Charlson Weighted Index Of Comorbidity Research Articles

Predictors of prolonged length of stay in adult patients with respiratory syncytial virus infections - a multi-center historical cohort study.

Several studies have reported risk factors for severe disease and mortality in hospitalized adults with RSV infections. There is limited information available regarding the factors that affect the duration of a patient's hospital length of stay (LOS). This was a multicenter historical cohort study of adult patients hospitalized for laboratory-confirmed RSV in Southeast Michigan between January 2017 and December 2021. Hospitalized patients were identified using the International Classification of Diseases, Tenth Revision 10 codes for RSV infection. Mean LOS was computed; prolonged LOS was defined as greater than the mean. We included 360 patients with a mean age (SD) of 69.9 ± 14.7 years, 63.6% (229) were female and 63.3% (228) of white race. The mean hospital LOS was 7.1 ± 5.4 days. Factors associated with prolonged LOS in univariable analysis were old age, body mass index (BMI), smoking status, Charlson Weighted Index of Comorbidity (CWIC), home oxygen, abnormal chest x-ray (CXR), presence of sepsis, use of oxygen, and antibiotics at the time of presentation. Predictors for prolonged LOS on admission in multivariable analysis were age on admission (p < 0.001), smoking status (p = 0.001), CWIC (p = 0.038) and abnormal CXR (p = 0.043). Our study found that age on admission, smoking history, higher CWIC and abnormal CXR on admission were significantly associated with prolonged LOS among adult patients hospitalized with RSV infection. These findings highlight the significance of promptly recognizing and implementing early interventions to mitigate the duration of hospitalization for adult patients suffering from RSV infection.

A retrospective study of Aeromonas hydrophila infections at a university tertiary hospital in Saudi Arabia

BackgroundAeromonas hydrophila can cause a wide range of diseases and is mainly found in patients with underlying diseases. Globally the data on Aeromonas infections is limited, and no studies have been published about the situation in Saudi Arabia. The aim of this study was to investigate the risk factors, clinical presentation, treatment, and outcomes of Aeromonas infections in Saudi Arabia.MethodsA retrospective study was performed at a tertiary university hospital with 1000 beds in Jeddah, Saudi Arabia. All patients 14 years and older with Aeromonas-positive cultures between January 1, 2015, and December 31, 2022 were included. Patient information was extracted from the electronic health records, including patient demographics, comorbidities, presenting symptoms, source of infection, human immunodeficiency virus status, culture results and antimicrobial susceptibility, use of immunosuppressive medication, and 30-day mortality.ResultsIn total 24 patients were identified with Aeromonas hydrophila-positive cultures, 22 of which were males (91.7%), and most (75%) had hospital-acquired infections. The 30-day mortality was 20.8%. All Aeromonas cultures were susceptible to gentamicin, cefepime, and ciprofloxacin, while the majority were resistant to ceftazidime (83.3%) and meropenem (62.5%). The most common disease presentation was skin and soft tissue infection (33.3%), the most common clinical sign was fever (58.3%), and the most common symptom was abdominal pain (37.5%). Comorbidities were very common (median 3, range 1–7). Pitt bacteremia score (p < 0.001), Charlson weighted comorbidity index (p < 0.02), international normalized ratio (p < 0.005), and the number of comorbidity factors (p < 0.05) were all associated with 30-day mortality due to Aeromonas infection. The number of comorbidities had the best predictive value (83.3%) of 30-day mortality (p < 0.05, Odds ratio 3.253, 95% confidence interval: 1.088–9.729).ConclusionsAeromonas hydrophila is an important pathogen to consider in nosocomial infections. The number of comorbidities had the best predictive value of 30-day mortality. The susceptibility pattern of this organism indicates that, in Saudi Arabia, when an Aeromonas infection is suspected, treatment with quinolone along with other broad-spectrum antibiotics should be started until the culture and susceptibility results are known.

Anemia And Other Independent Predictors Of 30-day Readmissions In Heart Failure Patients: A Retrospective Study

<h3>Objectives</h3> To determine if there is an association between anemia and 30-day readmissions in patients with heart failure, and to identify other risk factors for 30-day readmissions in this group. <h3>Background</h3> : Anemia commonly occurs in patients with chronic heart failure, with a prevalence of up to 79%. It can be explained by the presence of comorbidities, chronic kidney disease, and differences in heart failure treatment. Anemia is likely associated with worse clinical outcomes in those patients because of a mismatch in oxygen supply and demand, increased resistance to erythropoietin, higher rates of left ventricular hypertrophy and fluid overload, and chronic inflammation. Findings associated with anemia in heart failure patients include symptoms, echocardiogram measurements, renal function, mortality, hospitalization rates and lengths of hospital stays. Few studies, however, have assessed the association of anemia with 30-day readmission rates in these patients. <h3>Methods</h3> : We conducted a retrospective chart review of patients with heart failure admitted to Ascension St John Hospital in Michigan from 1/1/2018 to 12/31/2019. Data were collected on demographics, comorbidities, laboratory testing during the index hospitalization, echocardiogram findings, and 30-day readmissions. Anemia was defined as hemoglobin less than 13 g/dL in males and hemoglobin less than 12 g/dL in females. Data were analyzed using Student's t-test, the χ2 test and logistic regression. <h3>Results</h3> : We reviewed 1250 patients with heart failure, 58.2% male, 52.6% non-white, mean age 68.2 ± 15.3 years. Of those patients, 24.2% (303/1250) were readmitted within 30 days; 55.5% of those readmissions were a result of cardiovascular disease. Anemia was noted in 62.2% of the patients (778/1250). From univariable analysis, the following factors were found to be associated with 30-day readmissions in heart failure patients: anemia (p = 0.008), female sex (p = 0.03), pulmonary edema (p = 0.013), hyponatremia (p = 0.005), atrial fibrillation or flutter (p = 0.04), hyperlipidemia (p = 0.042), antiarrhythmic medications (p < 0.0001), and Charlson Weighted Index of Comorbidity (CWIC) score (p < 0.0001). From multivariable analysis, heart failure patients who were readmitted within 30 days were more likely to be anemic (OR = 1.4, p = 0.029), hyponatremic (OR = 1.5, p = 0.007), have pulmonary edema on chest imaging during the index hospitalization (OR = 1.4, p = 0.033), prescribed antiarrhythmic medications (OR = 1.8, p = 0.002), and have higher CWIC scores (OR = 1.1, p = 0.001). <h3>Conclusions</h3> : In patients with heart failure, after controlling for other risk factors, anemic patients were 40% more likely to be readmitted within 30-days compared to non-anemic patients. Other independent predictors of 30-day readmissions included hyponatremia, pulmonary edema, antiarrhythmic medications, and CWIC score.

Apical Sparing Strain Imaging In Patients With Hypertensive Emergency: A Study Of Patients Characteristics And Prognostic Value

<h3>Objective</h3> What are the clinical characteristics and prognostic values of patients with apical sparing strains compared to those with a normal strain pattern in hypertensive emergency? <h3>Background</h3> Differences in strain values among segments on the standard bull's eye model can give clues to different disease patterns. A pattern of apical sparing (AS) has been associated with cardiac amyloidosis, hypertrophic cardiomyopathy, hypertension, and aortic stenosis. Changes in longitudinal strain predict subsequent development of heart failure or reduction in left ventricular ejection fraction in patients undergoing cardiotoxic chemotherapy. <h3>Methods</h3> We conducted a historical cohort study of all patients with an admission diagnosis of hypertensive emergency who had an echocardiogram done with evaluation of the strain pattern. Patients with AS were compared to those without AS on the following characteristics: demographics (age, race, sex), comorbidities as measured by the Charlson Weighted Index of Comorbidity (CWIC), ejection fraction and laboratory values including creatinine and hemoglobin levels on admission, pro-BNP (if available), discharge disposition and readmission within 30 days. Patients were followed in time (via medical records) from the initial admission to collect any other ejection fraction data on echocardiogram that were in the medical records. <h3>Results</h3> There were 946 unique patients admitted with a diagnosis of hypertensive urgency or emergency. A total of 120 patients had an evaluation of the strain pattern on the echocardiogram. Approximately one-third [n=35] of patients admitted to the hospital with hypertensive emergency had apical sparing strain versus two-third [n=85] has non-apical sparing (figure 1). Forty percent and sixty percent of AS patients were males and females respectively, whereas, 55% and 45% of non-AS patients were males and females respectively. The mean age at admission was 58.2 ± 14.7 in AS and 60.6 ± 14.3 in non-apical sparing patients. A 97.1% of AS and 85.9% of non-AS patients were black p = 0.071. The mean baseline ejection fraction (EF) was 48.89% ± 12.55 and follow-up EF was 50.83% ± 12.63 in the apical sparing group p=0.58. On the other hand, the mean baseline EF was 53.47% ± 13.92, and follow-up EF% was 54.72% ± 14.83 in the non-apical sparing group p=0.39. The readmission rate within 30 days from discharge was 17.1% in AS versus 21.2% non-AS group. <h3>Conclusion</h3> The data showed a higher prevalence of AS strains in black patients and female patients. Patients with AS were younger than those without AS. The baseline and follow-up ejection fraction were similar in both study groups. Almost one-third of patients admitted to the hospital with hypertensive emergency/urgency have an apical sparing pattern. To summarize, the apical sparing pattern is not exclusive to cardiac amyloidosis and it is more commonly seen in hypertensive heart disease.

Clinical predictors and outcomes for Legionnaire's disease versus bacteremic pneumococcal pneumonia

BackgroundLegionnaires' disease (LD) is a serious sometimes fatal pneumonia caused by Legionella pneumophila. The clinical manifestations of LD may be similar to those by caused by Streptococcus pneumoniae. As both conditions can be serious illnesses but requiring different antimicrobial therapies, factors that can help differentiate these types of pneumonias can be helpful in the clinical management of hospitalized patients with bacterial pneumonia. This study aimed to compare clinical features and indicators of disease progression in hospitalized patients with community-acquired pneumonia caused by L. pneumophila and bacteremic S. pneumoniae. MethodsWe conducted a retrospective case comparison study of adult patients hospitalized with LD or S. pneumoniae. Data collected included demographic, clinical characteristics, and comorbidities, and outcomes. Data were analyzed using SPS vs 24.0. Multivariable analysis was done using logistic regression with a forward stepwise algorithm. ResultsA total of 106 patients met study criteria. The incidence of LD peaked in summer months and S. pneumoniae peaked in the winter quarter. From multivariable analysis predictors of LD were male gender (OR=21.6, p < 0.001), diarrhea (OR=4.5, p = 0.04), body mass index (BMI) (OR=1.13, p = 0.02), hyponatremia (OR=5.6, p = 0.03 and Charlson weighted index of comorbidity (CWIC) score (OR=0.61, p = 0.01). Patients with S. pneumoniae had higher rates of mechanical ventilation, septic shock, and death than those with LD. ConclusionsOur data suggests that variables that may distinguish LD from S. pneumoniae include male gender, diarrhea, hyponatremia, higher temperature on admission, higher BMI and fewer comorbidities. Bacteremic S. pneumoniae was associated with poorer outcomes than LD including higher rates of septic shock, mechanical ventilation, ICU admission, and death.

Clinical Features and Risk Factors for In-Hospital Mortality From COVID-19 Infection at a Tertiary Care Medical Center, at the Onset of the US COVID-19 Pandemic.

Background:Mortality from COVID-19 has been associated with older age, black race, and comorbidities including obesity, Understanding the clinical risk factors and laboratory biomarkers associated with severe and fatal COVID-19 will allow early interventions to help mitigate adverse outcomes. Our study identified risk factors for in-hospital mortality among patients with COVID-19 infection at a tertiary care center, in Detroit, Michigan.Methods:We conducted a single-center, retrospective cohort study at a 776-bed tertiary care urban academic medical center. Adult inpatients with confirmed COVID-19 (nasopharyngeal swab testing positive by real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay) from March 8, 2020, to June 14, 2020, were included. Clinical information including the presence of comorbid conditions (according to the Charlson Weighted Index of Comorbidity (CWIC)), initial vital signs, admission laboratory markers and management data were collected. The primary outcome was in-hospital mortality.Results:Among 565 hospitalized patients, 172 patients died for a case fatality rate of 30.4%. The mean (SD) age of the cohort was 64.4 (16.2) years, and 294 (52.0%) were male. The patients who died were significantly older (mean [SD] age, 70.4 [14.1] years vs 61.7 [16.1] years; P < 0.0001), more likely to have congestive heart failure (35 [20.3%] vs 47 [12.0%]; P = 0.009), dementia (47 [27.3%] vs 48 [12.2%]; P < 0.0001), hemiplegia (18 [10.5%] vs 18 [4.8%]; P = 0.01) and a diagnosis of malignancy (16 [9.3%] vs 18 [4.6%]; P = 0.03).From multivariable analysis, factors associated with an increased odds of death were age greater than 60 years (OR = 2.2, P = 0.003), CWIC score (OR = 1.1, P = 0.023), qSOFA (OR = 1.7, P < 0.0001), WBC counts (OR = 1.1, P = 0.002), lymphocytopenia (OR = 2.0, P = 0.003), thrombocytopenia (OR = 1.9, P = 0.019), albumin (OR = 0.6, P = 0.014), and AST levels (OR = 2.0, P = 0.004) on admission.Conclusions:This study identified risk factor for in-hospital mortality among patients admitted with COVID-19 in a tertiary care hospital at the onset of U.S. Covid-19 pandemic. After adjusting for age, CWIC score, and laboratory data, qSOFA remained an independent predictor of mortality. Knowing these risk factors may help identify patients who would benefit from close observations and early interventions.

Do risk factors at the time of hospital admission differ by sex for in-hospital mortality from coronavirus disease 2019 (COVID-19)?

Sex-disaggregated data for coronavirus disease 2019 (COVID-19) reported higher hospitalized fatality rates among men than women. To determine whether the risk factors for in-hospital mortality from COVID-19, present at the time of hospital admission, differed by patient sex. Single-center, retrospective cohort study at a tertiary-care urban academic center. We reviewed the electronic medical records of patients positive for COVID-19 via qualitative polymerase chain reaction (PCR) assay, admitted between March 8 and June 14, 2020. Patients were stratified by sex to assess the association of variables present on admission with in-hospital mortality. The overall inpatient case fatality rate (CFR) was 30.4% (172 of 565). The CFR among male patients was higher than among female patients: 99 (33.7%) versus 73 (26.9%), respectively (P = .08). Among males, comorbid conditions associated with in-hospital mortality were chronic pulmonary disease (P = .02) and connective tissue disease (P = .03). Among females, these comorbid conditions were congestive heart failure (P = .03), diabetes with complication (P = .05), and hemiplegia (P = .02). Variables that remained independently associated with death in males included age >70 years, public insurance, incremental increase in quick sepsis-related organ failure assessment (qSOFA) and C-reactive protein (CRP), lymphocytopenia, and thrombocytopenia. Among females, variables that remained independently associated with mortality included public insurance, incremental increase in Charlson weighted index of comorbidity (CWIC) score, qSOFA, and CRP. Risk factors for in-hospital mortality by sex included public insurance type, incremental increase in qSOFA and CRP in both sexes. For male patients, older age, lymphocytopenia and thrombocytopenia were also associated with mortality, whereas a higher Charlson score was associated with in-hospital mortality in female patients.

49. Clinical Utility of Oseltamivir Restriction Policy

BackgroundInappropriate use of oseltamivir and antibiotics for upper respiratory tract infections may increase risk of microbial resistance. Restriction policies have been used to curtail inappropriate use of oseltamivir and antimicrobials in suspected or confirmed influenza patients. We assessed the impact of Infectious Diseases (ID) consult on the management of oseltamivir and concomitant antibiotics.MethodsA single‐center, retrospective study of patients ≥ 17 years, admitted for greater than 24 hours who received oseltamivir from October 1, 2018 to May 1, 2019 were evaluated. Demographics, Charlson Weighted Index of Comorbidity (CWIC), length of hospital stay (LOS), discharge disposition, rapid flu test, respiratory viral panel, sputum and blood cultures, antibiotic regimen and duration were collected. Continuous variables were analyzed using Students t‐test and categorical variables with Chi square test.Results298 patients were screened and 182 patients met the inclusion criteria. Please see table below for results. Oseltamivir was appropriately continued in 92.9% in the ID consult group compared to 89.3% in the non-ID consult group (p = 0.51). Antibiotic interventions were appropriate in 63.2% of the ID consult group compared to 40% in non-ID group (p = 0.36).Results Summary ConclusionOseltamivir interventions were appropriate and similar in between groups. Further, there was higher percentage of appropriate antibiotic interventions in the ID physician group. Duration of antibiotics was longer in the ID physicians consulted group which may be due to higher severity of illness in the group.Disclosures All Authors: No reported disclosures

Combined associations of body mass index and adherence to a Mediterranean-like diet with all-cause and cardiovascular mortality: A cohort study.

It is unclear whether the effect on mortality of a higher body mass index (BMI) can be compensated for by adherence to a healthy diet and whether the effect on mortality by a low adherence to a healthy diet can be compensated for by a normal weight. We aimed to evaluate the associations of BMI combined with adherence to a Mediterranean-like diet on all-cause and cardiovascular disease (CVD) mortality. Our longitudinal cohort design included the Swedish Mammography Cohort (SMC) and the Cohort of Swedish Men (COSM) (1997-2017), with a total of 79,003 women (44%) and men (56%) and a mean baseline age of 61 years. BMI was categorized into normal weight (20-24.9 kg/m2), overweight (25-29.9 kg/m2), and obesity (30+ kg/m2). Adherence to a Mediterranean-like diet was assessed by means of the modified Mediterranean-like diet (mMED) score, ranging from 0 to 8; mMED was classified into 3 categories (0 to <4, 4 to <6, and 6-8 score points), forming a total of 9 BMI × mMED combinations. We identified mortality by use of national Swedish registers. Cox proportional hazard models with time-updated information on exposure and covariates were used to calculate the adjusted hazard ratios (HRs) of mortality with their 95% confidence intervals (CIs). Our HRs were adjusted for age, baseline educational level, marital status, leisure time physical exercise, walking/cycling, height, energy intake, smoking habits, baseline Charlson's weighted comorbidity index, and baseline diabetes mellitus. During up to 21 years of follow-up, 30,389 (38%) participants died, corresponding to 22 deaths per 1,000 person-years. We found the lowest HR of all-cause mortality among overweight individuals with high mMED (HR 0.94; 95% CI 0.90, 0.98) compared with those with normal weight and high mMED. Using the same reference, obese individuals with high mMED did not experience significantly higher all-cause mortality (HR 1.03; 95% CI 0.96-1.11). In contrast, compared with those with normal weight and high mMED, individuals with a low mMED had a high mortality despite a normal BMI (HR 1.60; 95% CI 1.48-1.74). We found similar estimates among women and men. For CVD mortality (12,064 deaths) the findings were broadly similar, though obese individuals with high mMED retained a modestly increased risk of CVD death (HR 1.29; 95% CI 1.16-1.44) compared with those with normal weight and high mMED. A main limitation of the present study is the observational design with self-reported lifestyle information with risk of residual or unmeasured confounding (e.g., genetic liability), and no causal inferences can be made based on this study alone. These findings suggest that diet quality modifies the association between BMI and all-cause mortality in women and men. A healthy diet may, however, not completely counter higher CVD mortality related to obesity.

2008. Outcomes of Patients with Positive Procalcitonin Levels Who Do Not Receive Continued Antibiotics

BackgroundProcalcitonin (PCT) is a biomarker used to direct continued use of antibiotic therapy in patients with sepsis and community-acquired pneumonia. There is a lack of data on outcomes of patients with a positive PCT who do not receive continued antibiotics. We compared outcomes in patients with positive PCT levels who received antibiotics <24 hours to those who received ≥ 24 hours.MethodsA single-center, retrospective study to compare outcomes of adult patients with positive PCT (>0.25 μg/L) levels based on antibiotic duration. A report of hospitalized patients from January to June 2018 was generated and screened for inclusion criteria. Data collection included demographics, microbiologic data, Charlson Weighted Index of Comorbidity (CWIC), ICU admission, length-of-stay (LOS), and in-hospital mortality. Continuous and categorical variables were analyzed using Student’s t-test and Chi-square, respectively.Results443 of 998 patients met the inclusion criteria. 113 patients (25.5%) received <24 hours of antibiotics (Group 1) and 330 patients (74.5%) received ≥ 24 hours (Group 2). Group 1 had a higher CWIC, lower mean PCT and were less likely to have positive cultures (see table). Mean LOS was significantly different between the groups. ICU admission and mortality were not found to be different between the groups. While Group 1 had higher rates of noninfectious causes of mortality and Group 2 had higher rates of infectious, the differences were not significant. Among patients who died in-hospital, 47.6% vs. 63.2% had acute or chronic renal failure in Group 1 vs. Group 2, respectively.ConclusionPatients with elevated PCT levels are a heterogenous group. There was no overall difference in mortality between the two groups indicating that the interpretation of positive PCT results was overall appropriate in this study. Clinicians need to consider noninfectious causes of elevated PCT when evaluating patients. Disclosures All authors: No reported disclosures.

2242. Use of a Procalcitonin Assay in Hospitalized Patients for CHF Reduced Subsequent Use of Antibiotics

BackgroundProcalcitonin (PCT) is a biomarker that rises in bacterial infections and is being increasingly used to support a diagnosis of bacterial pneumonia. In addition, it may be used in cases in which the diagnosis is not clear such as in patients with congestive heart failure (CHF), which may mimic the signs and symptoms of bacterial pneumonia. The PCT assay was implemented at our institution to reduce unnecessary antimicrobial use when evaluating patients for suspected pneumonia.MethodsWe performed a retrospective analysis of all patients with a discharge diagnosis of CHF, admitted in a 6-month period, to a large community teaching hospital. Patients with documented pneumonia were excluded. Data were collected on demographics, comorbidities to calculate the Charlson Weighted Index of Comorbidity (CWIC) score, clinical and laboratory information, PCT results (if collected), whether antimicrobials were used, and if so, duration of therapy. Data were analyzed using the Mann–Whitney U test.ResultsWe reviewed 299 charts, with 198 (66.2%) included for analysis. The mean age was 70.4 ± 15.0 years, 53% female and 49.5% black. PCT testing was done in 72 (36%) patients; 117 (59%) had antimicrobials given in the emergency department (ED). If the PCT was performed, patients were more likely to receive antibiotics in the ED (79.2% vs. 47.6%, P < 0.0001). Patients who had a PCT drawn were less likely to have antibiotics continued after discharge from the ED (27.6% vs. 73.3%, P < 0.0001). The median duration of antimicrobials was shorter in patients who had a PCT level drawn than those who did not, 1 day (range 0.5–14) vs. 3 days (0.5–61), P < 0.0001. The duration of antimicrobials also tended to be shorter in patients with PCT levels ≤ 0.25 compared with those with levels >0.25, 0.5 days (0.5–12) vs. 1.0 day (0.5–14), p = 0.06.ConclusionAmong patients with a discharge diagnosis of CHF, there was an association between the use of the PCT assay and both discontinuation of antibiotics given in the ED as well as decreased duration of antimicrobials in patients. These results support the ongoing use of this test to promote antimicrobial stewardship.Disclosures All authors: No reported disclosures.

1469. Effect of Treatment Duration on Outcomes in Septic Patients Admitted for Urinary Tract Infections from Extended Care Facilities

BackgroundAdults in extended care facilities (ECFs) are at an increased risk of urinary tract infections (UTIs) with sepsis and there are little data on effective antibiotic duration. The purpose of this project was to assess the impact of inpatient antibiotic duration on clinical outcomes in these patients.MethodsA single-center, retrospective study of adult, ECF, septic UTI patients from 5/1/16 to 4/30/18 were included. In-hospital mortality, 30-day readmission rate, and length-of-stay (LOS) were compared based on the effective antibiotic duration of short- and long-term therapies (≤ 5 and > 5 days, respectively). Pregnant and asymptomatic bacteriuria patients were excluded. Demographics, Charlson Weighted Index of Comorbidity (CWIC), presence of indwelling catheter, SIRS criteria, microbiologic results and antibiotic regimen were collected. Continuous variables were analyzed using Student’s t-test and categorical variables with Chi-square test.Results105 of 1,158 ECF patients met the inclusion criteria. 38 patients received ≤ 5 days of effective antibiotic therapy, and 67 received > 5 days. Baseline demographics were similar, except the ≤ 5 days group were older and less likely to have fever (see table). In-hospital mortality was 18.4% in the short-term antibiotic group and 6.0% in the long-term group. Overall 30-day readmission was not significantly different. LOS was significantly greater in the > 5 day overall and non-bacteremia group.ConclusionDuration of antibiotics (≤ 5 and > 5 days) did not significantly affect 30-day readmission and in-hospital mortality; however, LOS was significantly longer in the > 5 days group. Further studies are needed to confirm these findings. Disclosures All authors: No reported disclosures.

Diabetes and the hospitalized patient : A cluster analytic framework for characterizing the role of sex, race and comorbidity from 2006 to 2011.

In the US, one in four adults has two or more chronic conditions; this population accounts for two thirds of healthcare spending. Comorbidity, the presence of multiple simultaneous health conditions in an individual, is increasing in prevalence and has been shown to impact patient outcomes negatively. Comorbidities associated with diabetes are correlated with increased incidence of preventable hospitalizations, longer lengths of stay (LOS), and higher costs. This study focuses on sex and race disparities in outcomes for hospitalized adult patients with and without diabetes. The objective is to characterize the impact of comorbidity burden, measured as the Charlson Weighted Index of Comorbidities (WIC), on outcomes including LOS, total charges, and disposition (specifically, probability of routine discharge home). Data from the National Inpatient Sample (2006-2011) were used to build a cluster-analytic framework which integrates cluster analysis with multivariate and logistic regression methods, for several goals: (i) to evaluate impact of these covariates on outcomes; (ii) to identify the most important comorbidities in the hospitalized population; and (iii) to create a simplified WIC score. Results showed that, although hospitalized women had better outcomes than men, the impact of diabetes was worse for women. Also, non-White patients had longer lengths of stay and higher total charges. Furthermore, the simplified WIC performed equivalently in the generalized linear models predicting standardized total charges and LOS, suggesting that this new score can sufficiently capture the important variability in the data. Our findings underscore the need to evaluate the differential impact of diabetes on physiology and treatment in women and in minorities.

The use of Charlson weighted index to evaluate the time of observation in emergency internal observation room

Objective To investigate the role of underlying diseases in predicting the length of stay for observation in emergency department of internal medicine by the Charlson weighted index of comorbidities(WIC) . Methods A single-center retrospective analysis of clinical data of 2 836 patients admitted in emergency observation room of the Beijing Chaoyang Hospital from January 1 to June 30 in 2013 was carried out. The patients were divided into two groups according to the length of observation time: Group A (time of observation ≥72 h, n =1908) and Group B (time of observation <72 h, n =928) . The data of the length of observation time were recorded, and the WIC and the APACHEⅡ score were calculated. Logistic regression analysis was used to determine the independent predictors for 72-hour observation. Receiver operating characteristics (ROC) curve was used to evaluate the value of WIC in predicting 72-hour observation. Results Of 2836 patients, 1176 (41.5%) suffered from respiratory disease, 709 (25.0%) had cardiovascular and cerebrovascular diseases, 423 (14.9%) were contracted digestive system disease, 251 (8.8%) had renal and endocrinology system diseases and 277 (9.8%) had diseases arisen from physicochemical factor and miscellaneous causes. Compared with patients in Group B, the average age, the number of elderly patients residing in apartment exclusively for elderly, the WIC and the APACHEⅡ score were higher in patients in Group A. The one-variable and multi-variable Logistic regression analyses showed that age, the WIC score, the APACHEⅡ score and residing in apartment for elderly people were related with 72-hour observation in emergency observation room. The area under the ROC curve in predicting 72-hour observation was 0.701 for the WIC score, 0.788 for APACHEⅡ score and 0.853 for their combination. Conclusions The WIC scoring system can be a good predicting method for 72-hour observation in patients in emergency observation room.. Key words: Emergency; Charlson weighted index of comorbidities scoring system; Receiver operating characteristics curve; Underlying disease; Logistic regression analysis; Age; Acute physiology and chronic health evaluation; Predicting

Validating Severity of Illness Scoring Systems in the Prediction of Outcomes in Staphylococcus aureus Bacteremia

BackgroundSeverity of illness scores are helpful in predicting mortality; however, no standardized scoring system has been validated in patients with Staphylococcus aureus bacteremia (SAB). The modified Rapid Emergency Medicine Score (REMS), the CURB-65 (confusion, urea, respiratory rate, blood pressure and age 65) and the Charlson weighted index of comorbidity (CWIC) were compared in predicting outcomes at the onset of SAB. MethodsAll adult inpatients with SAB from July 15, 2008, to December 31, 2009, were prospectively assessed. The 3 scoring systems were applied: REMS, CURB-65 and CWIC. The end points were attributable and overall mortality. ResultsA total of 241 patients with SAB were reviewed during the study period. The all-cause mortality rate was 22.8% and attributable mortality 14.1%. Patients who died had higher mean CURB-65 score and REMS than those who lived, whereas the difference in the CWIC score was not significant. Two logistic regression models based on CURB-65 score or REMS, after controlling for CWIC, revealed that both scores were independent predictors of mortality, with an odds ratio of 3.38 (P<0.0001) and 1.45 (P<0.0001) for CURB-65 and REMS, respectively. Receiver operating characteristic analysis revealed that a cutoff point of 3.0 (CURB-65) and 6.0 (REMS) provided the highest sensitivity and specificity. The area under the curves for all-cause mortality were 0.832 and 0.806, and for attributable mortality 0.845 and 0.819, for CURB-65 and REMS, respectively. ConclusionsREMS and CURB-65 scores outperformed CWIC as predictors of mortality in SAB and may be effective in predicting the severity of illness at the onset of bacteremia.

Post-Operative Complications in Patients Older than 60 Years Old with Lumbar Stenosis after Spinal Decompressive Surgery

Background Data: Morbidity and mortality tend to increase with advancing in age, surgical interference and its outcome may be influenced by age. In elderly stenotic canal decompressive surgery outcome is affected by age.Purpose: To assess complications in patients older than 60 years old with lumbar canal stenosis after spinal decompressive surgery. Study Design: This is a retrospective clinical case study. Patients and Methods: All postoperative complications of patients with spinal canal stenosis older than 60 years old who went through spinal decompressive surgery were reviewed and evaluated using the Charlson Weighted Index. Fifty-five patients treated between 2004 and 2010 were evaluated for postoperative complications. Forty-five percent were women and fifty five percent were men. The follow-upperiod averaged 12 months. Results: Back pain was present preoperatively in 88%; after surgery, 43% experiencedcomplete relief and 33% partial improvement while 24% with no improvement (Figure 4). Leg pain was present preoperatively in 98%; after surgery 43% experienced complete relief and 42% partial improvement. Wound complications and systemic complications, were demonstrated in 24 and 16 patients, respectively. There was nomortality. The number of laminectomy levels was not predictive of complications. Length of operative time (p=0.003) and the Charlson Weighted Comorbidity Index score (p=0.088) were associated with both systemic and wound complicationsdenoting a predictive index for complications. Conclusion: Spinal decompressive surgery in patients older than age 60 years with stenotic canal can be safe with outcomes rates as in younger patients. The Charlson Weighted Comorbidity Index score and operative time were predictive of the risk of complications. (2013ESJ038)

Risk Factors for Mortality in Patients with Pseudomonas aeruginosa Bacteremia: Clinical Impact of Antimicrobial Resistance on Outcome

Despite the high prevalence of antimicrobial resistance among Pseudomonas aeruginosa bacteremia, the clinical consequence of resistance remains unclear. The purpose of this study was to identify predictors of mortality and evaluate the clinical impact of antimicrobial resistance on outcome in P. aeruginosa bacteremia. A retrospective cohort study including patients with P. aeruginosa bacteremia was performed. The risk factors for antimicrobial resistances were evaluated, and the impact of the respective resistances on mortality was assessed. Of 202 P. aeruginosa bacteremia cases, the resistance rates to ceftazidime, piperacillin, imipenem, fluoroquinolone, and aminoglycoside were 36.6%, 22.3%, 22.8%, 23.8%, and 17.8%, respectively. A prior use of fluoroquinolones and an indwelling urinary catheter were common risk factors for all types of antimicrobial resistance. The overall 30-day mortality rate was 25.2% (51/202), and the risk factors for mortality were corticosteroid use, nosocomial acquisition, polymicrobial infection, an increasing Charlson's weighted co-morbidity index, and intensive care unit care (p < 0.05). As compared with the susceptible group, ceftazidime-, piperacillin-, or imipenem-resistant groups had a higher mortality (p < 0.05). A multivariate analysis showed that resistance to ceftazidime or imipenem remained a significant factor associated with mortality (odds ratio, 2.96; 95% confidential interval, 1.20-7.31; and odds ratio, 2.74; 95% confidential interval, 1.02-7.31, respectively). Antimicrobial resistance, especially to ceftazidime or imipenem, adversely affected outcome in patients with P. aeruginosa bacteremia.

Laparoscopic colorectal surgery in elderly patients: a case-control study of 15 years of experience

Introduction The aim of this study was to review the impact of age (≥75 years) on the short-term outcomes of laparoscopic colorectal surgery. Methods Three hundred seventy-nine patients under 70 years of age and 91 patients 75 years and older were analyzed. Quantification of comorbidities was performed using the Charlson Weighted Comorbidity Index. Outcome measures were postoperative complications and 30-day mortality. Results There was no difference in the occurrence of postoperative complications between the younger and older patients. Bivariate analysis revealed that patient age was not a risk factor of major complications (odds ratio = 1.2; 95% confidence interval, .6–2.3). Although bivariate analysis revealed that older age had a statistically significant odds ratio for 30-day mortality (odds ratio = 12.8; 95% confidence interval, 1.3–125.4), multivariate analysis revealed that it was a weighted comorbidity index score of 5 or more ( P = .02) and long operative time ( P = .01) that were independent predictors of 30-day mortality and not age per se. Conclusions Age is not an independent predictor of morbidity and mortality in laparoscopic colorectal cancer surgery.

Staphylococcus aureus Bacteremia in Older Adults: Predictors of 7-Day Mortality and Infection With a Methicillin-Resistant Strain

To determine the predictors of 7-day mortality in older adult patients with Staphylococcus aureus bacteremia after controlling for comorbidity using the Charlson weighted index of comorbidity (WIC) and to identify the risk factors associated with bacteremia due to methicillin-resistant S. aureus (MRSA). Retrospective cohort study from January 2003 until December 2004. Two tertiary care, university-affiliated hospitals. One hundred thirty-five hospitalized patients with S. aureus bacteremia were included in the study. All patients who were 60 years or older and had 1 or more blood cultures positive for S. aureus were included in the study. The primary outcome was death 7 days after the onset of S. aureus bacteremia. Twenty-one patients (15.6%) died within 7 days after the onset of S. aureus bacteremia. Seventy-four patients (56.1%) had MRSA bacteremia. Multivariate analysis identified 3 independent determinants of 7-day mortality: Charlson WIC score greater than 5 (odds ratio [OR], 3.6 [95% confidence interval {CI}, 1.1-11.2]; P=.03), previous hospitalization in the past 3 months (OR, 5.0 [95% CI, 1.1-25.1]; P=.04), and altered mental status at the onset of S. aureus bacteremia (OR, 13.6 [95% CI, 2.9-64.6]; P=.001). Multivariate analysis identified previous hospitalization in the past 3 months (OR, 2.6 [95% CI, 1.1-5.9]; P=.02), residence in a long-term care facility (OR, 4.5 [95% CI, 1.7-12.3]; P=.003), and altered mental status at the onset of S. aureus bacteremia (OR, 2.5 [95% CI, 1.5-5.6]; P=.02) to be independently associated with the presence of MRSA. The Charlson WIC is significantly associated with increased mortality of S. aureus bacteremia in older adults. Previous hospitalization in the past 3 months, residence in a long-term care facility, and altered mental status should be used as a guidance for empirical vancomycin therapy and application of infection control measures in older adults with suspected S. aureus bacteremia.

Impact of the use of aminoglycosides in combination antibiotic therapy on septic shock and mortality due to Staphylococcus aureus bacteremia

Background The purpose of this study was to evaluate the possible impact of antimicrobial combination regimens containing an aminoglycoside (AG) on morbidity and mortality associated with S. aureus bacteremia. Methods All inpatients over 18 years of age with S. aureus bacteremia were prospectively enrolled in three tertiary care hospitals in France and Ireland. Patients were included in the group “treated with AG” if they received at least 24 h of aminoglycoside therapy within 7 days after a positive blood culture in combination with an effective antimicrobial against the S. aureus. A Cox's proportional hazard model was used in univariate and multivariate survival analysis, the covariate “treatment with AG” being introduced as a time-dependent covariate. Results Nine percent of the 90 patients who received AG died because of infection versus 13% in the group that did not receive a combination including an AG ( p > 0.05). In the multivariate Cox model, stratified by septic shock and controlling for age and Charlson-weighted index of comorbidity, the adjusted odds ratio for death due to S. aureus infection associated with the use of AG was 0.6 [95% CI: (0.2–1.9); p = 0.4]. However, AG was found to have a protective effect on septic shock occurrence [OR = 0.3; 95% CI: (0.1–0.7), p = 0.004], controlling for age, portal of entry not related to catheter infection, and diabetes. Conclusion Although there was no decrease in mortality due to S. aureus infection in patients treated with AG therapy, we found a significant benefit of AG in preventing septic shock. This data argues for the early use of AG in patients with S. aureus bacteremia.