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住院糖尿病患者的院内死亡率及其预测因素:一项前瞻性观察研究。

In-Hospital Mortality and Its Predictors among Hospitalized Diabetes Patients: A Prospective Observational Study.

机构信息

Jimma University, College of Health Sciences, School of Pharmacy, Jimma, Ethiopia.

Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Addis Ababa, Ethiopia.

出版信息

Int J Clin Pract. 2023 Mar 30;2023:9367483. doi: 10.1155/2023/9367483. eCollection 2023.

Abstract

BACKGROUND

Diabetes mellitus (DM) is one of the leading health emergencies of the 21 century and among the top ten causes of death among adults globally in 2017. Although Ethiopia has been victimized by the growing prevalence of DM, data regarding in-hospital mortality among admitted diabetic patients in Ethiopia, specifically in Jimma Medical Center (JMC), are lacking.

OBJECTIVE

The aim of the study is to assess in-hospital mortality and its predictors among DM patients admitted to Jimma Medical Center.

METHODS

A hospital-based prospective observational study was employed involving 120 diabetes patients admitted to JMC from October 01, 2020, to June 30, 2021. Data were collected on variables related to the patient, disease, medication, and clinical outcomes. Data were entered into Epidata version 4.6.0.4 for cleaning and exported to SPSS version 23.0 for analysis. Kaplan-Mayer and cox-regression analyses were used to compare the survival experience and to determine the predictors of clinical outcomes, respectively. Hazard ratio with its two-sided value <0.05 was considered to declare the statistical significance.

RESULT

Of 120 DM patients, 81 (67.5%) of them were males. The in-hospital mortality was 13.34% (16/120). Rural residence (AHR: 3.46; 95% CI (1.12, 9.81)), age (AHR: 1.03; 95% CI: (1.001, 1.059)), admission with diabetic ketoacidosis (AHR: 5.01; 95% CI (1.12, 21.88)), and multiple comorbidities: five comorbidities (AHR: 9.65; 95% CI (1.07, 19.59)) and six comorbidities (AHR: 14.02; 95% CI (1.74, 21.05)) were independently associated with in-hospital mortality. On the other hand, exposure to nonantidiabetic medications decreased the hazard of mortality by 86.5% (AHR: 0.135; 95% CI (0.04, 0.457)).

CONCLUSION

This study showed the rate of in-hospital mortality was noticeably high. The study showed that rural residence, age, DKA, and having comorbidities (five and six) were the statistically significant predictors of in-hospital mortality. In contrast, the use of nonantidiabetic medications such as statins, ASA, and other antihypertensive agents before admission remained protective. Thus, proper strategies have to be devised to improve in-hospital mortality among admitted DM patients.

摘要

背景

糖尿病(DM)是 21 世纪主要的健康紧急情况之一,也是 2017 年全球成年人十大死因之一。尽管埃塞俄比亚深受糖尿病患病率不断上升的影响,但关于埃塞俄比亚住院糖尿病患者的院内死亡率的数据,特别是在吉马医疗中心(JMC)的数据仍有所欠缺。

目的

本研究旨在评估在 Jimma 医疗中心住院的糖尿病患者的院内死亡率及其预测因素。

方法

采用医院前瞻性观察研究,纳入 2020 年 10 月 1 日至 2021 年 6 月 30 日期间在 JMC 住院的 120 名糖尿病患者。收集与患者、疾病、药物和临床结局相关的变量数据。数据录入 Epidata 版本 4.6.0.4 进行清理,并导出到 SPSS 版本 23.0 进行分析。Kaplan-Meier 和 Cox 回归分析用于比较生存体验,并确定临床结局的预测因素。双侧<0.05 的危险比被认为具有统计学意义。

结果

在 120 名糖尿病患者中,81 名(67.5%)为男性。院内死亡率为 13.34%(16/120)。农村居住(AHR:3.46;95%CI(1.12,9.81))、年龄(AHR:1.03;95%CI:(1.001,1.059))、入院时伴有糖尿病酮症酸中毒(AHR:5.01;95%CI(1.12,21.88))和多种合并症:五种合并症(AHR:9.65;95%CI(1.07,19.59))和六种合并症(AHR:14.02;95%CI(1.74,21.05))与院内死亡率独立相关。另一方面,使用非降糖药物可使死亡率降低 86.5%(AHR:0.135;95%CI(0.04,0.457))。

结论

本研究显示院内死亡率明显较高。研究表明,农村居住、年龄、DKA 和合并症(五种和六种)是院内死亡率的统计学显著预测因素。相比之下,在入院前使用他汀类药物、ASA 和其他降压药物等非降糖药物具有保护作用。因此,必须制定适当的策略来改善住院糖尿病患者的院内死亡率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b58/10079381/fe5cb65ffb55/IJCLP2023-9367483.001.jpg

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