因素:一项全国性研究。

Outcomes and Predictors of 30-Day Readmissions for Hyperthyroidism: A Nationwide Study.

机构信息

Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, USA.

Department of Internal Medicine, Central Michigan University, Saginaw, MI, USA.

出版信息

Endocrinol Metab (Seoul). 2021 Dec;36(6):1307-1311. doi: 10.3803/EnM.2021.1190. Epub 2021 Dec 1.

Abstract

Hyperthyroidism is associated with an elevated risk of cardiovascular events and worse hospital outcomes. The Nationwide Readmissions Database (NRD) 2018 was used to determine the characteristics of 30-day readmission in patients with hyperthyroidism. The 30-day all-cause readmission rate for hyperthyroidism was 10.3%. About 21.7% had hyperthyroidism as the principal diagnosis on readmission. Readmissions were associated with an increased odds of inpatient mortality (odds ratio, 7.04; 95% confidence interval [CI], 3.97 to 12.49), length of stay (5.2 days vs. 4.0 days; 95% CI, 0.7 to 1.8), total hospital charges, and cost of hospitalizations. Independent predictors of 30-day all-cause readmissions included Charlson Comorbidity Index ≥3 (adjusted hazard ratio [aHR], 1.76; 95% CI, 1.15 to 2.71), discharge against medical advice (aHR, 2.30; 95% CI, 1.50 to 3.53), protein-energy malnutrition (aHR, 1.54; 95% CI, 1.15 to 2.07), and atrial fibrillation (aHR, 1.41; 95% CI, 1.11 to 1.79). Aggressive but appropriate monitoring is warranted in patients with hyperthyroidism to prevent readmissions.

摘要

甲状腺功能亢进与心血管事件风险升高和住院结局恶化相关。使用 2018 年全国再入院数据库(NRD)确定了甲状腺功能亢进患者 30 天再入院的特征。甲状腺功能亢进的 30 天全因再入院率为 10.3%。约 21.7%的患者再入院时的主要诊断为甲状腺功能亢进。再入院与住院患者死亡率(比值比,7.04;95%置信区间[CI],3.97 至 12.49)、住院时间(5.2 天比 4.0 天;95%CI,0.7 至 1.8)、总住院费用和住院费用增加相关。30 天全因再入院的独立预测因素包括Charlson 合并症指数≥3(调整后危险比[aHR],1.76;95%CI,1.15 至 2.71)、出院时未遵医嘱(aHR,2.30;95%CI,1.50 至 3.53)、蛋白质-能量营养不良(aHR,1.54;95%CI,1.15 至 2.07)和心房颤动(aHR,1.41;95%CI,1.11 至 1.79)。需要对甲状腺功能亢进患者进行积极但适当的监测,以防止再入院。

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