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

Abstract

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.

Anaphylaxis admissions in pediatric intensive care units: Follow‐up and risk of recurrence

“…Hospital admissions for anaphylaxis are on the rise in many countries, particularly in children and patients with food allergy (FA) . A higher age in adults, medication as a trigger, and comorbidities increase the risk of severe anaphylaxis . Data about the recurrence are scarce, and little is known about the medical follow‐up after an anaphylaxis reaction.…”

Evaluation of an Online Educational Program for Parents and Caregivers of Children With Food Allergies

“…In food allergy, education remains an essential factor for improving patients' quality of life. A more holistic approach is needed, including training in and management of comorbidity [10]. Even though school-aged children are capable of acquiring skills that allow them to self-manage their condition, parents still play a fundamental role in education and are responsible for their well-being until they come of age [11].…”

“…It is a disease that requires thinking beyond the usual methods recommended during regular visits to allergy outpatient clinics, because most patients do not follow the recommendations (especially with respect to the epinephrine autoinjector) [10][11][12]. Our outcomes show that information about daily life is not easy to understand, and that additional efforts in education and skill building are needed to help patients, parents, and caregivers.…”

Clinical and demographic characteristics of fatal anaphylaxis in Spain (1998‐2011): A comparison between a series from the hospital system and a national forensic series

“…Possible cases of anaphylaxis were obtained from all discharge diagnoses using 2 strategies whose methodology has been explained elsewhere (Table ). A record in the database was considered fatal anaphylaxis if the discharge type was death.…”

“…23,24 The system uses the codes of the Spanish version of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and covers 98% of public hospitals and many private hospitals in Spain. 25 Possible cases of anaphylaxis were obtained from all discharge diagnoses using 2 strategies whose methodology has been explained elsewhere 23,26 (Table 1). A record in the database was considered fatal anaphylaxis if the discharge type was death.…”