Am J Perinatol. 2023 Jun 20. doi: 10.1055/a-2113-2892. Online ahead of print.
ABSTRACT
OBJECTIVE: This study aims to determine if pregnant patients with both pyelonephritis and anemia are at an increased risk of adverse maternal outcomes compared to those with pyelonephritis without anemia.
STUDY DESIGN: We conducted a retrospective cohort study utilizing the Nationwide Readmissions Database (NRD). Patients with antepartum pyelonephritis-associated hospitalizations from 10/15-12/18 were included. International Classification of Diseases codes were used to identify pyelonephritis, anemia, maternal comorbidities, and severe maternal morbidities. The primary outcome was a composite of severe maternal morbidity, as defined by Centers for Disease Control criteria. Univariate statistical methods, weighted to account for complex survey methods in the NRD, were used to assess for associations between anemia, baseline characteristics, and patient outcomes. Weighted logistic and Poisson regressions were used to assess for associations between anemia and outcomes, adjusting for clinical co-morbidities and other confounding factors.
RESULTS: In total, 29,296 pyelonephritis admissions were identified, corresponding to a weighted national estimate of 55,135 admissions. Of these, 11,798 (21.3%) were anemic. The rate of severe maternal morbidity was higher among anemic patients than non-anemic patients (27.8% vs 8.9%, respectively, p<0.001), and remained higher after adjustment (adjusted relative risk (aRR) 2.86 (95% CI: 2.67, 3.06)). Rates of individual components of severe maternal morbidities, including acute respiratory distress syndrome (4.0% vs 0.6%,aRR 3.97 (95% CI: 3.10, 5.08), sepsis (22.5% vs 7.9%,aRR 2.64 (95% CI: 2.45, 2.85)), shock (4.5% vs 0.6%,aRR 5.48 (95% CI: 4.32, 6.95)), and acute renal failure (2.9% vs 0.8%,aRR 1.99 (95% CI: 1.55, 2.55)) were all higher for anemic pyelonephritis. The mean length of stay was also longer (25% average increase, (95% CI: 22%, 28%)).
CONCLUSION: Among pregnant patients with pyelonephritis, those with anemia are at greater risk of severe maternal morbidity and longer hospital stay.
PMID:37339672 | DOI:10.1055/a-2113-2892
