Section of Cardiology.
Section of Cardiology, University of Toledo Medical Center, Toledo, Ohio.
Am J Cardiol. 2022 Jul 1;174:27-33. doi: 10.1016/j.amjcard.2022.03.027. Epub 2022 May 4.
Septic shock is a life-threatening host response to infection and a significant contributor to cost burden in the United States. Furthermore, sepsis-related inflammation has been linked to myocardial infarction (MI). We sought to examine the association of type 1 and type 2 MI with outcomes in hospitalizations admitted with septic shock. The National Readmission Database 2018 was queried to identify hospitalizations with hospital discharge diagnoses of septic shock without MI, septic shock with type 1 MI, or septic shock with type 2 MI. Complex-sample multivariable logistic and linear regression models were used to determine the association of these conditions with clinical outcomes. Of 354,528 hospitalizations with septic shock, 11,519 had type 1 MI (3.2%) and 13,970 had type 2 MI (3.9%). Compared with septic shock without MI, type 1 MI was associated with higher mortality (adjusted odds ratio [OR] 1.67, 95% confidence interval [CI] 1.57 to 1.77), costs (adjusted parameter estimate $4,571, 95% CI 3,020 to 6,122), and discharge to facility (adjusted OR 1.09, 95% CI 1.01 to 1.17). In contrast, septic shock with type 2 MI was associated with similar mortality and discharge to nursing facility and higher costs (adjusted parameter estimate 1,798, 95% CI 549 to 3,047). Septic shock hospitalizations with type 1 MI had higher in-hospital mortality (adjusted OR 1.74, 95% CI 1.60 to 1.90, p <0.001) compared with type 2 MI. In conclusion, type 1 MI is associated with higher mortality and resource utilization among septic shock hospitalizations. Furthermore, type 2 MI was associated with higher resource utilization.
感染导致的全身炎症反应综合征（脓毒症）是一种危及生命的宿主反应，也是导致美国医疗费用负担加重的重要因素。此外，与脓毒症相关的炎症与心肌梗死（MI）有关。我们试图研究 1 型和 2 型 MI 与因全身炎症反应综合征（脓毒症）入院的患者住院结局的相关性。本研究通过查询 2018 年国家再入院数据库，确定了无 MI 的脓毒症、1 型 MI 的脓毒症和 2 型 MI 的脓毒症患者的住院情况。采用复杂样本多变量逻辑回归和线性回归模型来确定这些情况与临床结局的相关性。在 354528 例因全身炎症反应综合征（脓毒症）入院的患者中，有 11519 例（3.2%）患有 1 型 MI，13970 例（3.9%）患有 2 型 MI。与无 MI 的脓毒症相比，1 型 MI 与更高的死亡率（校正比值比 [OR] 1.67，95%置信区间 [CI] 1.57 至 1.77）、更高的成本（校正参数估计值为 4571 美元，95%CI 为 3020 美元至 6122 美元）和机构出院（校正 OR 1.09，95%CI 1.01 至 1.17）相关。相反，2 型 MI 的脓毒症与相似的死亡率和护理机构出院率以及更高的成本（校正参数估计值 1798 美元，95%CI 549 美元至 3047 美元）相关。1 型 MI 的脓毒症患者院内死亡率更高（校正 OR 1.74，95%CI 1.60 至 1.90，p<0.001）。总之，1 型 MI 与脓毒症患者的死亡率和资源利用率较高相关。此外，2 型 MI 与更高的资源利用率相关。
