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慢性肾脏病患者经导管主动脉瓣置换术后再入院率、预测因素及原因

Rates, predictors, and causes of readmission after transcatheter aortic valve replacement in patients with chronic kidney disease.

作者信息

Teaima Taha, Carlini Gianfranco Bittar, Gajjar Rohan A, Aziz Imran, Shoura Sami J, Shilbayeh Abdul-Rahim, Battikh Naim, Alyousef Tareq

机构信息

Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, United States.

出版信息

World J Cardiol. 2024 Jul 26;16(7):402-411. doi: 10.4330/wjc.v16.i7.402.

Abstract

BACKGROUND

Transcatheter aortic valve replacement (TAVR) is a revolutionary procedure for severe aortic stenosis. The coexistence of chronic kidney disease (CKD) and TAVR introduces a challenge that significantly impacts patient outcomes.

AIM

To define readmission rates, predictors, and causes after TAVR procedure in CKD stage 1-4 patients.

METHODS

We used the national readmission database 2018 and 2020 to look into readmission rates, causes and predictors after TAVR procedure in patients with CKD stage 1-4.

RESULTS

Out of 24758 who underwent TAVR and had CKD, 7892 (32.4%) patients were readmitted within 90 days, and had higher adjusted odds of being females (adjusted odds ratio: 1.17, 95%CI: 1.02-1.31, = 0.02) with longer length of hospital stay > 6 days, and more comorbidities including but not limited to diabetes mellitus, anemia, and congestive heart failure (CHF).

CONCLUSION

Most common causes of readmission included CHF (18.0%), sepsis, and complete atrioventricular block. Controlling readmission predictors with very close follow-up is warranted to prevent such high rate of readmission.

摘要

背景

经导管主动脉瓣置换术(TAVR)是治疗严重主动脉瓣狭窄的一项革命性手术。慢性肾脏病(CKD)与TAVR并存带来了一项挑战,对患者预后有显著影响。

目的

确定1-4期CKD患者TAVR术后的再入院率、预测因素及原因。

方法

我们利用2018年和2020年的国家再入院数据库,研究1-4期CKD患者TAVR术后的再入院率、原因及预测因素。

结果

在24758例接受TAVR且患有CKD的患者中,7892例(32.4%)在90天内再次入院,女性再次入院的调整后几率更高(调整优势比:1.17,95%置信区间:1.02-1.31,P = 0.02),住院时间更长>6天,且有更多合并症,包括但不限于糖尿病、贫血和充血性心力衰竭(CHF)。

结论

再入院的最常见原因包括CHF(18.0%)、败血症和完全性房室传导阻滞。有必要通过密切随访控制再入院预测因素,以防止如此高的再入院率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a80d/11287458/268fece83751/WJC-16-402-g001.jpg

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