脆弱性预测了患有非的上胃肠道出血的患者的死亡率和程序性表现
Ali Jaan1, Adeena Maryyum2, Hassam Ali3
1Division of Internal Medicine Unity Hospital Rochester New York USA.
概括
虚弱性显著恶化了患有非上胃肠道出血 (NVUGIB) 的患者的结果,增加了死亡率和医院资源使用. 识别脆弱的患者对于NVUGIB的量身定制的管理策略至关重要.
科学领域:
- 胃肠病学 胃肠病学
- 老年病的医生 老年病的医生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 非静脉上部胃肠道出血 (NVUGIB) 是美国常见的住院原因,与大量死亡率有关.
- 脆弱对NVUGIB患者结果的影响仍然不完全理解.
研究的目的:
- 评估NVUGIB入院患者的脆弱性和临床结果之间的关联.
- 评估NVUGIB住院期间脆弱性对资源利用的影响.
主要方法:
- 2019年国家再接收数据库 (NRD) 的回顾性分析.
- 使用ICD-10-CM代码识别成年NVUGIB入院的情况.
- 根据虚弱状态对患者进行分层,使用医院虚弱风险评分 (HFRS ≥ 5).
- 多变量回归分析以确定与结果的关联.
主要成果:
- 近一半的NVUGIB入院 (45.69%) 涉及脆弱的患者,这些患者年龄较大,并患有较高的并发症负担.
- 脆弱的患者在住院死亡率显著上升 (aOR 5.64),急性损伤,呼吸衰竭,败血性休克和出血性休克的发生率增加.
- 脆弱的个体更有可能使用血管压缩器,机械呼吸,ICU入院,再出血和放射性栓塞,以及更长的住院时间和更高的成本.
- 尽管内镜干预的几率更高,但虚弱的患者在24小时内不太可能接受食道胃管内镜检查 (EGD).
- 在脆弱群体中,康复和30天再接收率明显高于脆弱群体.
结论:
- 脆弱性是NVUGIB中不良临床结果和医疗资源利用率增加的独立预测因素.
- 在NVUGIB患者中识别脆弱性可以增强风险分层.
- 根据脆弱性评估进行量身定制的管理策略,可以改善对这一脆弱群体的护理.
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