Cumulative Incidence Of Hospitalization Research Articles

A Prospective Cohort Study Evaluating Impact of Sarcopenia on Hospitalization in Patients on Continuous Ambulatory Peritoneal Dialysis

Data regarding the association of sarcopenia with hospitalization has led to inconclusive results in patients undergoing dialysis. The main goal of this research was to investigate the association between sarcopenia and hospitalization in Chinese individuals on continuous ambulatory peritoneal dialysis (CAPD). Eligible patients on CAPD were prospectively included, and followed up for 48 weeks in our PD center. Sarcopenia was identified utilizing the criteria set by the Asian Working Group on Sarcopenia in 2019 (AWGS 2019). Participants were categorized into sarcopenia (non-severe sarcopenia + severe sarcopenia) and non-sarcopenia groups. The primary outcome was all-cause hospitalization during the 48-week follow-up period. Association of sarcopenia with all-cause hospitalization was examined by employing multivariate logistic regression models. The risk of cumulative incidence of hospitalization in the 48-week follow-up was estimated using relative risk (RR and 95% CI). The cumulative hospitalization time and frequency at the end of 48-week follow-up were described as categorical variables, and compared by χ2 test or fisher's exact test as appropriate. Subgroup and sensitivity analyses were also conducted to examine whether the potential association between sarcopenia and hospitalization was modified. A total of 220 patients on CAPD (5 of whom were lost in follow-up) were included. Prevalences of total sarcopenia and severe sarcopenia were 54.1% (119/220) and 28.2% (62/220) according to AWGS 2019, respectively. A total of 113 (51.4%) participants were hospitalized during the 48-week follow-up period, of which, the sarcopenia group was 65.5% (78/119) and the non-sarcopenia group was 34.7% (35/101), with an estimated RR of 1.90 (95%CI 1.43–2.52). The cumulative hospitalization time and frequency between sarcopenia and non-sarcopenia groups were significantly different (both P < 0.001). Participants with sarcopenia (OR = 3.21, 95%CI 1.75–5.87, P < 0.001), non-severe sarcopenia (OR = 2.84, 95%CI 1.39–5.82, P = 0.004), and severe sarcopenia (OR = 3.66, 95%CI 1.68–8.00, P = 0.001) demonstrated a significant association with all-cause hospitalization compared to individuals in non-sarcopenia group in the 48-week follow-up. Moreover, participants in subgroups (male or female; < 60 or ≥ 60 years) diagnosed with sarcopenia, as per AWGS 2019, were at considerably high risk for hospitalization compared to those with non-sarcopenia. In sensitivity analyses, excluding participants lost in the follow-up, the relationships between sarcopenia and hospitalization (sarcopenia vs. non-sarcopenia; severe sarcopenia/non-severe sarcopenia vs. non-sarcopenia) were consistent. This research involving Chinese patients on CAPD demonstrated a significant association between sarcopenia and incident hospitalization, thereby emphasizing the importance of monitoring sarcopenia health in this population.

Myosteatosis is closely associated with sarcopenia and significantly worse outcomes in patients with cirrhosis

Myosteatosis is closely associated with sarcopenia and significantly worse outcomes in patients with cirrhosis

Long-term neurological outcomes of offspring misdiagnosed with fetal growth restriction.

Fetal growth restriction (FGR) is a major determinant of adverse short- and long-term perinatal outcomes. The current definition of FGR (estimated fetal weight measurement < 10th percentile) may lead, at times, to a false diagnosis of fetuses that are eventually born appropriate for gestational age (AGA). Our objective was to investigate the potential association between a misdiagnosis of antepartum fetal growth restriction and long-term neurological outcomes in offspring. A population-based cohort analysis was performed including deliveries between the years 1991-2020 in a tertiary medical center. We compared neurological hospitalization during childhood among AGA infants falsely diagnosed as FGR versus AGA infants without a false FGR diagnosis. A Kaplan-Meier survival curve was used to assess cumulative morbidity and a Cox proportional hazards model was employed to control for confounders. During the study period, 324,620 AGA infants met the inclusion criteria; 3249 of them were falsely classified as FGR. These offspring had higher rates of hospitalizations due to various neurological conditions, as compared to those without an FGR diagnosis (OR 1.431, 95% CI 1.278-1.608; P < 0.001). In addition, cumulative hospitalization incidence was elevated in the FGR group (log-rank P-value < 0.001). When controlling for confounders, a false FGR diagnosis remained independently associated with long-term neurological morbidities (adjusted HR 1.086, 95% CI 1.003-1.177, P = 0.043). Misdiagnosis of FGR in the antepartum period is associated with an increased risk for offspring long-term neurological morbidities.

COVID-19 hospitalization risk after outpatient nirmatrelvir/ritonavir use, January to August 2022, North Carolina.

In the USA, nirmatrelvir/ritonavir is authorized for the treatment of mild-to-moderate COVID-19 in patients at least 12 years of age, at high risk for progression to severe COVID-19. To estimate the impact of outpatient nirmatrelvir/ritonavir on COVID-19 hospitalization risk in a US healthcare system. We conducted a cohort study using electronic health records among outpatients with a positive SARS-CoV-2 PCR test between January and August 2022. We evaluated the association of nirmatrelvir/ritonavir therapy with time to hospitalization by estimating adjusted HRs and assessed the impact of nirmatrelvir/ritonavir on predicted COVID-19 hospitalizations using machine-learning methods. Among 44 671 patients, 4948 (11%) received nirmatrelvir/ritonavir, and 201 (0.4%) were hospitalized within 28 days of COVID-19 diagnosis. Nirmatrelvir/ritonavir recipients were more likely to be older, white, vaccinated, have comorbidities and reside in areas with higher average socioeconomic status. The 28 day cumulative incidence of hospitalization was 0.06% (95% CI: 0.02%-0.17%) among nirmatrelvir/ritonavir recipients and 0.52% (95% CI: 0.46%-0.60%) among non-recipients. For nirmatrelvir/ritonavir versus no therapy, the age-adjusted HR was 0.08 (95% CI: 0.03-0.26); the fully adjusted HR was 0.16 (95% CI: 0.05-0.50). In the machine-learning model, the primary features reducing predicted hospitalization risk were nirmatrelvir/ritonavir, younger age, vaccination, female gender and residence in a higher socioeconomic status area. COVID-19 hospitalization risk was reduced by 84% among nirmatrelvir/ritonavir recipients in a large, diverse healthcare system during the Omicron wave. These results suggest that nirmatrelvir/ritonavir remained highly effective in a setting substantially different than the original clinical trials.

Hospitalization for Infection in Patients with Primary Autoimmune Hemolytic Anemia Treated with Rituximab. a Prospective, Nationwide Cohort Study in France

Introduction Autoimmune hemolytic anemia (AIHA) is a rare disease caused by the production of autoantibodies directed against red blood cells. Infections are frequent and severe in patients with primary AIHA. Rituximab is the reference second-line treatment for warm AIHA and the basis of the treatment of symptomatic cold agglutinin disease. However, the risk of infection after rituximab is not known in these patients with primary AIHA the real-world. Opportunistic infections had been described and the use of specific prophylaxis is debated. Consequently, this cohort study aimed to: (i) measure the incidence of hospitalization for infection after the exposure to rituximab in adult patients with primary AIHA; (ii) describe the types of these infections; (iii) measure the 30-day overall mortality after the first hospitalization for infection; (iv) determine the factors associated with hospitalization for infection; and (v) assess the effectiveness of pneumocystis prophylaxis. Methods Patients were selected from the AHEAD cohort (Autoimmune HEmolytic Anemia: a population-baseD study) between January 2012 and July 2018. This cohort consists in all adult patients with incident AIHA, selected in the French National Health Database. This database covers virtually the entire French population (67 million individuals). It links socio-demographic, outpatient, and hospitalization data. Patients with AIHA were identified using the International Classification of Diseases, tenth version (ICD-10) D59.1 code as hospital discharge or long-term disease diagnosis (the latter being coded by general practitioners). Incident cases were selected using a prior observation period of at least 2 years without the D59.1 diagnosis code. This code yielded a positive predictive value of 90.0% (95% CI: 79.5 to 96.2) in a previous validation study. We restricted the study population to adult patients exposed to rituximab. The first infusion of rituximab defined the index date. Patients with causes of secondary AIHA before the index date were excluded. We assessed the cumulative incidence of hospitalizations with a discharge diagnosis of infection during the six months after the index date (median duration of B-cell depletion). The overall mortality was measured during the 30 days after hospitalization for infection. We assessed the association of age, sex, comorbidities, red blood cell transfusions before the index date (as indicator of AIHA severity), exposure to corticosteroids, to other immunosuppressive drugs, splenectomy (time-varying exposures) as well as pneumococcal and influenza vaccinations before the index date on the occurrence of hospitalization for infection using Cox regression models. A sensitivity analysis was performed using Fine and Gray's models with death as competitive risk. Pneumocystis pneumonia was identified using the B48.5 and B59 discharge diagnosis codes. The association with specific prophylaxis was assessed. Results Between 2012 and 2018, we identified 959 adult patients with incident primary AIHA who received rituximab. The mean age was 67 years and 61% of the patients were women. The 6-month cumulative incidence of hospitalization with a discharge diagnosis of infection was 18.3% (95% CI: 15.9 to 20.9). The most frequently characterized infections were pulmonary, urogenital, and gastrointestinal. Opportunistic infections were observed in 28 (16.6%) patients. The 30-day overall mortality after the first hospitalization for infection was 12.5% (95% CI: 8.0 to 18.0). The risk factors associated with hospitalization for infection in multivariable analysis were an age ≥70 years (HR: 2.7; 95% CI: 1.6-4.6) and current exposure to corticosteroids (HR: 1.6; IC 95%: 1.2-2.2). The results of the sensitivity analysis were concordant. In total, 189 (19.7%) patients were exposed to pneumocystis prophylaxis and 14 pneumocystis pneumonia occurred. All cases occurred during the exposure to corticosteroids and in patients with no specific prophylaxis. All but 2 were aged ≥70 years. Conclusion The incidence of hospitalizations for infection and mortality after hospitalization for infection were high in adult patients with primary AIHA treated with rituximab. Opportunistic infections were not uncommon. Concomitant exposure to corticosteroids and an older age are the main risk factors for infection. Pneumocystis prophylaxis should be discussed for these patients.

Maternal pruritus gravidarum and its long-term effect on dermatological morbidity in the offspring

Purpose Pruritus gravidarum is characterized by general pruritus in the absence of primary skin lesions. In this study, we sought to evaluate whether the offspring (≤ 18 years) of mothers diagnosed with pruritus gravidarum, are at increased risk of long-term dermatology-related hospitalization. Methods A population-based, retrospective cohort study of all singleton deliveries between 1991 and 2021 was conducted at a tertiary medical center. Offspring of mothers diagnosed with pruritus gravidarum were compared to offspring of non-exposed mothers. First admission involving dermatological morbidity of the offspring were analyzed using ICD-9 codes. Kaplan-Meier survival curves were used to compare the cumulative hospitalization incidence between the groups and Cox regression models were utilized to adjust for confounding variables. Results A total of 849 women out of 356,356 deliveries that fulfilled the inclusion criteria were diagnosed with pruritus gravidarum during pregnancy (0.23%). Among offspring to mothers with pruritus gravidarum versus non-pruritus gravidarum mothers, hospitalization rates involving dermatological morbidity, were higher (7.1% vs. 4.6%, p < .001) a finding that was consistent with the Kaplan-Meier survival curve (Log rank p = .002). In the Cox regression model, pruritus gravidarum was found to be a significant independent risk factor for dermatological-related hospitalizations in the offspring after controlling for gestational age, hypertensive disorders, diabetic disorders, meconium-stained amniotic fluid exposure and fertility treatments (adjusted HR = 1.44, 95% CI 1.12–1.85, p = .004). Conclusions Maternal pruritus gravidarum is an independent risk factor for long-term dermatology-related hospitalization in the offspring up to the age of 18 years.

Intrapartum Maternal Fever and Long-Term Infectious Morbidity of the Offspring.

Maternal intrapartum fever can lead to various maternal and neonatal complications and is attributed to various etiologies including infectious and non-infectious processes. In this study, we evaluated whether intrapartum fever affects the offspring's tendency to long-term infectious morbidity. A population-based cohort analysis including deliveries between 1991 and 2021 was conducted. The incidence of hospitalizations of the offspring up to the age of 18 years, due to various infectious conditions, was compared between pregnancies complicated by intrapartum fever and those that were not. A Kaplan-Meier survival curve was used to assess cumulative hospitalization incidence. A Cox proportional hazards model was used to control for confounders. Overall, 538 of the 356,356 included pregnancies were complicated with fever. A higher rate of pediatric hospitalizations due to various infectious conditions was found among the exposed group, which was significant for viral, fungal and ENT infections (p < 0.05 for all). The total number of infectious-related hospitalizations was significantly higher (30.1% vs. 24.1%; OR = 1.36; p = 0.001), as was the cumulative incidence of hospitalizations. This association remained significant after controlling for confounders using a Cox proportional hazards model (adjusted HR = 1.21; 95% CI 1.04-1.41, p = 0.016). To conclude, fever diagnosed close to delivery may influence offspring susceptibility to pediatric infections.

Peer Counselor Intervention for Reducing Mortality and/or Hospitalization in Adults With Hypertensive Urgency in Tanzania: A Pilot Study.

Worldwide, people with hypertensive urgency experience high rates of hospitalization and death due to medication non-adherence. Interventions to improve medication adherence and health outcomes after hypertensive urgency are urgently needed. This prospective cohort assessed the effect of a peer counselor intervention-named Rafiki mwenye msaada-on the 1-year incidence of hospitalization and/or death among adults with hypertensive urgency in Mwanza, Tanzania. We enrolled 50 patients who presented with hypertensive urgency to 2 hospitals in Mwanza, Tanzania. All 50 patients received a Rafiki mwenye msaada an individual-level, time-limited case management intervention. Rafiki mwenye msaada aims to empower adult patients with hypertensive urgency to manage their high blood pressure. It consists of 5 sessions delivered over 3 months by a peer counselor. Outcomes were compared to historical controls. Of the 50 patients (median age, 61 years), 34 (68%) were female, and 19 (38%) were overweight. In comparison to the historical controls, the intervention cohort had a significantly lower proportion of patients with a secondary level of education (22% vs. 35%) and health insurance (40% vs. 87%). Nonetheless, the 1-year cumulative incidence of hospitalization and/or death was 18% in the intervention cohort vs. 35% in the control cohort (adjusted Hazard Ratio, 0.48, 95% CI 0.24-0.97; P = 0.041). Compared to historical controls, intervention participants maintained higher rates of medication use and clinic attendance at both 3- and 6-months but not at 12 months. Of intervention participants who survived and remained in follow-up, >90% reported good medication adherence at all follow-up time points. Our findings support the hypothesis that a peer counselor intervention may improve health outcomes among adults living with hypertensive urgency. A randomized clinical trial is needed to evaluate the intervention's effectiveness.

Cardiovascular diseases among macrosomic infants of diabetic mothers

While the association between diabetes mellitus during pregnancy and cardiac morbidity of the offspring is well characterized, few existing investigations have assessed the long-term cardiovascular outcomes of macrosomic infants in specific. In this study we have examined the contributory role of diabetes on cardiac disease formation among macrosomic offspring. A population-based cohort analysis including deliveries of macrosomic infants (birthweight above 4 kilograms) between the years 1991 to 2021 at a tertiary referral hospital was conducted. Incidence of hospitalizations due to various cardiovascular conditions was compared between infants of women with and without diabetes. A Kaplan-Meyer survival curve was used to assess cumulative hospitalization incidence. A Cox proportional hazards model was used to control for confounders. Of the 16,466 macrosomic infants, 11% were of women with diabetes during pregnancy (pregestational and gestational diabetes mellitus). Offspring of both diabetic and nondiabetic mothers had comparable rates of cardiovascular-related hospitalization during childhood and adolescence (1.5% and 1.1% respectively, p=0.155; Table). Cumulative incidence of hospitalizations was similar, as shown in the Kaplan-Meyer survival curve (log rank p-value=0.246; Figure), and A Cox proportional hazards model found no association as well (adjusted HR = 1.27, 95% CI 0.82–1.95, p=0.284). In our population of macrosomic infants, diabetes mellitus does not seem to be associated with elevated rates of cardiovascular diseases.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Rate of Hospitalizations and Mortality of Respiratory Syncytial Virus Infection Compared to Influenza in Older People: A Systematic Review and Meta-Analysis.

Respiratory Syncytial Virus (RSV) is commonly regarded as an infection typical of children, but increasing literature is showing its importance in older people. Since the data regarding the impact of RSV are still limited for older people, the aim of this systematic review and meta-analysis is to compare the rate of hospitalization and mortality between RSV and influenza in this population. A systematic literature search until 15 June 2022 was done across several databases and including studies reporting incidence rate and cumulative incidence of hospitalization and mortality in RSV and influenza affecting older people. Among 2295 records initially screened, 16 studies including 762,084 older participants were included. Compared to older patients having influenza, patients with RSV did not show any significant different risk in hospitalization (either cumulative or incidence rate). Similar results were evident for mortality. The quality of the studies was in general good. In conclusion, our systematic review and meta-analysis showed that the rate of hospitalization and mortality was similar between RSV and influenza in older adults, suggesting the importance of vaccination for RSV in older people for preventing negative outcomes, such as mortality and hospitalization.

Factors Associated with Hospitalization with Symptomatic COVID-19 Illness Among Pregnant Individuals: A Multi-Center Retrospective Cohort Study

BackgroundPregnant individuals are at increased risk of COVID-19 hospitalization and death, and primary and booster COVID-19 vaccination is recommended for this population.MethodsAmong a cohort of pregnant individuals who received prenatal care at three healthcare systems in the United States, we estimated the cumulative incidence of hospitalization with symptomatic COVID-19 illness. We also identified factors associated with COVID-19 hospitalization using a multivariable Cox proportional-hazards model with pregnancy weeks as the timescale and a time-varying adjustor that accounted for SARS-CoV-2 circulation; model covariates included site, age, race, ethnicity, insurance status, pre-pregnancy weight status, and selected underlying medical conditions. Data were collected primarily through medical record extraction.ResultsAmong 19,456 pregnant individuals with an estimated due date March 1, 2020-February 28, 2021, 75 (0.4%) were hospitalized with symptomatic COVID-19. Factors associated with hospitalization for symptomatic COVID-19 were Hispanic ethnicity (aHR: 2.7; 95% CI: 1.3,5.5), native Hawaiian or Pacific Islander race (aHR: 12; 95% CI: 3.2,45.5), age <25 years (aHR: 3.1; 95% CI: 1.3,7.6), pre-pregnancy obesity (aHR: 2.1; 95% CI: 1.1,3.9), diagnosis of a metabolic disorder (aHR: 2.2; 95% CI: 1.2,3.8), lung disease excluding asthma (aHR: 49; 95% CI: 28,84) and cardiovascular disease (aHR: 2.6; 95% CI: 1.5,4.7).ConclusionAlthough hospitalization with symptomatic COVID-19 was uncommon, pregnant individuals should be aware of risk factors associated with severe illness when considering COVID-19 vaccination.

Effectiveness of COVID -19 vaccine on cancer patients in one Latin American country: A follow-up of ACHOC-C19 study.

e18721 Background: In our experience during the first year of development of ACHOC-C19 study, we observed 26% mortality in patients with cancer and COVID 19 infection. The impact of vaccination was not evaluated prior to the implementation of this strategy worldwide in this kind of population. It was proposed to evaluate the effectiveness of immunization during the second phase of our investigation. Methods: Cohort study derived from the National Registry of Patients with Cancer and COVID-19 (ACHOCC-19). Data were collected from June 2021 since vaccine was available. Patients were: older than 18 years, diagnosed with cancer (solid tumors), treated and/or under follow-up, and with COVID-19 infection. The comparative analysis of the vaccinated and non-vaccinated cohort is presented. Outcomes included: all-cause mortality within 30 days of infection diagnosis, hospitalization, and mechanical ventilation. Effect estimation was performed through relative risk (RR) and multivariate analysis for each event, using generalized linear models of the binomial family. Results: 896 patients were included, 470 were older than 60 years (52.4%) and 59% women (n = 530). 172 patients were recruited in the vaccinated cohort and 724 in the non-vaccinated cohort (ratio: 1 to 4.2). The cumulative incidence of hospitalization among the unvaccinated was 42.4% (n = 307), and among the vaccinated, 29% (n = 50); invasive mechanical ventilation requirement was 8.4% (n = 61) in unvaccinated, and 4.6% (n = 8) in vaccinated. The cumulative incidence of mortality from all causes in the unvaccinated was 17% (n = 123) and in the vaccinated 4.65% (n = 8). Table summarizes the multivariate analysis. The adjusted RR for mortality for the unvaccinated is 3.4 (95% CI: 1.7-6.8), for hospitalization 1.36 (95% CI: 1.08-1.72), and for mechanical ventilation 2.1 (95% CI: 1.02-4.2). Conclusions: The incidence of complications and death in patients with cancer and COVID-19 infection is significantly higher in those who have not received a vaccination schedule compared to those who have been vaccinated. Immunization should be promoted and intensified in this population group.[Table: see text]

Black-White Risk Differentials in Pediatric COVID-19 Hospitalization and Intensive Care Unit Admissions in the USA.

PurposeThe COVID-19 morbidity with SARS-CoV-2 as a causative pathogenic microbe remains a pandemic with children experiencing less mortality but with severe manifestations. The current study aimed to assess SARS-CoV-2 cumulative incidence, COVID-19 hospitalization, and ICU admission with respect to racial differentials.Materials and MethodsA cross-sectional nonexperimental epidemiologic design was used to examine pediatric COVID-19 data from CDC during 2020. The variables assessed were ICU admissions, hospitalization, sex, race, and region. The Chi-Square (X2) statistic was used to examine the independence of the variables by race, while the binomial regression model was used to predict racial risk differentials in hospitalization and ICU admissions.ResultsThe pediatric COVID-19 data observed the cumulative incidence of hospitalization to be 96,376, while ICU admission was 12,448. Racial differences were observed in hospitalization, ICU admissions, sex, and region. With respect to COVID-19 hospitalization, Black/African American (AA) children were two times as likely to be hospitalized compared to their White counterparts, prevalence risk ratio (pRR) = 2.20, 99% confidence interval (CI = 2.12–2.28). Similarly, Asians were 45% more likely to be hospitalized relative to their White counterparts, pRR = 1.45, 99% CI = 1.32–1.60. Regarding ICU admission, there was a disproportionate racial burden, implying excess ICU admission among Black/AA children relative to their White counterparts, pRR = 5.18, 99% CI = 4.44–6.04. Likewise, Asian children were 3 times as likely to be admitted to the ICU compared to their White counterparts, pRR = 3.36, 99% CI = 2.37–4.77. Additionally, American Indians/Alaska Natives were 2 times as likely to be admitted to ICU, pRR = 2.54, 99% CI = 0.82–7.85.ConclusionRacial disparities were observed in COVID-19 hospitalization and ICU admission among the US children, with Black/AA children being disproportionately affected, implying health equity transformation.

Prematurity and Long-Term Respiratory Morbidity-What Is the Critical Gestational Age Threshold?

Respiratory morbidity is a hallmark complication of prematurity. Children born preterm are exposed to both short- and long-term respiratory morbidity. This study aimed to investigate whether a critical gestational age threshold exists for significant long-term respiratory morbidity. A 23-year, population-based cohort analysis was performed comparing singleton deliveries at a single tertiary medical center. A comparison of four gestational age groups was performed according to the WHO classification: term (≥37.0 weeks, reference group), moderate to late preterm (32.0–36.6 weeks), very preterm (28.0–31.6 weeks) and extremely preterm (24.0–27.6 weeks). Hospitalizations of the offspring up to the age of 18 years involving respiratory morbidities were evaluated. A Kaplan–Meier survival curve was used to compare cumulative hospitalization incidence between the groups. A Cox proportional hazards model was used to control for confounders and time to event. Overall, 220,563 singleton deliveries were included: 93.6% term deliveries, 6% moderate to late preterm, 0.4% very preterm and 0.1% extremely preterm. Hospitalizations involving respiratory morbidity were significantly higher in children born preterm (12.7% in extremely preterm children, 11.7% in very preterm, 7.0% in late preterm vs. 4.7% in term, p < 0.001). The Kaplan–Meier survival curve demonstrated a significantly higher cumulative incidence of respiratory-related hospitalizations in the preterm groups (log-rank, p < 0.001). In the Cox regression model, delivery before 32 weeks had twice the risk of long-term respiratory morbidity. Searching for a specific gestational age threshold, the slope for hospitalization rate was attenuated beyond 30 weeks’ gestation. In our population, it seems that 30 weeks’ gestation may be the critical threshold for long-term respiratory morbidity of the offspring, as the risk for long-term respiratory-related hospitalization seems to be attenuated beyond this point until term.

Maternal fever during labor and long-term infectious morbidity of the offspring

Maternal intrapartum fever (i.e., fever of over 38.0°C encountered just before or during delivery) can lead to a variety of maternal and neonatal complications and is attributed to various etiologies including benign infectious and non-infectious processes. In this study we sought to evaluate whether intrapartum fever carries an impact on the long-term infectious morbidity of the offspring. A population-based cohort analysis including deliveries between the years 1991 to 2014 in a tertiary referral hospital was conducted. Incidence of hospitalizations of the offspring up to the age of 18 years due to various infectious conditions was compared between pregnancies complicated by intrapartum fever, and those who were not. A Kaplan-Meier survival curve was used to assess cumulative hospitalization incidence. A Cox proportional hazards model was used to control for baseline selected confounders. During the study period, 249,840 pregnancies met the inclusion criteria. Of those, 407 (0.2%) were accompanied by intrapartum fever. Hospitalization rate of the offspring due to bacterial infections (0.7% vs. 0.1%; OR=5.35, 95% CI 1.7-16.73; p=0.02), ear, nose and throat infections (2.9% vs. 1.5%; OR=2.03, 95% CI 1.14-3.61; p=0.014) and total infectious morbidity (14.7% vs. 11.0%; OR=1.4, 95% CI 1.06-1.84; p=0.017) was higher among the exposed group (Table), as was the cumulative incidence of hospitalizations presented in the Kaplan-Meier survival curve (log rank p=0.005; Figure). This association remained significant after controlling for potential confounders (including gestational age, maternal age, hypertensive disorders of pregnancy and diabetes mellitus) using a Cox proportional hazards model (adjusted HR = 1.36; 95% CI 1.05–1.76, p=0.018). Maternal fever diagnosed close to delivery may influence offspring susceptibility to pediatric infections, as it is linked to higher rates of long-term infectious morbidity of the offspring.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Systematic Review and Meta-Analysis: Risk of Hospitalization in Patients with Ulcerative Colitis and Crohn's Disease in Population-Based Cohort Studies.

Inflammatory bowel diseases (IBD) lead to high morbidity and unplanned healthcare utilization. We conducted a systematic review with meta-analysis to estimate the cumulative incidence of IBD-related (and all-cause) hospitalization in patients with ulcerative colitis (UC) and Crohn's disease (CD). Through a systematic review to September 3, 2019, we identified population-based inception cohort studies in patients with IBD that reported patient-level cumulative incidence of hospitalization at 1, 3 and 5 years after diagnosis. Hospitalization risk was pooled using random effects meta-analysis, and risk factors analyzed through mixed-effects meta-regression and qualitative synthesis. In patients with UC (6 cohorts), 1-, 3- and 5-year risk of UC-related hospitalization was 10.4% (95% CI 8.2-13.2), 17.0% (95% CI 14.0-20.4) and 21.5% (95% CI 18.0-25.4), respectively, with considerable heterogeneity. In patients with CD (6 cohorts), 1-, 3- and 5-year risk of CD-related hospitalization was 29.3% (95% CI 20.0-40.8), 38.5% (95% CI 26.8-51.7) and 44.3% (95% CI 32.7-56.5), respectively, with considerable heterogeneity. On meta-regression, steady decline in risk of hospitalization was observed in patients diagnosed in a more contemporary era. Younger age at onset (both UC and CD), extensive colitis (UC), ileal-dominant CD, perianal CD and penetrating and/or stricturing behavior (CD) and early need for corticosteroids and immunosuppressive therapy (both UC and CD) were associated with increased risk of hospitalization. Approximately one in five and one in two patients with UC and CD are hospitalized within 5years of diagnosis, respectively. Population health management strategies are required to mitigate unplanned healthcare utilization.

Very long-term outcomes of older adults with stable coronary artery disease (from the CORONOR study).

There are limited data on stable coronary artery disease (CAD) in the very elderly. The present study aimed to investigate incident cardiovascular events and mortality in older adults (≥85 years) included in a multicenter registry on stable CAD. A long-term follow-up was performed in 198 patients ≥85 years with stable CAD, free from myocardial infarction (MI) or coronary revascularization within the year. The median age was 87 years. Clinical events during the follow-up period [death, MI, ischemic stroke, coronary revascularization and hospitalization for heart failure (HF)] were centrally adjudicated. There were 164 deaths during follow-up. The cumulative risk of all-cause death was 9.1% at 1 year, 53.9% at 5 years and 85.5% at 10 years. The cause of death was adjudicated as cardiovascular in 64 patients with death from HF in 36 patients. Male gender, previous hospitalization for HF and an estimated glomerular filtration rate <60 ml/min/1.73 m2 were independently associated with all-cause death. Ten-year cumulative incidences of MI, ischemic stroke and coronary revascularization were low (6.6, 7.7 and 6.6%, respectively). By contrast, the 10-year cumulative incidence of hospitalization for HF was high (27.8%). The 10-year mortality of elderly patients with stable CAD is very high. While ischemic events are relatively unfrequent, HF events are frequent and represent the most common cause of cardiovascular death in this population. Prevention and management of HF are important goals for physicians in charge of older adults with stable CAD.

Incidence of adverse cardiovascular events in type2 diabetes mellitus patients after initiation of glucose-lowering agents: A population-based community study from the Shizuoka Kokuho database.

Aims/IntroductionIncreased incidence of hospitalization for heart failure (HHF) among patients with diabetes is increasingly being reported. We investigated the incidence of adverse cardiovascular events including HHF among patients with type 2 diabetes mellitus, and the potential clinical improvement with sodium–glucose cotransporter 2 inhibitors (SGLT2i) using a contemporary administrative claims database from a large governmental district of Japan.Materials and MethodsWe included initiators of any oral glucose‐lowering drugs between 2013 and 2018. We estimated the 5‐year cumulative incidence of hospitalization for HF, myocardial infarction and stroke, treating death as a competing risk. We evaluated the possible impact of introducing SGLT2i to the potential recipients of the drug, using the inclusion criteria from Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA‐REG OUTCOME) and Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58 (DECLARE‐TIMI 58) trials, assuming the same risk reduction as theirs.ResultsAmong 23,340 drug initiators (54.0% men, and 6.4% aged >85 years), the 5‐year cumulative incidence was 5.4% (95% confidence interval 4.9–5.9%) for HHF, 1.9% (95% confidence interval 1.7–2.2%) for myocardial infarction admission and 6.1% (95% confidence interval 5.7–6.6%) for stroke admission. Among 6,192 patients with laboratory test data, 651 (10.5%) and 2,680 (43.3%) patients met the EMPA‐REG‐like and DECLARE‐like criteria, respectively. The 5‐year cumulative incidence among the 2,849 patients meeting either of the criteria was estimated to decrease from 97.1 to 75.6 events through 75% adoption of SGLT2i.ConclusionsThe incidence of HHF was similar to that of stroke. A significant portion of our cohort met the inclusion criteria for major randomized clinical trials for SGLT2i, and estimated reduction in the HHF events was substantial.

Abstract 13289: Incidence of Heart Failure Hospital Admissions Among Type 2 Diabetes Mellitus Patients and the Potential Impact of SGLT2 Inhibitors in Japan: A Population-based Study From the Shizuoka Kokuho Database

Introduction: Recent large-scale clinical trials have shown that the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduces the risk of cardiovascular (CV) events, particularly heart failure (HF) hospitalizations, in type 2 diabetes mellitus (T2DM) patients with established CV disease. We aimed to assess (1) the incidence of HF admissions, and (2) the potential reduction in HF admissions with the further introduction of SGLT2i, in a contemporary large administrative claims database in Japan. Methods: We selected patients aged ≥40 years, without previous HF diagnosis, who newly initiated oral antidiabetics in Shizuoka Kokuho Database between 2013 and 2018. We estimated the 5-year cumulative incidence of hospitalization for HF, myocardial infarction (MI), and stroke, treating death as a competing risk. Among the subgroup of patients with laboratory data, we identified patients meeting the inclusion criteria for EMPA-REG OUTCOME (EMPA-REG) or DECLARE-TIMI 58 (DECLARE) regarding HbA1c, eGFR, and CV disease. We estimated the number of events that can be reduced if they benefited the same risk reduction from the trials. Results: Among 23,340 oral antidiabetic drug initiators (46.0% women, 21.9% ≥75 years old) included, 2.6% were initiated on SGLT2i. The 5-year cumulative incidences of hospitalization for HF, MI, and stroke were 5.4% (95% confidence interval: 4.9-5.9%), 1.9% (1.7-2.2%), and 6.1% (5.7-6.6%), respectively. Among 6192 patients with laboratory data, 651 (10.5%) and 2680 (43.3%) patients met the EMPA-REG-like and DECLARE-like criteria, respectively (Figure). The 5-year cumulative incidence among the 2849 patients meeting either of the criteria was estimated to decrease from 97.1 to 75.2 events via 75% adoption of SGLT2i. Conclusion: The burden of HF among Japanese T2DM patients was high, almost equivalent to stroke. Increased use of SGLT2i among patients with high CV risk may significantly reduce its disease burden.

Autoimmune Hemolytic Anemia: A Disease of the Elderly and the Very Elderly with Increased Mortality and Increased Rates of Hospitalization for Thrombosis and Infection

Introduction Autoimmune hemolytic anemia (AIHA) is a rare disease characterized by the destruction of red blood cells by warm or cold autoantibodies. Epidemiological data are lacking about AIHA incidence, the prevalence of associated disorders and the risk of death, thrombosis and infection as compared with the general population. This study was designed to answer these questions. Methods Patients were selected from the AHEAD cohort. This cohort is built in the French national health database (named Système national des données de santé, SNDS) linking sociodemographics, out-hospital and hospital data for the entire French population (67 million inhabitants). The AHEAD cohort is the cohort of all incident AIHA in France. Patients were selected between 2012-2017. The date of AIHA diagnosis was defined by the first hospital discharge diagnosis or the first long-term disease (recorded by general practitioners) of AIHA occurring after a prior observation period in the SNDS of at least two years. Patients were identified using the D59.1 code of the international classification of diseases, version 10 (positive predictive value: 90.0%). The incidence of AIHA was calculated in the whole French population, by age, sex and calendar months. Causes of secondary AIHA and Evans syndrome were searched in the year before the diagnosis of AIHA using long-term disease and hospital discharge diagnoses. Each patient was matched to five controls on age and sex from the general population. The follow-up ended on December 31, 2018. One- and five-year cumulative incidences of death, hospitalization for thrombosis and for infection were assessed in AIHA patients and in controls, with their 95% confidence intervals (95% CIs). Results During the study period, 9,663 incident AIHA patients were included. The median age was 69 years and 55.6 of the patients were female. The overall incidence of AIHA was 2.4 per 100,000 person-years (95% CI: 2.4 - 2.5). The incidence of AIHA in women during genital activity (15 - 45 years-old, 1.2 per 100,000 person-years, 95% CI: 1.1 - 1.3) was higher than in males of same age (0.7 per 100,000 person-years, 95% CI: 0.6 - 0.7). The incidence of AIHA was dramatically increased in the elderly (&amp;gt;75 years of age: 10.5 per 100,000 person-years; 95% CI: 10.2 - 10.8) and the very elderly (&amp;gt;90 years of age, 12.1 per 100,000 person-years; 95% CI: 11.1 - 13.2), as compared with people &amp;lt;50 year-old (0.9 per 100,000 person-years; 95% CI: 0.9 - 1.0). Incidences were higher in males than in females in people &amp;gt;65 year-old. This pattern was observed for both primary and secondary AIHA. There were no relevant variations of incidence by calendar months for both primary and secondary AIHA. AIHA was primary in 55.2% of cases, associated with hematological malignancy in 30.2% and with lupus in 5.2%. Evans syndrome accounted for 5.8% of AIHAs. The patients were matched with 47,753 controls. The overall follow-up in the cohort was 28,630 person-years. The 1-year cumulative incidence of death was 18.6% (95% CI: 17.8 - 19.4) in AIHA (in primary AIHA: 16.5%, 95% CI: 15.5 - 17.4), versus 3.1% (95% CI: 3.0 - 3.3) in controls. The 5-year cumulative incidence of death was 36.1% (95% CI: 34.9 - 37.2) in AIHA (in primary AIHA: 32.4%, 95% CI: 30.9 - 33.8) and 15.1% (95% CI: 14.7 - 15.5) in controls. The 1-year cumulative incidence of hospitalization for thrombosis was 6.0% (95% CI: 5.6 - 6.5) in AIHA (in primary AIHA: 5.7%, 95% CI: 5.1 - 6.4) versus 1.8% (95% CI: 1.7 - 1.9) in controls. The 5-year cumulative incidence of hospitalizations for thrombosis was 11.1% (95% CI: 10.4 - 11.8) in AIHA (in primary AIHA: 10.9%, 95% CI: 9.9 - 11.9) versus 7.0% (95% CI: 6.7 - 7.3) in controls. The 1-year cumulative incidence of hospitalization for infection was 22.9% (95% CI: 22.1 - 23.8) in AIHA (in primary AIHA: 20.9%, 95% CI: 19.8 - 22.0) versus 3.5% (95% CI: 3.3 - 3.6) in controls. The 5-year cumulative incidence of hospitalization for infection was 37.5% (95% CI: 36.4 - 38.6) in AIHA (in primary AIHA: 33.7%, 95% CI: 32.2 - 35.1) versus 13.5% (95% CI: 13.1 - 13.9) in controls. Conclusion The incidence of AIHA (primary or secondary) was more than ten times higher in the elderly and very elderly as compared with people &amp;lt;50 year-old, suggesting a potential role for immunosenescence. As compared with the general population, AIHA patients had an increased risk of death, hospitalization for infection and thrombosis. It was similar in primary and secondary AIHA. Disclosures Moulis: Grifols: Research Funding; Amgen: Other: meeting attendance grant; Novartis SAS: Membership on an entity's Board of Directors or advisory committees, Other: meeting attendance grant, Research Funding.