open access

Vol 84, No 6 (2016)
ORIGINAL PAPERS
Published online: 2016-12-07
Submitted: 2016-09-13
Accepted: 2016-11-02
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Contemporary national trends of cystic fibrosis hospitalizations and co-morbidities in the United States

Kshitij Chatterjee, Abhinav Goyal, Nishi Shah, Krishna Kakkera, Rajani Jagana, Paula Anderson
DOI: 10.5603/ARM.2016.0041
·
Adv Respir Med 2016;84(6):316-323.

open access

Vol 84, No 6 (2016)
ORIGINAL PAPERS
Published online: 2016-12-07
Submitted: 2016-09-13
Accepted: 2016-11-02

Abstract

INTRODUCTION: Cystic fibrosis (CF) is a life-limiting multisystemic genetic disease. Patients with CF have a high rate of hospitalization. We attempt to ascertain national trends of inpatient stays, prevalence of various co-morbidities during hospitalizations, outcomes and discharge disposition among CF patients.

MATERIAL AND METHODS: Data from the National Inpatient Sample (NIS) was used to identify all hospitalizations of patients with CF and their demographic characteristics from 2003 to 2013. Prevalence and effects of various co-morbidities like acute kidney injury (AKI) were determined. Detailed sub-group analysis was performed for individuals with lung transplant.

RESULTS: The annual rate of hospitalization per 1,000 CF patients in the U.S. increased from 994 in 2003 to 1,072 in 2013. The overall in-hospital mortality was 1.5%; median age at death was 27 years. In-hospital mortality trended down from 1.9% to 1.2% from 2003 to 2013 (p-value for trend: 0.002). The median length of stay was 7 days. The prevalence of chronic liver disease and AKI was 3.7% and 3.8% respectively. Multivariate adjusted odds of mortality for AKI was 1.74 (95% CI 1.57−1.93, p < 0.001). Patients with prior lung transplantation accounted for 6.5% of hospitalizations. These patients had a significantly higher prevalence of AKI.

CONCLUSIONS: The annual hospitalization rates of CF patients is increasing over the years. Females with CF constitute a higher proportion of hospitalized patients despite a higher male preponderance of males with CF in the community. AKI is associated with a significantly higher in-hospital mortality. Lung transplant recipients have a higher prevalence of AKI and mortality.

Abstract

INTRODUCTION: Cystic fibrosis (CF) is a life-limiting multisystemic genetic disease. Patients with CF have a high rate of hospitalization. We attempt to ascertain national trends of inpatient stays, prevalence of various co-morbidities during hospitalizations, outcomes and discharge disposition among CF patients.

MATERIAL AND METHODS: Data from the National Inpatient Sample (NIS) was used to identify all hospitalizations of patients with CF and their demographic characteristics from 2003 to 2013. Prevalence and effects of various co-morbidities like acute kidney injury (AKI) were determined. Detailed sub-group analysis was performed for individuals with lung transplant.

RESULTS: The annual rate of hospitalization per 1,000 CF patients in the U.S. increased from 994 in 2003 to 1,072 in 2013. The overall in-hospital mortality was 1.5%; median age at death was 27 years. In-hospital mortality trended down from 1.9% to 1.2% from 2003 to 2013 (p-value for trend: 0.002). The median length of stay was 7 days. The prevalence of chronic liver disease and AKI was 3.7% and 3.8% respectively. Multivariate adjusted odds of mortality for AKI was 1.74 (95% CI 1.57−1.93, p < 0.001). Patients with prior lung transplantation accounted for 6.5% of hospitalizations. These patients had a significantly higher prevalence of AKI.

CONCLUSIONS: The annual hospitalization rates of CF patients is increasing over the years. Females with CF constitute a higher proportion of hospitalized patients despite a higher male preponderance of males with CF in the community. AKI is associated with a significantly higher in-hospital mortality. Lung transplant recipients have a higher prevalence of AKI and mortality.

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Keywords

cystic fibrosis/mortality; lung transplantation/mortality; acute kidney injury; national inpatient sample

About this article
Title

Contemporary national trends of cystic fibrosis hospitalizations and co-morbidities in the United States

Journal

Advances in Respiratory Medicine

Issue

Vol 84, No 6 (2016)

Pages

316-323

Published online

2016-12-07

DOI

10.5603/ARM.2016.0041

Bibliographic record

Adv Respir Med 2016;84(6):316-323.

Keywords

cystic fibrosis/mortality
lung transplantation/mortality
acute kidney injury
national inpatient sample

Authors

Kshitij Chatterjee
Abhinav Goyal
Nishi Shah
Krishna Kakkera
Rajani Jagana
Paula Anderson

References (25)
  1. CF Patient Registry Reports. https://www.cff.org/Our-Research/ /CF-Patient-Registry/CF-Patient-Registry-Reports/ (25.09.2015).
  2. Ratjen F, Döring G. Cystic fibrosis. The Lancet. 2003; 361(9358): 681–689.
  3. Ramsey BW. Management of pulmonary disease in patients with cystic fibrosis. N Engl J Med. 1996; 335(3): 179–188.
  4. Flume PA, Mogayzel PJ, Robinson KA, et al. Clinical Practice Guidelines for Pulmonary Therapies Committee. Cystic fibrosis pulmonary guidelines: treatment of pulmonary exacerbations. Am J Respir Crit Care Med. 2009; 180(9): 802–808.
  5. Park RW, Grand RJ. Gastrointestinal manifestations of cystic fibrosis: a review. Gastroenterology. 1981; 81(6): 1143–1161.
  6. HCUP-US NIS Overview. https://www.hcup-us.ahrq.gov//nisoverview.jsp (23.04.2016).
  7. Elixhauser A, Steiner C, Harris DR, et al. Comorbidity measures for use with administrative data. Med Care. 1998; 36(1): 8–27.
  8. Waikar SS, Wald R, Chertow GM, et al. Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal Failure. J Am Soc Nephrol. 2006; 17(6): 1688–1694.
  9. Armitage P. Tests for Linear Trends in Proportions and Frequencies. Biometrics. 1955; 11(3): 375–386.
  10. Healthcare Cost and Utilization Project (HCUP) NIS Notes [Internet]. https://www.hcup-us.ahrq.gov/db/vars/hosp_bedsize/nisnote.jsp (25.04.2016).
  11. Harness-Brumley CL, Elliott AC, Rosenbluth DB, et al. Gender differences in outcomes of patients with cystic fibrosis. J Womens Health (Larchmt). 2014; 23(12): 1012–1020.
  12. Rosenfeld M, Davis R, FitzSimmons S, et al. Gender gap in cystic fibrosis mortality. Am J Epidemiol. 1997; 145(9): 794–803.
  13. Downes KJ, Patil NR, Rao MB, et al. Risk factors for acute kidney injury during aminoglycoside therapy in patients with cystic fibrosis. Pediatr Nephrol. 2015; 30(10): 1879–1888.
  14. Goss CH, Muhlebach MS. Review: Staphylococcus aureus and MRSA in cystic fibrosis. J Cyst Fibros. 2011; 10(5): 298–306.
  15. Lister PD, Wolter DJ, Hanson ND. Antibacterial-resistant Pseudomonas aeruginosa: clinical impact and complex regulation of chromosomally encoded resistance mechanisms. Clin Microbiol Rev. 2009; 22(4): 582–610.
  16. Ren CL, Konstan MW, Yegin A, et al. Scientific Advisory Group, Investigators, and Coordinators of the Epidemiologic Study of Cystic Fibrosis. Multiple antibiotic-resistant Pseudomonas aeruginosa and lung function decline in patients with cystic fibrosis. J Cyst Fibros. 2012; 11(4): 293–299.
  17. Nazareth D, Walshaw M. A review of renal disease in cystic fibrosis. J Cyst Fibros. 2013; 12(4): 309–317.
  18. Wolter JM, Bowler SD, Nolan PJ, et al. Home intravenous therapy in cystic fibrosis: a prospective randomized trial examining clinical, quality of life and cost aspects. Eur Respir J. 1997; 10(4): 896–900.
  19. Balaguer A, González de Dios J, Balaguer A, et al. Home versus hospital intravenous antibiotic therapy for cystic fibrosis. Cochrane Database Syst Rev. 2012(3): CD001917.
  20. Kimura N, Khan MS, Schecter M, et al. Changing demographics and outcomes of lung transplantation recipients with cystic fibrosis. J Heart Lung Transplant. 2016; 35(10): 1237–1244.
  21. Lyu DM, Zamora MR. Medical complications of lung transplantation. Proc Am Thorac Soc. 2009; 6(1): 101–107.
  22. George TJ, Arnaoutakis GJ, Beaty CA, et al. Acute kidney injury increases mortality after lung transplantation. Ann Thorac Surg. 2012; 94(1): 185–192.
  23. eteorological Versus Astronomical Summer — What’s the Difference? | National Centers for Environmental Information (NCEI) formerly known as National Climatic Data Center (NCDC). https:////www.ncdc.noaa.gov/news/meteorological-versus-astronomica.
  24. Smith WD, Wilmot JK. A JNA. 228 Seasonal variation in the number or the severity of pulmonary exacerbations in adult CF patients. J Cyst Fibros. 2005; 4: S60.
  25. Johansen HK, Høiby N. Seasonal onset of initial colonisation and chronic infection with Pseudomonas aeruginosa in patients with cystic fibrosis in Denmark. Thorax. 1992; 47(2): 109–111.

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