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血浆置换在高甘油三酯血症性急性胰腺炎中的应用

Plasmapheresis in hypertriglyceridemia-induced acute pancreatitis.

作者信息

Shaka Hafeez, El-Amir Zain, Jamil Abdul, Kwei-Nsoro Robert, Wani Farah, Dahiya Dushyant Singh, Kichloo Asim, Amblee Ambika

机构信息

Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois.

Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, Michigan.

出版信息

Proc (Bayl Univ Med Cent). 2022 Aug 11;35(6):768-772. doi: 10.1080/08998280.2022.2106531. eCollection 2022.

Abstract

The study involved hospitalizations with a diagnosis of hypertriglyceridemia-induced acute pancreatitis (HTGAP). This cohort was grouped into plasmapheresis and nonplasmapheresis groups using ICD-10 codes (6A550Z3 and 6A551Z3). Information was obtained on inpatient mortality, length of stay, total hospital charges, as well as the occurrence of comorbid systemic immune response syndrome, sepsis, septic shock, acute respiratory failure, acute respiratory distress syndrome, kidney failure, hypocalcemia, and need for transfusion of blood products. The study identified independent predictors of plasmapheresis. The plasmapheresis group had a higher proportion of patients with diabetes mellitus and obesity. Inpatient mortality was higher in the plasmapheresis group (0.86% vs 0.57%), and plasmapheresis was also associated with longer length of stay and higher total hospital charges. Overall, plasmapheresis was associated with higher proportions of inpatient complications. Patients with HTGAP had higher odds of undergoing plasmapheresis if they were in an urban location (adjusted odds ratio [aOR] 6.14, 95% confidence Interval [CI] 1.86-20.28,  = 0.003), larger hospital (aOR 3.37, 95% CI 2.14-5.29,  < 0.001), and teaching hospital (aOR 2.01, 95% CI 1.39-2.92,  < 0.001). Black patients were less likely to undergo plasmapheresis than white patients (aOR 0.42, 95% CI 0.23-0.78,  = 0.006). Patients with HTGAP who receive plasmapheresis may be at higher risk of numerous in-hospital complications, including death, compared to those who do not receive plasmapheresis. Black and older patients were less likely to undergo plasmapheresis.

摘要

该研究纳入了诊断为高甘油三酯血症性急性胰腺炎(HTGAP)的住院患者。使用国际疾病分类第十版(ICD - 10)编码(6A550Z3和6A551Z3)将该队列分为血浆置换组和非血浆置换组。获取了关于住院死亡率、住院时间、总住院费用以及合并全身性免疫反应综合征、脓毒症、感染性休克、急性呼吸衰竭、急性呼吸窘迫综合征、肾衰竭、低钙血症和输血需求等情况的信息。该研究确定了血浆置换的独立预测因素。血浆置换组中糖尿病和肥胖患者的比例更高。血浆置换组的住院死亡率更高(0.86%对0.57%),并且血浆置换还与更长的住院时间和更高的总住院费用相关。总体而言,血浆置换与更高比例的住院并发症相关。HTGAP患者若位于城市地区(调整后的优势比[aOR]为6.14,95%置信区间[CI]为1.86 - 20.28,P = 0.003)、规模较大的医院(aOR为3.37,95% CI为2.14 - 5.29,P < 0.001)以及教学医院(aOR为2.01,95% CI为1.39 - 2.92,P < 0.001),接受血浆置换的几率更高。黑人患者接受血浆置换的可能性低于白人患者(aOR为0.42,95% CI为0.23 - 0.78,P = 0.006)。与未接受血浆置换的HTGAP患者相比,接受血浆置换的患者可能面临包括死亡在内的更多院内并发症风险。黑人和老年患者接受血浆置换的可能性较小。

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本文引用的文献

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