Francis-Morel Garry, Guevara-Rodriguez Nehemias, Portillo-Canales Shellsea, Arias Morales Carlos Ernesto, Sotello David
Department of Medicine, Division of Internal Medicine, Saint Louis University Hospital, Saint Louis, Missouri, USA.
Department of Medicine, Internal Medicine, St. Barnabas Hospital, Bronx, New York, USA.
Proc (Bayl Univ Med Cent). 2024 Jan 29;37(3):450-457. doi: 10.1080/08998280.2024.2307833. eCollection 2024.
Every July, new residents begin training across the United States, but it is unclear whether this affects the mortality rate of critically ill patients such as those with diabetes ketoacidosis (DKA).
This national retrospective cohort study included patients aged 18 years or older admitted to acute care with DKA between 2016 and 2020. Data were obtained from the National Inpatient Sample Database. We compared patients admitted in July and August with those admitted during the remaining months and assessed the primary endpoint of all-cause inpatient mortality. We also obtained an odds ratio adjusted for confounders using multivariate logistic regression analysis. Secondary endpoints included length of hospital stay, total hospital charges, the crude rate of mechanical ventilation, acute kidney injury requiring hemodialysis, and vasopressor requirement. Hypothesis testing was conducted using the chi-square test for categorical variables and Student's test for continuous variables. A two-tailed value of < 0.05 was considered statistically significant.
Of the 269,095 hospitalizations identified over 5 years with a discharge diagnosis of DKA, 250,990 met the inclusion criteria. During July and August, 42,668 (17%) hospitalizations occurred, and 208,322 (83%) occurred during the remaining months. The mean age of the patients was 47 years, and there was no significant difference among the cohorts ( = 0.41). Female patients represented 54% of the total patients, and there was no difference between the cohorts ( = 0.68). Of the admitted patients, 61% were White, 21% were Black, and 11% were Hispanic, with no differences between the cohorts ( = 0.38). Medicare (35%) and Medicaid (30%) were the primary payers for most patients, and approximately 25% had private insurance. There were no differences between the cohorts in terms of primary payers ( = 0.49). The mean length of stay was 7 days, and the total hospitalization cost was $85,509. Admission in July or August did not increase the odds of inpatient mortality (adjusted odds ratio 0.96, = 0.58).
In this retrospective cohort study of patients admitted with DKA, inpatient care during July and August did not increase the odds of inpatient mortality.
每年7月，美国各地都会有新的住院医师开始培训，但尚不清楚这是否会影响糖尿病酮症酸中毒（DKA）等重症患者的死亡率。
这项全国性回顾性队列研究纳入了2016年至2020年间因DKA入住急症科的18岁及以上患者。数据来自全国住院患者样本数据库。我们将7月和8月入院的患者与其余月份入院的患者进行比较，并评估全因住院死亡率这一主要终点。我们还使用多因素逻辑回归分析获得了经混杂因素调整后的比值比。次要终点包括住院时间、总住院费用、机械通气的粗发生率、需要血液透析的急性肾损伤以及血管升压药的使用情况。使用卡方检验对分类变量进行假设检验，使用学生t检验对连续变量进行假设检验。双侧P值<0.05被认为具有统计学意义。
在5年期间确定的269,095例出院诊断为DKA的住院病例中，250,990例符合纳入标准。7月和8月期间发生了42,668例（17%）住院病例，其余月份发生了208,322例（83%）。患者的平均年龄为47岁，各队列之间无显著差异（P = 0.41）。女性患者占总患者的54%，各队列之间无差异（P = 0.68）。在入院患者中，61%为白人，21%为黑人，11%为西班牙裔，各队列之间无差异（P = 0.38）。医疗保险（35%）和医疗补助（30%）是大多数患者的主要支付方，约25%的患者有私人保险。各队列在主要支付方方面无差异（P = 0.49）。平均住院时间为7天，总住院费用为85,509美元。7月或8月入院并未增加住院死亡率的几率（调整后的比值比为0.96，P = 0.58）。
在这项对因DKA入院患者的回顾性队列研究中，7月和8月的住院治疗并未增加住院死亡率的几率。
