Burden of kidney disease on the discrepancy between reasons for hospital admission and death: An observational cohort study

<h4>Background</h4> Physicians have long noted a substantial discrepancy between the reasons for hospital admission and ultimate causes of death, particularly among older adults or patients with complex underlying diseases. However, objective data on this phenomenon are lacking. We aimed...

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Autores principales:	Shintaro Mandai, Fumiaki Ando, Takayasu Mori, Koichiro Susa, Soichiro Iimori, Shotaro Naito, Eisei Sohara, Shinichi Uchida, Kiyohide Fushimi, Tatemitsu Rai
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1b42eeabca6249e09a0630072e2c4617
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spelling	oai:doaj.org-article:1b42eeabca6249e09a0630072e2c46172021-11-11T07:14:45ZBurden of kidney disease on the discrepancy between reasons for hospital admission and death: An observational cohort study1932-6203https://doaj.org/article/1b42eeabca6249e09a0630072e2c46172021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8565775/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4> Physicians have long noted a substantial discrepancy between the reasons for hospital admission and ultimate causes of death, particularly among older adults or patients with complex underlying diseases. However, objective data on this phenomenon are lacking. We aimed to examine the risk of in-hospital death caused by a reason other than the original reason for hospitalization and its association with underlying kidney disease in a nationwide inpatient database. <h4>Methods</h4> In this retrospective cohort study, we studied 639,556 Japanese adults who died in the hospital from 2012 to 2015, using data from Japan’s Diagnosis Procedure Combination database. We analyzed the discrepancy rate between reasons for hospital admission and death and associated factors using the International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes and seven related categories. <h4>Results</h4> Among non-chronic kidney disease (CKD) (590,551), CKD (24,708), and end-stage kidney disease (ESKD) (24,297) patients, the median age was 77 years (interquartile range [IQR]: 67–84 years), 83 years (IQR: 75–88), and 75 years (IQR: 67–81), and 25.7%, 30.3%, and 41.6% died from a reason other than the original reason for hospitalization, respectively. Multivariate logistic regression analyses determined CKD/ESKD as the predominant risk factor for this discrepancy, rather than older age, male sex, obesity, and other comorbidities. Sankey diagrams that presented diagnostic changes from hospital admission to death revealed multiple wider segments connecting to different disease classifications, particularly to congestive and septic death in CKD and ESKD patients, respectively. Death owing to another disease classification led to an increase in the median length of hospital stay by 5–7 days and to a 1.3-–1.4-fold increase in medical costs across the populations. <h4>Conclusions</h4> A substantial proportion of patients with CKD and ESKD died during hospitalization for a reason other than their original reason for admission, leading to increased length of hospital stay and cost.Shintaro MandaiFumiaki AndoTakayasu MoriKoichiro SusaSoichiro IimoriShotaro NaitoEisei SoharaShinichi UchidaKiyohide FushimiTatemitsu RaiPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Shintaro Mandai Fumiaki Ando Takayasu Mori Koichiro Susa Soichiro Iimori Shotaro Naito Eisei Sohara Shinichi Uchida Kiyohide Fushimi Tatemitsu Rai Burden of kidney disease on the discrepancy between reasons for hospital admission and death: An observational cohort study
description	<h4>Background</h4> Physicians have long noted a substantial discrepancy between the reasons for hospital admission and ultimate causes of death, particularly among older adults or patients with complex underlying diseases. However, objective data on this phenomenon are lacking. We aimed to examine the risk of in-hospital death caused by a reason other than the original reason for hospitalization and its association with underlying kidney disease in a nationwide inpatient database. <h4>Methods</h4> In this retrospective cohort study, we studied 639,556 Japanese adults who died in the hospital from 2012 to 2015, using data from Japan’s Diagnosis Procedure Combination database. We analyzed the discrepancy rate between reasons for hospital admission and death and associated factors using the International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes and seven related categories. <h4>Results</h4> Among non-chronic kidney disease (CKD) (590,551), CKD (24,708), and end-stage kidney disease (ESKD) (24,297) patients, the median age was 77 years (interquartile range [IQR]: 67–84 years), 83 years (IQR: 75–88), and 75 years (IQR: 67–81), and 25.7%, 30.3%, and 41.6% died from a reason other than the original reason for hospitalization, respectively. Multivariate logistic regression analyses determined CKD/ESKD as the predominant risk factor for this discrepancy, rather than older age, male sex, obesity, and other comorbidities. Sankey diagrams that presented diagnostic changes from hospital admission to death revealed multiple wider segments connecting to different disease classifications, particularly to congestive and septic death in CKD and ESKD patients, respectively. Death owing to another disease classification led to an increase in the median length of hospital stay by 5–7 days and to a 1.3-–1.4-fold increase in medical costs across the populations. <h4>Conclusions</h4> A substantial proportion of patients with CKD and ESKD died during hospitalization for a reason other than their original reason for admission, leading to increased length of hospital stay and cost.
format	article
author	Shintaro Mandai Fumiaki Ando Takayasu Mori Koichiro Susa Soichiro Iimori Shotaro Naito Eisei Sohara Shinichi Uchida Kiyohide Fushimi Tatemitsu Rai
author_facet	Shintaro Mandai Fumiaki Ando Takayasu Mori Koichiro Susa Soichiro Iimori Shotaro Naito Eisei Sohara Shinichi Uchida Kiyohide Fushimi Tatemitsu Rai
author_sort	Shintaro Mandai
title	Burden of kidney disease on the discrepancy between reasons for hospital admission and death: An observational cohort study
title_short	Burden of kidney disease on the discrepancy between reasons for hospital admission and death: An observational cohort study
title_full	Burden of kidney disease on the discrepancy between reasons for hospital admission and death: An observational cohort study
title_fullStr	Burden of kidney disease on the discrepancy between reasons for hospital admission and death: An observational cohort study
title_full_unstemmed	Burden of kidney disease on the discrepancy between reasons for hospital admission and death: An observational cohort study
title_sort	burden of kidney disease on the discrepancy between reasons for hospital admission and death: an observational cohort study
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/1b42eeabca6249e09a0630072e2c4617
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Burden of kidney disease on the discrepancy between reasons for hospital admission and death: An observational cohort study

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