癌症住院患者急性肺栓塞的结局。
Outcomes of acute pulmonary embolism in hospitalized patients with cancer.
机构信息
Department of Internal Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030-1235, USA.
Advanced Heart Failure and Transplant Cardiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
出版信息
BMC Pulm Med. 2022 Jan 6;22(1):11. doi: 10.1186/s12890-021-01808-9.
BACKGROUND
Cancer-associated pulmonary embolism (PE) places a significant burden on patients and health care systems.
METHODS
A retrospective cross-sectional analysis of the National Inpatient Sample (NIS) database was performed in patients with acute PE from 2002 to 2014. Among patients hospitalized with PE, we investigated the differences in clinical outcomes and healthcare utilization in patients with and without cancer. A multivariate logistic regression model was applied to calculate adjusted odds ratios (OR) to estimate the impact of cancer on clinical outcomes. Wilcoxon rank sum tests were used to determine the differences in healthcare utilization between the two cohorts.
RESULTS
Among 3,313,044 patients who were discharged with a diagnosis of acute PE, 84.2% did not have cancer, while 15.8% had cancer as a comorbidity (56% metastatic cancer, 35% solid tumor without metastasis, and 9% lymphoma). Patients with cancer had a higher mean age but lower rates of common comorbidities except for coagulation deficiency than patients without a cancer diagnosis. In patients with cancer, the rate of IVC filter placement was higher (21.7% vs. 13.11%, OR 1.76 (95% CI 1.73-1.79); p < 0.0001) and thrombolytic use lower (1.34% vs. 2.15%, OR 0.68 (95% CI 0.64-0.72); p < 0.0001). Patients with cancer hospitalized for PE had a higher all-cause in-hospital mortality (11.8% vs. 6.6%, OR 1.79 (95% CI 1.75-1.83); p < 0.0001), longer length of stay (6 vs. 5 days; p < 0.0001), higher total charge per hospitalization ($30,885 vs. $27,273; p < 0.0001), and higher rates of home health services upon discharge (35.8% vs. 23.2%; p < 0.0001) compared with those without cancer.
CONCLUSION
Concurrent cancer diagnosis in patients hospitalized for acute PE was associated with a 90% increase in all-cause mortality, longer length of stay, higher total charge per hospitalization, and higher rates of home health services upon discharge. The majority (56%) of patients with cancer had metastatic disease. Furthermore, there were identifiable differences in the intervention for acute PE between the two groups.
背景
癌症相关肺栓塞（PE）给患者和医疗保健系统带来了巨大负担。
方法
对 2002 年至 2014 年期间国家住院患者样本（NIS）数据库中急性 PE 患者进行回顾性横断面分析。在因 PE 住院的患者中，我们研究了伴有和不伴有癌症患者在临床结局和医疗保健利用方面的差异。应用多变量逻辑回归模型计算调整后的优势比（OR），以估计癌症对临床结局的影响。采用 Wilcoxon 秩和检验比较两组间医疗保健利用的差异。
结果
在 3313044 例被诊断为急性 PE 且出院的患者中，84.2%的患者无癌症，而 15.8%的患者合并癌症（56%转移性癌症，35%无转移实体瘤，9%淋巴瘤）。与无癌症诊断的患者相比，癌症患者的平均年龄更高，但常见合并症的发生率较低，除了凝血功能障碍。在癌症患者中，静脉滤器置入率较高（21.7% vs. 13.11%，OR 1.76（95% CI 1.73-1.79）；p<0.0001），溶栓使用率较低（1.34% vs. 2.15%，OR 0.68（95% CI 0.64-0.72）；p<0.0001）。因 PE 住院的癌症患者全因院内死亡率较高（11.8% vs. 6.6%，OR 1.79（95% CI 1.75-1.83）；p<0.0001），住院时间较长（6 天 vs. 5 天；p<0.0001），每次住院总费用较高（30885 美元 vs. 27273 美元；p<0.0001），出院后家庭健康服务的比例较高（35.8% vs. 23.2%；p<0.0001）。
结论
急性 PE 住院患者并发癌症诊断与全因死亡率增加 90%、住院时间延长、每次住院总费用增加和出院后家庭健康服务使用率增加有关。大多数（56%）癌症患者患有转移性疾病。此外，两组间急性 PE 的干预措施存在明显差异。
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