Solanki Dhanshree, Lal Darshan, Sunny Angel, Han Xianghui, Iyanar Swathi, Halder Abhik, Mullangi Sanjana, Desai Maheshkumar, Khan Uzair, Theli Abhinay, Devani Hiteshkumar, Kumar Piyush, Patel Achint A, Lekkala Manidhar
Hospital Administration, Rutgers University, New Brunswick, USA.
Hospital Medicine, University of Nevada, Las Vegas, School of Medicine, Las Vegas, USA.
Cureus. 2022 Jul 30;14(7):e27477. doi: 10.7759/cureus.27477. eCollection 2022 Jul.
Background This retrospective study was conducted to analyze the temporal trends, predictors, and impact of disseminated intravascular coagulation (DIC) on outcomes among septicemic patients using a nationally representative database. Methods We derived data from the National Inpatient Sample (NIS) for the years 2008-2017 for adult hospitalizations due to sepsis. The primary outcomes were in-hospital mortality and discharge to facility. The Cochran-Armitage test and multivariable survey logistic regression models were used to analyze the data. Results Out of 12,820,000 hospitalizations due to sepsis, 153,181 (1.18%) were complicated by DIC. The incidence of DIC decreased from 2008 to 2017. In multivariable regression analysis, demographics and comorbidities were associated with higher odds of DIC. During the study period, in-hospital mortality among patients with sepsis decreased, but the attributable risk percent of in-hospital mortality due to DIC increased. We observed similar trends for discharge to facility; however, the adjusted odds of discharge to facility due to DIC remained stable over the study period. Conclusion Although the incidence of sepsis complicated by DIC decreased, the attributable in-hospital mortality rate due to DIC increased during the study period. We identified several predictors associated with the development of DIC in sepsis, some of which are potentially modifiable.
背景 本回顾性研究旨在利用一个具有全国代表性的数据库，分析脓毒症患者中弥散性血管内凝血（DIC）的时间趋势、预测因素及其对预后的影响。方法 我们从2008年至2017年的全国住院患者样本（NIS）中获取因脓毒症住院的成年患者的数据。主要结局为住院死亡率和转至医疗机构。采用 Cochr an-Armitage检验和多变量调查逻辑回归模型对数据进行分析。结果 在12820000例因脓毒症住院的患者中，153181例（1.18%）并发DIC。DIC的发病率从2008年到2017年有所下降。在多变量回归分析中，人口统计学特征和合并症与DIC的较高发生几率相关。在研究期间，脓毒症患者的住院死亡率下降，但DIC所致住院死亡率的归因风险百分比增加。我们观察到转至医疗机构的情况也有类似趋势；然而，在研究期间，因DIC转至医疗机构的校正几率保持稳定。结论 尽管并发DIC的脓毒症发病率下降，但在研究期间，DIC所致的住院死亡率归因率增加。我们确定了脓毒症中与DIC发生相关的几个预测因素，其中一些可能是可改变的。
