系统性硬化症肺动脉高压:全国住院病人分析。

IF 1.4 4区 医学 Q3 RHEUMATOLOGY
ARP Rheumatology Pub Date : 2024-04-01
Hania Sami, Faria Sami, Almurtada Razok, Mona Dasgupta, Rohan Gajjar
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引用次数: 0

摘要

目的:我们旨在研究 SS 中肺动脉高压的患病率和流行病学,以及 PAH 对美国 SSc 住院治疗的影响:我们旨在研究 SS 中肺动脉高压的患病率和流行病学,以及 PAH 对美国 SSc 患者住院治疗的影响:我们利用 2016-2019 年的全国住院病人样本(NIS),获得了主要/次要诊断为 SSc 和并存 PAH(SSc-PAH)的成人住院病例。研究了流行病学变量、死亡率和次要结果,包括肺栓塞、心房扑动、心房颤动和心室颤动、肺炎、脓毒症、心脏骤停和心肾功能衰竭以及呼吸机需求。根据住院总费用(THC)和住院时间(LOS)估算医疗负担。统计分析采用 STATA 16.1,使用线性和逻辑回归分析:在 126,685 名住院的系统性硬化症成人患者中,16.89%患有 PAH(SSc-PAH)。SSc-PAH组中女性明显较多(85.4% 对 83.8%),平均年龄较高(64.85±13.29 对 62.56±14.51)。该组非裔美国人比对照组多(19.5% 对 14.6,P 值):与无 PAH 的 SSc 患者相比,SSc 患者的肺动脉高压与死亡率和发病率方面更差的预后以及更高的医疗负担有关。此外,PAH 对白人、非裔美国人和亚裔人群的影响尤为严重。目前仍迫切需要继续努力,对 SSc 患者的 PAH 进行早期诊断和管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pulmonary arterial hypertension in systemic sclerosis: a national inpatient analysis.

Objectives: We aim to study the prevalence and epidemiology of pulmonary arterial hypertension in SS, and the impact of PAH on SSc hospitalizations in the United States population.

Methods: We utilized the National Inpatient Sample (NIS) from 2016-2019 to obtain adult hospitalizations with the primary/secondary diagnosis of SSc and coexistent PAH (SSc-PAH). Epidemiological variables, mortality rates, and secondary outcomes were studied including pulmonary embolism, atrial flutter, atrial and ventricular fibrillation, pneumonia, sepsis, cardiac arrest and cardiac & renal failure, and ventilator requirement. Healthcare burden was estimated from total hospital charges (THC) and length of stay (LOS). Statistical analysis was performed on STATA 16.1, using linear and logistic regression analyses.

Results: Out of 126,685 adult systemic sclerosis hospitalizations, 16.89% had PAH (SSc-PAH). The SSc-PAH group had significantly more females (85.4 % vs. 83.8%) and higher mean age (64.85±13.29 vs. 62.56±14.51). More African Americans were in this group than in the control group (19.5% vs. 14.6, p-value<0.001) while Whites (61.3% vs. 65.6%, p<0.001) and Asians (18.0 % vs. 2.8%, p<0.001) were less common. Charlson comorbidity index was higher for the SSc-PAH population (3.42 vs. 2.94, p-value<0.001). SSc-PAH group had a higher adjusted odds ratio (aOR) for mortality (aOR: 1.39, p<0.001), increased LOS (6.64 vs. 6.0 days, p<0.001) increased THC ($83,813 vs. $71,016, p <0.001). For the SSc-PAH group, there were also significantly higher odds of cardiac failure (aOR 3.13), ventilator requirement (aOR 2.15), cardiac arrest (aOR 1.39), kidney failure (aOR 1.63), pulmonary embolism (aOR 1.84), atrial flutter (aOR 1.86) atrial fibrillation (aOR1.56) and pneumonia (aOR 1.22). No significant difference in ventricular fibrillation, sepsis, or respiratory failure was noted.

Conclusion: Pulmonary arterial hypertension in SSc is associated with worse outcomes in terms of mortality and morbidity, and higher healthcare burden compared to SSc without PAH. Also, PAH disproportionately affects White, African American & Asian populations. There remains a pressing need to continue efforts for early diagnosis and management of PAH in SSc patients.

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