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2015 年至 2020 年全国住院患者样本中人类免疫缺陷病毒患者冠状动脉旁路移植术的结局:一项基于人群的研究。

Coronary artery bypass grafting outcomes of patients with human immunodeficiency virus: a population-based study of National Inpatient Sample from 2015 to 2020.

机构信息

The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, D.C., 20052, USA.

Department of Surgery, The George Washington University Hospital, Washington, D.C., USA.

出版信息

Sci Rep. 2024 Jun 22;14(1):14394. doi: 10.1038/s41598-024-65518-y.

Abstract

Individuals affected by human immunodeficiency virus (HIV) have a growing demand for coronary artery bypass grafting (CABG) due to heightened risk for cardiovascular diseases and extended life expectancy. However, CABG outcomes in HIV patients are not well-established, with insights only from small case series studies. This study conducted a comprehensive, population-based examination of in-hospital CABG outcomes in HIV patients. Patients underwent CABG were identified in National Inpatient Sample from Q4 2015-2020. Patients with age < 18 years and concomitant procedures were excluded. A 1:5 propensity-score matching was used to address preoperative group differences. Among patients who underwent CABG, 613 (0.36%) had HIV and were matched to 3119 out of 167,569 non-HIV patients. For selected HIV patients, CABG is relatively safe, presenting largely similar outcomes. After matching, HIV and non-HIV patients had comparable in-hospital mortality rates (2.13% vs. 1.67%, p = 0.40). Risk factors associated with mortality among HIV patients included previous CABG (aOR = 14.32, p = 0.01), chronic pulmonary disease (aOR = 8.24, p < 0.01), advanced renal failure (aOR = 7.49, p = 0.01), and peripheral vascular disease (aOR = 6.92, p = 0.01), which can be used for preoperative risk stratification. While HIV patients had higher acute kidney injury (AKI; 26.77% vs. 21.77%, p = 0.01) and infection (8.21% vs. 4.18%, p < 0.01), other complications were comparable between the groups.

摘要

个体感染人类免疫缺陷病毒 (HIV) 后,心血管疾病风险增加,预期寿命延长,因此对冠状动脉旁路移植术 (CABG) 的需求不断增长。然而,HIV 患者的 CABG 结果尚未得到充分证实,仅有少数病例系列研究提供了相关见解。本研究对 HIV 患者住院期间 CABG 的结果进行了全面的基于人群的研究。2015 年第四季度至 2020 年期间,在国家住院患者样本中确定了接受 CABG 的患者。排除年龄 < 18 岁和合并手术的患者。采用 1:5 倾向评分匹配来解决术前组间差异。在接受 CABG 的患者中,有 613 例(0.36%)患有 HIV,并与 167569 例非 HIV 患者中的 3119 例进行匹配。对于选定的 HIV 患者,CABG 相对安全,结果大致相似。匹配后,HIV 和非 HIV 患者的住院死亡率相当(2.13% vs. 1.67%,p=0.40)。与 HIV 患者死亡相关的风险因素包括既往 CABG(aOR=14.32,p=0.01)、慢性肺部疾病(aOR=8.24,p<0.01)、晚期肾衰竭(aOR=7.49,p=0.01)和外周血管疾病(aOR=6.92,p=0.01),这些因素可用于术前风险分层。虽然 HIV 患者的急性肾损伤 (AKI;26.77% vs. 21.77%,p=0.01) 和感染(8.21% vs. 4.18%,p<0.01)的发生率更高,但两组之间的其他并发症发生率相当。

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