Food, drug, insect sting allergy, and anaphylaxis
Hospitalization rates and prognosis of patients with anaphylactic shock in Denmark from 1995 through 2012

https://doi.org/10.1016/j.jaci.2015.10.027Get rights and content

Background

Anaphylactic shock (AS) is an acute, potentially life-threatening hypersensitivity reaction. There are limited population-based data on changes in the hospitalization rate and prognosis of AS.

Objectives

We sought to examine the proportion of patients with AS admitted to an intensive care unit (ICU), the prognosis of AS, and time trends in AS hospitalization rates in Denmark from 1995 through 2012.

Methods

We performed a population-based cohort study in Denmark from 1995 through 2012 (cumulative population, 7.1 million) using the Danish National Patient Registry and the Danish Civil Registration System. Outcomes included time trends in first-time AS hospitalization rates, percentage admitted to an ICU, and 30-day mortality overall and stratified by year.

Results

We included 6,707 patients with a first-time hospitalization for AS during 103,747,997 person-years of observation time. The average AS hospitalization rate was 64.6 (95% CI, 63.1-66.2) per 1,000,000 person-years. From 1995 to 2012, the annual AS hospitalization rate increased more than 2-fold (rate ratio, 2.6; 95% CI, 2.2-3.0). However, the annual hospitalization rate in children increased 10-fold (rate ratio, 10.75; 95% CI, 5.59-20.67). Only 0.7% of patients died within 30 days after admission (50 deaths), and most fatal AS cases occurred among patients aged 30 years or older. During the 2005-2012 period, 14.5% of patients hospitalized with AS were admitted to an ICU.

Conclusion

The AS hospitalization rate increased from 1995 to 2012; however, the 30-day mortality was less than 1%.

Section snippets

Setting

This prospective cohort study was conducted within the cumulative population of 7.1 million persons living in Denmark from 1995 through 2012. The unique civil registration number assigned to each Danish resident at birth or on immigration enables linkage among all Danish administrative and medical registries at the individual level.14 The universal Danish National Health Service provides tax-supported health care to all residents with unrestricted access to hospitals, including all acute care.

Hospitalization for AS

Patients' characteristics

From 1995 through 2012, 6,707 patients were identified with a first-time hospitalization for AS during 103,747,997 person-years of observation time. Of these patients, 365 had a subsequent hospitalization for AS, and 77 had more than 2 such hospitalizations.

The median age at diagnosis was 44.2 years for men and 45.6 years for women. The sex distribution was 49.5% male and 50.5% female (Table I). Overall, 78% of patients had no comorbidity, and the presence of severe and very severe comorbidity

Discussion

This is the first nationwide, population-based cohort study examining long-term trends in the AS hospitalization rate. We found a substantial increase in first-time hospitalizations for a diagnosis of AS from 1995 to 2012. Although the AS hospitalization rate increased in all age groups, it increased as much as 10-fold among children. Still, only 1 of 7 patients with AS was admitted to an ICU, and 30-day mortality was less than 1%.

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    Supported by Aarhus University Research Foundation and the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation.

    Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.

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