Baral Nischit, Volgman Annabelle Santos, Gupta Tripti, Kunadi Arvind, Khan Mahin R, Kambalapalli Soumya, Changezi Hameem U, Tracy Melissa
Department of Internal Medicine, McLaren Flint/Michigan State University College of Human Medicine, Flint, Michigan, USA.
Department of Internal Medicine, Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
Heliyon. 2022 Jun 4;8(6):e09655. doi: 10.1016/j.heliyon.2022.e09655. eCollection 2022 Jun.
Infective endocarditis (IE) is a rare but serious complication following a Solid Organ Transplant (SOT). Due to the lack of sufficient studies, we aimed to compare in-hospital mortality and length of stay (LOS) of patients primarily admitted for IE (index or principal hospitalization) with history of SOT, including the subgroup of heart or lung transplant (HLT), to those without a history of SOT (non-SOT) or HLT (non-HLT). We used the 2016-2019 National Inpatient Sample, the largest all-payer inpatient hospital data from Healthcare Cost and Utilization Project (HCUP), including patients 18 years or older with IE, as a principal diagnosis for hospitalization. From 2016 to 2019, there were 56,330 principal or index hospitalizations for IE. Among them, 0.6 % (n = 327) were SOT recipients, 0.1% (n = 68) were HLT recipients, and 41.4% were females. The mean age was 51.9 ± 19.2 years. Compared to non-SOT controls, SOT recipients were older (mean age 59.3 vs. 51.8 years; P = 0.002) and had higher Charlson-comorbidity-index (CCI) of 3 or more (87.7% vs. 33.2%; p < 0.001). SOT status was not statistically significant for a higher or lower odds of in-hospital mortality (adjusted odds ratio (aOR) 0.7; 95% confidence interval (CI): 0.2, 2.4; p = 0.60) or increased or decreased LOS (coefficient: -0.1, 95% CI: -0.4, 0.1; p = 0.23) among index IE hospitalizations after controlling for age, sex, race, hospital-region, hospital-teaching status, income, insurance status, and CCI. HLT status was also not associated with higher or lower odds of in-hospital mortality (aOR 1.4; 95% CI: 0.2, 13.1; p = 0.77) or increased or decreased LOS (coefficient: -0.1, 95% CI: -0.3, 0.5; p = 0.59). From 2016 to 2019, the rate of index IE hospitalization trends from 37.8 to 41.4 per 100,000 overall hospitalizations (p = 0.001). We found the rate of index IE hospitalizations increasing with time. Among index IE hospitalizations, SOT, including a subgroup of HLT recipients, have similar in-hospital mortality and LOS compared to non-SOT or non-HLT groups. We need a larger sample size to comment on outcomes of IE hospitalizations with the HLT subgroup.
感染性心内膜炎（IE）是实体器官移植（SOT）后一种罕见但严重的并发症。由于缺乏足够的研究，我们旨在比较因IE（索引住院或主要住院）首次入院且有SOT病史（包括心脏或肺移植（HLT）亚组）的患者与无SOT病史（非SOT）或HLT病史（非HLT）的患者的院内死亡率和住院时长（LOS）。我们使用了2016 - 2019年国家住院样本，这是医疗成本与利用项目（HCUP）中最大的全付费者住院医院数据，包括18岁及以上以IE作为住院主要诊断的患者。2016年至2019年期间，有56330例因IE的主要或索引住院病例。其中，0.6%（n = 327）为SOT受者，0.1%（n = 68）为HLT受者，41.4%为女性。平均年龄为51.9±19.2岁。与非SOT对照组相比，SOT受者年龄更大（平均年龄59.3岁对51.8岁；P = 0.002），且Charlson合并症指数（CCI）为3或更高的比例更高（87.7%对33.2%；p < 0.001）。在控制年龄、性别、种族、医院地区、医院教学状况、收入、保险状况和CCI后，SOT状态对于索引IE住院病例的院内死亡几率更高或更低（调整后的优势比（aOR）0.7；95%置信区间（CI）：0.2，2.4；p = 0.60）或LOS增加或减少（系数： - 0.1，95% CI： - 0.4，0.1；p = 0.23）并无统计学显著意义。HLT状态与院内死亡几率更高或更低（aOR 1.4；95% CI：0.2，13.1；p = 0.77）或LOS增加或减少（系数： - 0.1，95% CI： - 0.3，0.5；p = 0.59）也无关联。2016年至2019年期间，每100000例总体住院病例中索引IE住院率从37.8升至41.4（p = 0.001）。我们发现索引IE住院率随时间增加。在索引IE住院病例中，SOT（包括HLT受者亚组）与非SOT或非HLT组相比，院内死亡率和LOS相似。我们需要更大的样本量来评论HLT亚组的IE住院病例的结局。
