Zou Guangchen, Liu Hongli, Lin Kaiqing, Zhu Kaiwen, Hsieh Tien-Chan
Internal Medicine, Danbury Hospital, Danbury, USA.
Internal Medicine, Rochester Regional Health, Rochester, USA.
Cureus. 2022 Apr 25;14(4):e24484. doi: 10.7759/cureus.24484. eCollection 2022 Apr.
Introduction Influenza causes significant morbidity and mortality annually in the United States (US) and people with chronic medical conditions are thought to be at higher risk for severe disease and death. Infection is a leading cause of death for patients with end-stage kidney disease (ESKD). We used a national-level inpatient database to study the trend of influenza hospitalizations and in-hospital mortality for patients without and with ESKD. Methods The National Inpatient Sample (NIS) 2010-2019 was used. A primary diagnosis of influenza was identified using ICD-9-CM (487.X, 488.X) and ICD-10-CM codes (J09.X, J10.X, J11.X). ESKD was identified using a validated algorithm identifying patients with a diagnosis of ESKD or procedure code for dialysis and excluding patients with a diagnosis of acute kidney injury. Other diagnoses and procedures were identified using validated algorithms based on ICD-9-CM, ICD-10-CM, and ICD-10-PCS codes. Discharge-level weights were used to estimate the total number of admissions in the NIS universe. Weighted multivariable logistic regression was performed to study the association between ESKD and in-hospital death. Results 131,942 admissions with a primary diagnosis of influenza with 4,647 admissions for ESKD patients among them were included in our analysis. Admissions varied by influenza season and ESKD patients accounted for 2.91% to 3.65% of all influenza admissions each season. 2,081 influenza patients (1.58%) died in the hospital and 115 patients with influenza and ESKD (2.47%) died in the hospital. Age-adjusted in-hospital mortality varied from season to season but was consistently higher in ESKD patients (2.25% vs 1.38%). ESKD was a risk factor for in-hospital death (OR 1.26, 95% CI 1.15-1.38) after adjusting for age, gender, primary payer, heart failure, chronic lung disease, obesity, drug abuse, immunocompromised status, bacterial pneumonia, the Charlson Comorbidity Index, and the influenza season. Conclusion ESKD patients accounted for a significant proportion of influenza hospitalizations in the US from 2010-11 to the 2018-19 influenza season. Among people hospitalized primarily for influenza, age-adjusted in-hospital mortality varied from season to season and was consistently higher in ESKD patients. For people hospitalized primarily for influenza, ESKD was an independent risk factor for in-hospital death.
引言
在美国，流感每年都会导致大量发病和死亡，患有慢性疾病的人群被认为患重症疾病和死亡的风险更高。感染是终末期肾病（ESKD）患者死亡的主要原因。我们使用了一个国家级住院患者数据库来研究ESKD患者和非ESKD患者流感住院率及院内死亡率的趋势。
方法
使用2010 - 2019年全国住院患者样本（NIS）。通过ICD - 9 - CM（487.X、488.X）和ICD - 10 - CM编码（J09.X、J10.X、J11.X）确定流感的主要诊断。通过一种经过验证的算法确定ESKD，该算法可识别出诊断为ESKD或有透析程序编码的患者，并排除急性肾损伤诊断患者。基于ICD - 9 - CM、ICD - 10 - CM和ICD - 10 - PCS编码，使用经过验证的算法确定其他诊断和程序。出院水平权重用于估计NIS总体中的入院总数。进行加权多变量逻辑回归以研究ESKD与院内死亡之间的关联。
结果
我们的分析纳入了131,942例主要诊断为流感的入院患者，其中4,647例为ESKD患者。入院情况因流感季节而异，ESKD患者占每个季节所有流感入院患者的2.91%至3.65%。2,081例流感患者（1.58%）在医院死亡，115例患有流感和ESKD的患者（2.47%）在医院死亡。年龄调整后的院内死亡率因季节而异，但ESKD患者的死亡率始终较高（2.25%对1.38%）。在调整了年龄、性别、主要支付方、心力衰竭、慢性肺病、肥胖、药物滥用、免疫功能低下状态、细菌性肺炎、Charlson合并症指数和流感季节后，ESKD是院内死亡的一个危险因素（比值比1.26，95%置信区间1.15 - 1.38）。
结论
在2010 - 11年至2018 - 19年流感季节期间，ESKD患者在美国流感住院患者中占很大比例。在主要因流感住院的人群中，年龄调整后的院内死亡率因季节而异，ESKD患者的死亡率始终较高。对于主要因流感住院的人群，ESKD是院内死亡的独立危险因素。
