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Clinical Profile of Patients With Severe Anaphylaxis Hospitalized in the Spanish Hospital System: 1997-2011

Nieto-Nieto A1,2, Tejedor-Alonso MA1,3, Farias-Aquino E1,2, Moro-Moro M1, Rosado Ingelmo A1, Gonzalez-Moreno A1, Gil de Miguel A4

1Allergy Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
2International Doctoral School, Universidad Rey Juan Carlos, Alcorcón, Spain
3Medicine Department, Universidad Rey Juan Carlos, Alcorcón, Spain
4Preventive Medicine and Public Health Area, Universidad Rey Juan Carlos, Alcorcón, Spain

J Investig Allergol Clin Immunol 2017; Vol 27(2) : 111-126
doi: 10.18176/jiaci.0146

Background: Studies assessing the severity of anaphylaxis lack a comprehensive approach to collecting data on comorbidities that may worsen prognosis.
Objective: Using the Elixhauser score (a systematic index associated with longer stay, hospital charges, and mortality), we determined which comorbidities were associated with more severe anaphylaxis.
Methods: We based our study on the Spanish Ministry of Health database of hospital discharges in Spain between 1997 and 2011. We constructed logistic regression models in which the dependent variables were outcomes related to greater severity (death, cardiac arrest, need for invasive mechanical ventilation or vasopressor drugs, admission to the intensive care unit, and length of stay) and the independent variables were the 30 comorbidities that comprise the Elixhauser score, age, sex, and main causes of anaphylaxis.
Results: We found that a higher risk of severe anaphylaxis was associated (3 or more logistic regressions) with age >50 years or having experienced cardiac arrhythmia, coagulation disorder, associated fluid-electrolyte imbalance, chronic pulmonary disease, or Echinococcus anaphylaxis. Likewise, in the adjusted analysis, a higher Elixhauser score was associated with most of the outcomes analyzed for severity of anaphylaxis.
Conclusions: Cardiovascular and respiratory diseases increase the severity of anaphylaxis, and the resulting poor health status (represented as a higher Elixhauser score) is associated with more severe anaphylaxis.

Key words: Severity, Anaphylaxis, Comorbidities, Elixhauser score, Cardiovascular, Respiratory, Diseases