背景:移植物抗宿主病(GVHD)是接受骨髓移植(BMT)的个体中公认的并发症。需要关于经历BMT的个体中GVHD的患者预后的补充数据。我们的分析旨在评估接受BMT的住院患者与GVHD相关的医疗负担和结局。
方法:在这项回顾性研究中,我们使用了2016年至2019年全国住院患者样本(NIS)数据库的数据.利用ICD-10代码,我们区分了与BMT相关的住院治疗,并将其分为两类:GVHD患者和无GVHD患者.我们的重点领域包括住院死亡率,逗留时间,charges,以及与GVHD相关的协会。未调整的赔率比/系数是通过单变量分析计算的,其次是多变量分析中考虑潜在混杂因素的校正比值比(aORs)/系数.
结果:从2016年到2019年,收集了13,999例骨髓移植住院患者的数据。其中,836例发生GVHD。患者特征显示两组之间的平均年龄和人口统计学略有不同,GVHD患者的平均年龄为51.61岁,男性和白人的百分比更高。分析结果,GVHD患者的住院时间明显延长(41.4天与21.3天)和更高的总住院费用(824,058美元与335,765美元)。调整混杂因素,GVHD构成了巨大的风险。GVHD住院死亡率的aOR为7.20(95%CI:5.54-9.36,p<.001)。住院时间的系数为19.36天(95%CI:17.29-21.42,p<.001),GVHD病例的总住院费用系数为453,733美元(95%CI:396,577美元至510,889美元,p<.001)。此外,患者的GVHD与各种医疗状况的风险升高相关。败血症的AOR,肺炎,急性呼吸衰竭,插管和机械通气,艰难梭菌感染,GVHD患者的急性肾损伤(AKI)为2.79(95%CI:2.28-3.41,p<.001),3.30(95%CI:2.57-4.24,p<.001),5.10(95%CI:4.01-6.49,p<.001),4.88(95%CI:3.75-6.34,p<.001),1.45(95%CI:1.13-1.86,p=0.003),和3.57(95%CI:2.97-4.29,p<.001)。
结论:接受BMT的个体GVHD与死亡率升高有关,住院时间延长,和更高的医疗成本。此外,他们面临的并发症风险显著增加,比如败血症,肺炎,急性呼吸衰竭,艰难梭菌感染,AKI。这些结果强调了警惕监测和有效管理GVHD以改善患者预后并减少与BMT相关的并发症的迫切需要。然而,进一步的前瞻性研究对于更深刻地了解和全面评估这些住院患者的结局至关重要.
BACKGROUND: Graft-versus-host disease (GVHD) is a recognized complication among individuals undergoing bone marrow transplantation (BMT). There is a requirement for supplementary data regarding the in-patient outcomes of GVHD in individuals who have undergone BMT. Our analysis seeks to assess the healthcare burden and outcomes associated with GVHD in hospitalized patients who have undergone BMT.
METHODS: In this retrospective study, we used data from the National Inpatient Sample (NIS) database spanning from 2016 to 2019. Utilizing ICD-10 codes, we distinguished hospitalizations related to BMT and grouped them into two categories: those with GVHD and those without GVHD. Our areas of focus included in-hospital mortality, length of stay, charges, and associations related to GVHD. Unadjusted odds ratios/coefficients were computed through univariable analysis, followed by adjusted odds ratios (aORs)/coefficients from multivariable analysis that considered potential confounding factors.
RESULTS: From 2016 to 2019, data were collected from 13,999 hospitalizations with bone marrow transplants. Among them, 836 had GVHD cases. Patient characteristics showed slight differences in mean age and demographics between the two groups, with GVHD patients having a mean age of 51.61 years and higher percentages of males and whites. Analyzing outcomes, patients with GVHD experienced significantly longer hospital stays (41.4 days vs. 21.3 days) and higher total hospital charges ($824,058 vs. $335,765). Adjusting for confounding factors, GVHD posed a substantial risk. The aOR for mortality in GVHD hospitalizations was 7.20 (95% CI: 5.54-9.36, p < .001). The coefficient for the length of stay was 19.36 days (95% CI: 17.29-21.42, p < .001), and the coefficient for total hospital charges was $453,733 (95% CI: $396,577 to $510,889, p < .001) in GVHD cases. Furthermore, GVHD in patients was associated with elevated risks of various medical conditions. The aORs for sepsis, pneumonia, acute respiratory failure, intubation and mechanical ventilation, Clostridium difficile infection, and acute kidney injury (AKI) in GVHD patients were 2.79 (95% CI: 2.28-3.41, p < .001), 3.30 (95% CI: 2.57-4.24, p < .001), 5.10 (95% CI: 4.01-6.49, p < .001), 4.88 (95% CI: 3.75-6.34, p < .001), 1.45 (95% CI: 1.13-1.86, p = .003), and 3.57 (95% CI: 2.97-4.29, p < .001).
CONCLUSIONS: GVHD in individuals undergoing BMT is linked to elevated mortality rates, prolonged hospitalization, and higher healthcare costs. Moreover, they face a significantly increased risk of developing complications, such as sepsis, pneumonia, acute respiratory failure, C. difficile infection, and AKI. These results underscore the critical need for vigilant monitoring and effective GVHD management to improve patient outcomes and reduce the complications associated with BMT. Nevertheless, further prospective studies are essential to obtain a more profound understanding and a comprehensive assessment of outcomes in these hospitalized patients.