Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey.
Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey.
Ophthalmology. 2022 Dec;129(12):1440-1447. doi: 10.1016/j.ophtha.2022.07.006. Epub 2022 Jul 16.
Characterize the impact of frailty on endogenous endophthalmitis (EE) development and clinical outcomes among septicemic patients.
Population-level, retrospective cohort study.
Adult inpatients within the National Inpatient Sample (years 2002-2014) diagnosed with bacterial septicemia.
Septicemic patients were classified as frail or nonfrail using the previously validated Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator, and diagnosis of EE was abstracted from International Classification of Diseases 9 codes. We used multivariable logistic regression to generate odds ratios (ORs) for rates of EE development and in-hospital mortality based on frailty status. We also examined the association between frailty and blood culture-proven organism class, inpatient length of stay, and total charges billed to insurance.
Incidence of EE among septicemic patients; rates of EE development among frail and nonfrail patients; blood culture-proven microbe type, length of stay, and total charges billed to insurance.
9294 of 18 470 658 (0.05%) inpatients with bacteremia developed EE, 2102 (22.6%) of whom had at least 1 frailty-defining feature (predominantly malnutrition [68%]). Odds of developing EE were 16.7% higher for frail patients (OR, 1.167; 95% confidence interval, 1.108-1.229) when controlling for age, sex, race, concomitant human immunodeficiency virus/AIDS, pyogenic liver abscess, infectious endocarditis, cirrhosis, and diabetes with chronic complications. Frail EE patients had a 27.9% increased odds of in-hospital death, independent of age, sex, race, and Elixhauser comorbidity score (OR, 1.279; 95% confidence interval, 1.056-1.549). Higher rates of methicillin-resistant Staphylococcus aureus bacteremia (14.3% vs. 10.9%, P = 0.000016), gram-negative bacteremia (7.6% vs. 4.9%, P = 0.000003), and concomitant candidemia (10.4% vs. 7.0%, P = 0.0000004) were associated with frailty. Hospital stays were significantly longer (median, 14 days; interquartile range, 19 days; P < 0.00001) and total charges billed to insurance were significantly greater (median, $96 398; interquartile range, $154,682; P < 0.00001) among frail EE patients.
Frailty syndrome is independently associated with development of EE in the setting of bacterial septicemia; frailty-associated EE may occur in patients with malnutrition and particular bacterial subtypes, and it predisposes to higher rates of in-hospital death and health care resource usage.
描述虚弱对脓毒症患者内源性眼内炎（EE）发展和临床结局的影响。
基于人群的回顾性队列研究。
2002 年至 2014 年间国家住院患者样本中诊断为细菌性败血症的成年住院患者。
使用先前验证的约翰霍普金斯调整临床组虚弱定义诊断指标，将败血症患者分为虚弱或非虚弱，并从国际疾病分类第 9 版代码中提取 EE 诊断。我们使用多变量逻辑回归根据虚弱状况生成 EE 发展和住院死亡率的优势比（OR）。我们还检查了虚弱与血培养阳性菌属、住院时间和向保险公司开具的总费用之间的关联。
败血症患者中 EE 的发生率；虚弱和非虚弱患者中 EE 的发展率；血培养阳性的微生物类型、住院时间和向保险公司开具的总费用。
18470658 名菌血症住院患者中有 9294 名（0.05%）发生 EE，其中 2102 名（22.6%）至少有 1 项虚弱定义特征（主要是营养不良[68%]）。在控制年龄、性别、种族、合并人类免疫缺陷病毒/艾滋病、化脓性肝脓肿、感染性心内膜炎、肝硬化和伴有慢性并发症的糖尿病后，虚弱患者发生 EE 的几率高出 16.7%（OR，1.167；95%置信区间，1.108-1.229）。虚弱 EE 患者的院内死亡风险增加 27.9%，独立于年龄、性别、种族和 Elixhauser 合并症评分（OR，1.279；95%置信区间，1.056-1.549）。耐甲氧西林金黄色葡萄球菌菌血症（14.3% vs. 10.9%，P = 0.000016）、革兰氏阴性菌血症（7.6% vs. 4.9%，P = 0.000003）和合并念珠菌血症（10.4% vs. 7.0%，P = 0.0000004）的发生率较高与虚弱有关。虚弱 EE 患者的住院时间明显延长（中位数 14 天；四分位间距 19 天；P < 0.00001），向保险公司开具的总费用明显增加（中位数 96398 美元；四分位间距 154682 美元；P < 0.00001）。
虚弱综合征与细菌性败血症患者 EE 的发生独立相关；虚弱相关的 EE 可能发生在营养不良和特定细菌亚型的患者中，并且易导致更高的院内死亡率和医疗资源使用。
