住院造血干细胞移植受者的侵袭性肺曲霉病:基于美国国家再入院数据库的结果

Q1 Medicine

Hematology/ Oncology and Stem Cell Therapy Pub Date : 2023-07-20 DOI:10.56875/2589-0646.1109

Amir Khalil, Paramveer Singh, Tanveer Mir, Mohammed Uddin, Ayman O Soubani

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引用次数: 0

摘要

背景和目的:造血干细胞移植(HSCT)是一种成熟的治疗血液恶性肿瘤和某些自身免疫性疾病和先天性疾病的方法。造血干细胞移植与免疫功能低下和感染风险增加有关。本研究评估了侵袭性肺曲霉病(IPA)是否影响HSCT患者的住院死亡率和30天再入院率。次要目的是检查有IPA和没有IPA的HSCT之间并发症的潜在差异。材料和方法:对具有全国代表性的住院队列进行了回顾性研究，数据收集自2013年至2019年医疗保健研究和质量机构的医疗保健成本和利用项目全国再入院数据库。使用国际疾病分类第10版(ICD-10)和第9版(ICD-9)诊断代码来识别IPA和HSCT患者。所有≥18岁的成人患者均纳入研究。结果:2013 - 2019年有90451例HSCT住院;89,331例(98.8%)患者为无IPA的HSCT，而1092例(1.2%)住院患者为有IPA的HSCT。HSCT-IPA的住院死亡率高于不进行IPA的HSCT (18.3% vs. 4.2%;P < 0.001)。HSCT-IPA患者的30天再入院率(36.2%)明显高于无IPA的HSCT患者(24.0%)。HSCT-IPA的平均入院费用(303,437美元)也高于不接受IPA的HSCT(57,587美元)。HSCT-IPA组有更高的多器官并发症，包括呼吸衰竭(51.3%比13.5%，p < 0.001)、败血症(38.2%比18.5%，p < 0.001)、感染性休克(16.1%比5.1%，p < 0.001)、需要机械通气(21.1%比5.1% p < 0.001)、无创正压通气(4.9%比2.5%，p < 0.001)和入住重症监护病房(21.8%比6.1% p < 0.001)。结论:IPA是与HSCT相关的一种罕见但严重的并发症，与没有IPA的HSCT相比，住院死亡率、多器官衰竭并发症、再入院率和住院费用更高。

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Invasive Pulmonary Aspergillosis in Hospitalized Hematopoietic Stem Cell Transplantation Recipients: Outcomes Based on the United States National Readmission Database.

Background and objective: Hematopoietic stem cell transplant (HSCT) is a well-established treatment for hematologic malignancies and certain autoimmune and congenital conditions. HSCT is associated with immunocompromise and increased risk of infections. This study assessed whether invasive pulmonary aspergillosis (IPA) affects in-hospital mortality and 30-day readmission among HSCT patients. A secondary objective was to examine potential differences in complications between HSCT with and without IPA.

Materials and methods: A retrospective study of a nationally representative cohort of hospital admissions was conducted, with data collected from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmissions Database between 2013 and 2019. The International Classification of Diseases, 10th revision (ICD-10), and 9th revision (ICD-9) diagnostic codes were used to identify patients with IPA and HSCT. All adult patients ≥18 years were included in the study.

Results: There were 90,451 hospitalizations for HSCT from 2013 to 2019; 89,331 (98.8%) had HSCT without IPA, while 1092 (1.2%) hospitalizations had HSCT with IPA. The in-hospital mortality for HSCT-IPA was higher compared to HSCT without IPA (18.3% vs. 4.2%; p < 0.001). HSCT-IPA had a significantly higher 30-day readmission rate (36.2%) than that of HSCT without IPA (24.0%). HSCT-IPA also had a higher mean cost of admission ($303,437) than that of HSCT without IPA ($57,587).The HSCT-IPA group had higher multi-organ complications, including respiratory failure (51.3% vs. 13.5%, p < 0.001), sepsis (38.2% vs. 18.5%, p < 0.001), septic shock (16.1% vs. 5.1%, p < 0.001), need for mechanical ventilation (21.1% vs. 5.1% p < 0.001), non-invasive positive pressure ventilation (4.9% vs. 2.5%, p < 0.001), and intensive-care unit admission (21.8% vs. 6.1% p < 0.001).

Conclusion: IPA is a rare but severe complication associated with HSCT, with higher in-hospital mortality, complications due to multi-organ failure, readmission rates, and cost of hospitalization when compared to HSCT without IPA.

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来源期刊

Hematology/ Oncology and Stem Cell Therapy Medicine-Hematology

CiteScore

4.30

自引率

0.00%

发文量

审稿时长

27 weeks

期刊介绍： Hematology Oncology and Stem Cell Therapy is an international, peer-reviewed, open access journal that provides a vehicle for publications of high-quality clinical as well as basic science research reports in hematology and oncology. The contents of the journal also emphasize the growing importance of hematopoietic stem cell therapy for treatment of various benign and malignant hematologic disorders and certain solid tumors.The journal prioritizes publication of original research articles but also would give consideration for brief reports, review articles, special communications, and unique case reports. It also offers a special section for clinically relevant images that provide an important educational value.