背景:胃食管反流病(GERD)与肺动脉高压(PH)患者的发病率和死亡率之间的关系尚不清楚。我们的目标是研究社会人口统计学的差异,合并症,PH患者的发病率/死亡率也被诊断为GERD,与无GERD的PH患者相比。
方法:我们对美国国家大型住院患者样本进行了回顾性横断面研究,确定了主要诊断为原发性肺动脉高压(PH)的患者。纳入NIS数据库中2001年1月1日至2013年12月31日主要诊断为PH的所有≥18岁患者。我们分析了有和没有GERD的PH患者的社会人口统计学和临床合并症。我们调查了该人群中PH并发症的预测因素和医院利用率的差异。
结果:合并GERD的PH患者年龄大于18-29岁。他们更有可能是白种人和女性,与收入最低的25%相比,他们不太可能成为收入最高的75%的一部分。GERD患者更有可能获得医疗保险或私人保险,但不太可能获得医疗补助或没有保险。患者更容易肥胖,患有哮喘,慢性支气管炎,阻塞性睡眠呼吸暂停,高血压,和甲状腺功能减退,但不太可能有糖尿病或饮酒史。患有GERD的PH患者不太可能发生心肌梗塞,心脏骤停,肺栓塞,肺出血,心脏干预,急性呼吸衰竭,急性肾功能衰竭,或与没有GERD的尿路感染相比。GERD患者,然而,更有可能有急性心力衰竭恶化和吸入性肺炎。诊断为GERD的患者死亡率较低,停留时间(LOS)以及与同行相比的医院费用。
结论:合并出现GERD与PH患者的不良结局较少相关。虽然它是众所周知的治疗GERD是有益的肺部疾病,GERD在PH中的确切作用尚未确定。这项研究有助于表征适当治疗的GERD在预防PH引起的发病率和死亡率方面可能发挥的重要作用。
BACKGROUND: The association between gastroesophageal reflux disease (GERD) and morbidity and mortality in patients with pulmonary arterial hypertension (PH) is unknown. Our objective was to examine the difference in socio-demographics, comorbidities, and morbidity/mortality in PH patients also diagnosed with GERD, compared to PH patients without GERD.
METHODS: We performed a retrospective cross-sectional study of the large U.S. National Inpatient Sample identifying patients with a primary diagnosis of primary pulmonary hypertension (PH). All patients ≥ 18 years old that were admitted with a primary diagnosis of PH from January 1, 2001, to December 31, 2013, in the NIS database were included. We analyzed the socio-demographic and clinical comorbidities in PH patients with and without GERD. We investigated the predictors for complications of PH and differences in hospital utilization in this population.
RESULTS: PH patients with GERD were more likely to be older than 18-29 years. They were more likely to be Caucasian and female and less likely to be part of the top 75% median income compared to the bottom 25%. Patients with GERD were more likely insured with Medicare or private insurance but less likely to have Medicaid or be uninsured. Patients were more likely to be obese, and have asthma, chronic bronchitis, obstructive sleep apnea, hypertension, and hypothyroidism but were less likely to have diabetes or a history of alcohol use. PH Patients with GERD were less likely to have myocardial infarctions, cardiac arrests, pulmonary embolisms, pulmonary hemorrhages, cardiac interventions, acute respiratory failure, acute renal failure, or urinary tract infections compared to those without GERD. Patients with GERD were, however, more likely to have acute heart failure exacerbations and aspiration pneumonia. Patients with a diagnosis of GERD had lower mortality, length of stay (LOS), and hospital costs compared to their counterparts.
CONCLUSIONS: The concomitant presence of GERD is associated with fewer adverse outcomes in patients with PH. Though it is well understood that treatment of GERD is beneficial for lung disease, the exact role of GERD in PH has not been identified. This study helps characterize the important role appropriately treated GERD may play in preventing morbidity and mortality due to PH.