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一项回顾性调查:来自美国中西部农村医院的脓毒症患者伴有和不伴有甲状腺功能减退症二次诊断的结局比较

A Retrospective Investigation: Outcome Comparisons Between Septic Patients With and Without Secondary Diagnosis of Hypothyroidism From a Rural Midwest Hospital.

作者信息

Eshghi Anna, Fanaee Aaron S, B Sloan Shelly N, Stahl Greg, Johnson Kerry, Goade Scott, Arnce Robert

机构信息

College of Medicine, Kansas City University, Joplin, USA.

Department of Data Improvement, Freeman Health System, Joplin, USA.

出版信息

Cureus. 2022 Feb 21;14(2):e22467. doi: 10.7759/cureus.22467. eCollection 2022 Feb.

Abstract

Background Sepsis morbidity and mortality rates have remained high despite recent developments in clinical guidelines aimed to curtail this disease process. Understanding how sepsis interacts with comorbidities and pre-existing disease states is necessary for improving sepsis treatment. Accounting for specific pre-existing conditions in the treatment of sepsis patients may not only improve patient outcomes but also reduce healthcare costs by preventing possible complications. We sought to evaluate whether the presence of hypothyroidism affects outcomes in septic patients. Methods In this retrospective observational study, we analyzed the patient dataset from a not-for-profit rural hospital from January 2019 through June 2020. We chose the initial patient sample based on International Classification of Disease (ICD10) codes for sepsis. We then used the ICD10 code for hypothyroidism within that sample to identify the septic patients with hypothyroidism. We did two-sample proportion summary hypothesis tests to identify differences in mortality and 30-day readmission rates. Results In our dataset, we had 1,122 patients with sepsis, of whom 225 had hypothyroidism. There was no difference in sepsis outcomes between patients who had hypothyroidism compared to patients who did not have hypothyroidism. Additionally, we did not find sufficient evidence to conclude that the patient's sex affects sepsis outcomes in hypothyroid patients.  Conclusion  Within this Midwest population, the sepsis outcomes were not impacted by having hypothyroidism as a secondary diagnosis. Additionally, there was no sufficient evidence to suggest an impact on sepsis outcomes based on sex, either male or female, when considering concomitant hypothyroidism.

摘要

背景 尽管近期临床指南有所发展,旨在遏制脓毒症的病程,但脓毒症的发病率和死亡率仍然很高。了解脓毒症如何与合并症及既往疾病状态相互作用,对于改善脓毒症治疗至关重要。在脓毒症患者的治疗中考虑特定的既往病症,不仅可能改善患者预后,还可通过预防可能的并发症降低医疗成本。我们试图评估甲状腺功能减退症的存在是否会影响脓毒症患者的预后。方法 在这项回顾性观察研究中,我们分析了一家非营利性农村医院2019年1月至2020年6月的患者数据集。我们根据脓毒症的国际疾病分类(ICD10)编码选择初始患者样本。然后,我们在该样本中使用甲状腺功能减退症的ICD10编码来识别患有甲状腺功能减退症的脓毒症患者。我们进行了双样本比例汇总假设检验,以确定死亡率和30天再入院率的差异。结果 在我们的数据集中,有1122例脓毒症患者,其中225例患有甲状腺功能减退症。患有甲状腺功能减退症的患者与未患有甲状腺功能减退症的患者在脓毒症预后方面没有差异。此外,我们没有找到足够的证据得出患者性别会影响甲状腺功能减退症患者脓毒症预后的结论。结论 在这个中西部人群中,甲状腺功能减退症作为次要诊断并未影响脓毒症的预后。此外,在考虑合并甲状腺功能减退症时,没有足够的证据表明男性或女性的性别对脓毒症预后有影响。

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本文引用的文献

1
Epidemiology of severe sepsis.严重脓毒症的流行病学。
Virulence. 2014 Jan 1;5(1):4-11. doi: 10.4161/viru.27372. Epub 2013 Dec 11.
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Hypothyroidism: an update.甲状腺功能减退症:更新。
Am Fam Physician. 2012 Aug 1;86(3):244-51.

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