CHARACTERISTICS, OUTCOMES, AND MORTALITY PREDICTORS IN HOSPITALIZATIONS WITH MYXEDEMA COMA

Abstract

SESSION TITLE: Pulmonary Manifestations of Systemic DiseasesSESSION TYPE: Original InvestigationsPRESENTED ON: 10/18/2022 02:45 pm - 03:45 pmPURPOSE: There is paucity of data on outcomes of hospitalizations with myxedema coma due to its rarity. We examined characteristics and outcomes of these hospitalizations using the National Inpatient Sample (NIS) database.METHODS: We looked at hospitalizations between 2016 and 2019 using the discharge data from the NIS, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. We identified those with myxedema coma using the International Classification of Diseases, 10th revision, Clinical Modification code: E03.5. IBM SPSS statistics was used to perform statistical analyses and statistical significance was defined as P<.05.RESULTS: There were 9,970 adult hospitalizations associated with myxedema coma between 2016 and 2019. Mean (standard deviation) age was 66.7 (+/- 15.9) years. Median (interquartile range) length of stay was 7 (4-13) days. Females comprised 67.4%. All-cause in-hospital mortality was 15.3% and there was no significant difference in mortality between males and females (17.4% vs 14.3%, P=.069). 29.5% of these hospitalizations had sepsis. Hospitalizations with sepsis had higher mortality compared to those without (29.8% vs 9.2%, P<.001). Hospitalizations with sepsis compared to those without were more likely to be associated with acute kidney injury (AKI) (66.9% vs 45.4%, P<.001), acute or acute on chronic respiratory failure (ARF/ACRF) (62.7% vs 37.3%, P<.001), shock (58.5% vs 4.5%, P<.001), encephalopathy (51.5% vs 39.7%, P<.001), mechanical ventilation (MV) (50.5% vs 23.5%, P<.001), and severe protein-calorie malnutrition (SPCM) (15.3% vs 6.3%, P<.001). Mortality was higher in hospitalizations with shock (37.1% vs 9.7%, P<.001), MV (28.8% vs 9.1%, P<.001), ARF/ACRF (23.9% vs 8.4%, P<.001), SPCM (23.6% vs 14.5%, P=.001), AKI (20.8% vs 9.5%, P<.001), but lower in those with morbid obesity (11.1% vs 16.1%, P=.022) and nicotine dependence (8.8% vs 16.9%, P<.001). A binary logistic regression analysis (χ2(16)=300.79, P<.001, Nagelkerke R2=.244) performed to predict in-hospital mortality showed that increasing age (P<.001), MV (P<.001), shock (P<.001), sepsis (P=.001), ARF/ACRF (P=.005), and AKI (P=.013) were all associated with increased odds of mortality; while nicotine dependence was associated with marginally decreased odds of mortality (P=.049). At P<.05, diabetes, dyslipidemia, hypertension, chronic kidney disease, encephalopathy, morbid obesity, acute or acute on chronic left heart failure, paroxysmal atrial fibrillation, and ischemic heart disease did not predict mortality.CONCLUSIONS: Sepsis appears to be present in the majority of myxedema coma hospitalizations and is associated with higher mortality. Increasing age, presence of sepsis, shock, ARF/ACRF, AKI, and need for MV are predictors of mortality.CLINICAL IMPLICATIONS: Our study looks at mortality predictors and outcomes in hospitalizations associated with myxedema coma at a national level.DISCLOSURES: No relevant relationships by Namratha Seetharam MedaNo relevant relationships by Emil OweisNo relevant relationships by Harshkumar PatelNo relevant relationships by Mark Slivka SESSION TITLE: Pulmonary Manifestations of Systemic Diseases SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: There is paucity of data on outcomes of hospitalizations with myxedema coma due to its rarity. We examined characteristics and outcomes of these hospitalizations using the National Inpatient Sample (NIS) database. METHODS: We looked at hospitalizations between 2016 and 2019 using the discharge data from the NIS, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. We identified those with myxedema coma using the International Classification of Diseases, 10th revision, Clinical Modification code: E03.5. IBM SPSS statistics was used to perform statistical analyses and statistical significance was defined as P<.05. RESULTS: There were 9,970 adult hospitalizations associated with myxedema coma between 2016 and 2019. Mean (standard deviation) age was 66.7 (+/- 15.9) years. Median (interquartile range) length of stay was 7 (4-13) days. Females comprised 67.4%. All-cause in-hospital mortality was 15.3% and there was no significant difference in mortality between males and females (17.4% vs 14.3%, P=.069). 29.5% of these hospitalizations had sepsis. Hospitalizations with sepsis had higher mortality compared to those without (29.8% vs 9.2%, P<.001). Hospitalizations with sepsis compared to those without were more likely to be associated with acute kidney injury (AKI) (66.9% vs 45.4%, P<.001), acute or acute on chronic respiratory failure (ARF/ACRF) (62.7% vs 37.3%, P<.001), shock (58.5% vs 4.5%, P<.001), encephalopathy (51.5% vs 39.7%, P<.001), mechanical ventilation (MV) (50.5% vs 23.5%, P<.001), and severe protein-calorie malnutrition (SPCM) (15.3% vs 6.3%, P<.001). Mortality was higher in hospitalizations with shock (37.1% vs 9.7%, P<.001), MV (28.8% vs 9.1%, P<.001), ARF/ACRF (23.9% vs 8.4%, P<.001), SPCM (23.6% vs 14.5%, P=.001), AKI (20.8% vs 9.5%, P<.001), but lower in those with morbid obesity (11.1% vs 16.1%, P=.022) and nicotine dependence (8.8% vs 16.9%, P<.001). A binary logistic regression analysis (χ2(16)=300.79, P<.001, Nagelkerke R2=.244) performed to predict in-hospital mortality showed that increasing age (P<.001), MV (P<.001), shock (P<.001), sepsis (P=.001), ARF/ACRF (P=.005), and AKI (P=.013) were all associated with increased odds of mortality; while nicotine dependence was associated with marginally decreased odds of mortality (P=.049). At P<.05, diabetes, dyslipidemia, hypertension, chronic kidney disease, encephalopathy, morbid obesity, acute or acute on chronic left heart failure, paroxysmal atrial fibrillation, and ischemic heart disease did not predict mortality. CONCLUSIONS: Sepsis appears to be present in the majority of myxedema coma hospitalizations and is associated with higher mortality. Increasing age, presence of sepsis, shock, ARF/ACRF, AKI, and need for MV are predictors of mortality. CLINICAL IMPLICATIONS: Our study looks at mortality predictors and outcomes in hospitalizations associated with myxedema coma at a national level. DISCLOSURES: No relevant relationships by Namratha Seetharam Meda No relevant relationships by Emil Oweis No relevant relationships by Harshkumar Patel No relevant relationships by Mark Slivka