Charlson合并症指数与急性心肌梗死患者院内死亡及长时住院的关系

Relationship Between Charlson Comorbidity Index and In-hospital Mortality,Long-term Hospitalization in Patients with Acute Myocardial Infarction

目的分析Charlson合并症指数与急性心肌梗死(AMI)患者院内死亡及长时住院的关系。方法选取北京某三甲医院2014-2016年2012例AMI住院患者,使用住院病案首页的出院诊断字段统计患者的Charlson合并症种类及数量,计算相应的Charlson合并症指数(CCI)评分。分析不同CCI评分的AMI患者院内死亡及长时住院(住院超过14 d)的差异,运用Logistic回归分析探索AMI患者院内死亡及长时住院的影响因素。结果2012例AMI患者中,合并充血性心力衰竭的患者最多(57.46%),其次为糖尿病(不伴合并症)(35.88%)和脑血管疾病(17.25%)。164例(8.15%)患者发生院内死亡,其中44.51%有重度合并症(CCI≥3),而中度合并症(CCI=2)占26.22%,轻度合并症(CCI=1)占25.00%。402例(19.98%)住院时长超过14 d的患者中,重度、中度、轻度合并症患者分别占34.33%、26.87%和28.86%。Logistic回归分析显示,充血性心力衰竭、糖尿病(不伴合并症)、肾病是AMI患者院内死亡的独立影响因素,充血性心力衰竭、慢性肺部疾病、肾病是AMI患者长时住院的独立影响因素。结论Charlson合并症指数对AMI患者院内死亡和住院时长有影响,利用CCI评分评价不同合并症具有一定可行性。

Objective To analyze the relationship between Charlson comorbidity index and in-hospital death,long-term hospitalization in patients with acute myocardial infarction(AMI).Methods From 2014 to 2016,a total of 2012 AMI patients of a third class hospital in Beijing were retrospectively screened as the study subjects.The types and number of Charlson complications were counted by using relevant fields on the first page of inpatient medical records,and the corresponding Charlson comorbidity index(CCI)scores were calculated to analyze the differences of in-hospital death and long-term hospitalization among AMI patients with different CCI scores.Logistic regression analysis was used to investigate the influencing factors of in-hospital death and long-term hospitalization in AMI patients.Results Among 2012 AMI patients,congestive heart failure was the most common(57.46%),followed by diabetes mellitus(without comorbidities)(35.88%)and cerebrovascular disease(17.25%).Among 164 patients(8.15%)who died in hospital,44.51%had severe complications(CCI≥3),moderate complications(CCI=2)accounted for 26.22%,and mild complications(CCI=1)accounted for 25.00%.Among 402 patients(19.98%)hospitalized for more than 14 days,severe,moderate and mild complications accounted for 34.33%,26.87%and 28.86%,respectively.Logistic regression analysis showed that congestive heart failure,diabetes mellitus(without complications)and nephropathy were independent influencing factors of in-hospital death in AMI patients;congestive heart failure,chronic lung disease and nephropathy were independent influencing factors of long-term hospitalization in AMI patients.Conclusion Charlson comorbidity index has an effect on in-hospital death and long-term hospitalization in patients with AMI,and it is feasible to evaluate different comorbidities by CCI score.