Greater Number Of Comorbidities Research Articles

Frailty in inflammatory bowel disease: analysis of the National Inpatient Sample 2015-2019.

Preoperative frailty has been associated with adverse postoperative outcomes in various populations, but of its use in patients with inflammatory bowel disease (IBD) remains sparse. The present study aimed to characterize the impact of frailty, as measured by the modified frailty index (mFI), on postoperative clinical and resource utilization outcomes in patients with IBD. This retrospective population-based cohort study assessed patients from the National Inpatient Sample database from 1 September 2015 to 31 December 2019. Corresponding International Classification of Diseases 10th Revision Clinical Modification codes were used to identify adult patients (>18 years of age) with IBD, undergoing either small bowel resection, colectomy or proctectomy. Patient demographics and institutional data were collected for each patient to calculate the 11-point mFI. Patients were categorized as either frail or robust using a cut-off of 0.27. Primary outcomes were postoperative in-hospital morbidity and mortality, whilst secondary outcomes included system-specific morbidity, length of stay, in-hospital healthcare costs and discharge disposition. Logistic and linear regression models were used for primary and secondary outcomes. Overall, 7144 patients with IBD undergoing small bowel resection, colectomy or proctectomy were identified, 337 of whom were classified as frail (i.e., mFI < 0.27). Frail patients were more likely to be women, older, have lower income and a greater number of comorbidities. After adjusting for relevant covariates, frail patients were at greater odds of in-hospital mortality (adjusted odds ratio [aOR] 5.42, 95% CI 2.31-12.77, P < 0.001), overall morbidity (aOR 1.72, 95% CI 1.30-2.28, P < 0.001), increased length of stay (adjusted mean difference 1.3 days, 95% CI 0.09-2.50, P = 0.035) and less likely to be discharged to home (aOR 0.59, 95% CI 0.45-0.77, P < 0.001) compared to their robust counterparts. Frail IBD patients are at greater risk of postoperative mortality and morbidity, and reduced likelihood of discharge to home, following surgery. This has implications for clinicians designing care pathways for IBD patients following surgery.

Predictors of unplanned emergency hospital admissions among patients aged 65+ with multimorbidity and depression in Northwest London during and after the Covid-19 lockdown in England.

Individuals with multimorbidity have an increased likelihood of using unplanned secondary care including emergency department visits and emergency hospitalisations. Those with mental health comorbidities are affected to a greater extent. The Covid-19 pandemic has negatively impacted on psychosocial wellbeing and multimorbidity care, especially among vulnerable older individuals. To examine the risk of unplanned hospital admissions among patients aged 65+ with multimorbidity and depression in Northwest London, England, during- and post-Covid-19 lockdown. Retrospective cross-sectional data analysis with the Discover-NOW database for Northwest London was conducted. The overall sample consisted of 20,165 registered patients aged 65+ with depression. Two time periods were compared to observe the impact of the Covid-19 lockdown on emergency hospital admissions between 23rd March 2020 to 21st June 2021 (period 1) and equivalent-length post-lockdown period from 22nd June 2021 to 19th September 2022 (period 2). Multivariate logistic regression was conducted on having at least one emergency hospital admission in each period against sociodemographic and multimorbidity-related characteristics. The odds of having an emergency hospitalisation were greater in men than women (OR = 1.19 (lockdown); OR = 1.29 (post-lockdown)), and significantly increased with age, higher deprivation, and greater number of comorbidities in both periods across the majority of categories. There was an inconclusive pattern with ethnicity; with a statistically significant protective effect among Asian (OR = 0.66) and Black ethnicities (OR = 0.67) compared to White patients during post-lockdown period only. The likelihood of unplanned hospitalisation was higher in men than women, and significantly increased with age, higher deprivation, and comorbidities. Despite modest increases in magnitude of risk between lockdown and post-lockdown periods, there is evidence to support proactive case-review by multi-disciplinary teams to avoid unplanned admissions, particularly men with multimorbidity and comorbid depression, patients with higher number of comorbidities and greater deprivation. Further work is needed to determine admission reasons, multimorbidity patterns, and other clinical and lifestyle predictors.

Peculiarities of pharmacotherapy of patients with rheumatoid arthritis associated with interstitial lung disease

Objective: a comparative study of the peculiarities of pharmacotherapy of rheumatoid arthritis (RA) in presence and in absence of interstitial lung disease (ILD).Material and methods. The study included 1034 patients with active RA who met the 2010 ACR/EULAR criteria. Patients were divided into two groups: with ILD according to high-resolution computed tomography of the lungs (n=82) and without ILD or other types of chronic obstructive pulmonary diseases, including bronchial asthma (52 patients excluded; n=900). Based on medical documentation, archived medical records and medical history, a “drug card” was created for all stages of pharmacotherapy of patients with active RA. The Cumulative Illness Index Score (CIRS) was used to assess the profile and severity of comorbidities.Results and discussion. The main indicators of RA activity in the patients of the two groups were comparable, but a greater number of comorbidities (p˂0.0001) and a higher value of the CIRS multimorbidity index (p˂0.0001) were found in the group with ILD. The presence of ILD had no influence on the frequency of prescription, the total duration of use and the maximum dose of glucocorticoids (GC) (p˂0.05). The average dose of GC was statistically significantly higher in the group with ILD (p=0.008). These patients were taking disease-modifying antirheumatic drugs (DMARDs): methotrexate (p=0.04), leflunomide (p=0.02) and sulfasalazine (p=0.03), less frequently, but they took hydroxychloroquine significantly more frequently (p=0.02) with a comparable total duration of use of each medication. RA patients with ILD and without ILD received biologic DMARDs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) in 62.2 and 59.6% of cases, respectively (p˂0.05). At the same time, patients without ILD had experience of taking a greater number of different bDMARDs/tsDMARDs (p=0.03). In the group with ILD, patients more frequently received anti-B-cell therapy (p˂0.0001) and significantly less frequently drugs of other classes: tumour necrosis factor α inhibitors (p˂0.0001) and interleukin 6 inhibitors (p=0.01), T-cell costimulation blocker (p=0.04) and Janus kinase inhibitors (p=0.001). Patients with ILD were statistically significantly older at the start of bDMARD/tsDMARD therapy (p˂0.0001), and the period from the onset of RA to the start of bDMARD/tsDMARD therapy was comparable in both groups (p˂0.05).Conclusion. The observed peculiarities of pharmacotherapy in the group with ILD (frequency of use, choice and dose of GC, DMARDs, biologics and tsDMARDs) are probably related to the presence of ILD on the one hand and to the characteristics of concomitant pathology and older age on the other, as the activity of RA was comparable in our patients with and without ILD.

Predictors of persistence of post-chemotherapy symptoms among survivors of solid tumor cancers.

Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment. Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time. Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor. Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms. Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.

2033 ``Polyclinics'' - a concept of multiple clinic attendance. A pilot quantitative and qualitative review

Abstract Introduction The concept of “polypharmacy” is a well-recognised phenomenon, forming a keystone of any comprehensive geriatric assessment. We considered whether a similar concept could be applied to the number of outpatient clinics that patients may attend - a concept we have coined “polyclinic”. We recognise that older populations may have a greater number of comorbidities and, as a result, have more healthcare professionals inputting into their care. Similar to the potential detrimental effects of multiple medications, we were interested to explore if a similar detrimental effect may apply to patients attending multiple clinics. We also attempted to consider environmental and financial impacts. We approached this in both a quantitative and qualitative manner. Method A cohort was selected from all admissions to a subacute Geriatrics ward at University Hospital of Wales during the month of April 2023. National records were used to review the last decade of clinic attendances. For interviews every 4th patient was contacted Results 66 patients (75% female) were identified with 3 exclusions. The average number of clinics attended was 18.4 with 0.36 new diagnoses being made per clinic and 0.69 interventions per attendance. Geriatric clinic attendance yielded both a higher average number of diagnoses and interventions (0.93 and 1.4 respectively). Patient feedback was limited to 8 patients and 7 next of kin. Feedback regarding ‘worthwhileness’ was very positive with ratings &amp;gt;8/10. Feelings about possible cutting back on clinics or virtual clinic attendance were mixed with concerns regarding suitability and access to technology Conclusions We identified several limitations to this pilot project but overall feedback was positive. This study does not have the scope to suggest that attending multiple clinics are detrimental but aims to raise the concept of “polyclinic” that may be overlooked, particularly in a comorbid population and considers potential patient impact and concerns.

Implementation of frailty screening for older people living with HIV in Brighton, UK.

To evaluate the implementation of frailty screening in people living with HIV (PLWH) in a large urban cohort of patients in Brighton, UK. Focus group discussions with HIV professionals and PLWH interviews helped inform the design and implementation of the frailty screening pathway in the clinic. Data were collected from PLWH aged over 60 years attending their HIV annual health check from July 2021 to January 2023 (n = 590), who were screened for frailty by nurses using the FRAIL scale. We assessed the proportions of PLWH who screened as frail, prefrail or robust and compared patient characteristics across groups. All PLWH identified as frail were offered a comprehensive geriatric assessment delivered by a combined HIV geriatric clinic, and uptake was recorded. A total of 456/590 (77.3%) PLWH aged over 60 years were screened for frailty. Median age and time since HIV diagnosis (range) for those screened were 66 (60-99) years and 21 (0-32) years, respectively. In total, 56 (12.1%) of those screened were identified as frail, 118 (25.9%) as prefrail and 282 (61.8%) as robust. A total of 10/56 (18%) people identified as frail declined an appointment in the geriatric clinic. Compared with non-frail individuals, frail PLWH had been living with HIV for longer and had a greater number of comorbidities and comedications but were not chronologically older. Implementing frailty screening in PLWH over 60 years old is feasible in a large cohort of PLWH, as recommended by the European AIDS Clinical Society. More research is needed to determine if frailty screening can improve clinical outcomes of older PLWH and the use of the comprehensive geriatric assessment within HIV services.

Quality of Life and Comorbidities of Adult Survivors of Allogeneic Hematopoietic Cell Transplant Versus Their Siblings

Background: Survivors of allogeneic hematopoietic cell transplant (allo-HCT) are at risk of developing chronic health conditions. Prior studies have shown that survivors of allo-HCT in childhood/young adulthood who mainly received high dose total body irradiation (TBI)-based conditioning experience excess health conditions and more distress vs. their siblings. In recent years, allo-HCT is offered to adults of increasing age and there has been increasing use of chemotherapy +/- low dose TBI conditioning rather than high dose TBI. We set out to describe and compare the QoL and comorbidities of adults who underwent allo-HCT with chemotherapy +/- low dose TBI conditioning vs. their siblings. Methods: Allo-HCT recipients attending 1 of 2 survivorship clinics at ≥2 years post-HCT without active cGVHD or relapse, were enrolled. Beginning in 2023, participants were asked to forward an electronic version of the study survey to their biological sibling(s). The survey includes the PROMIS-Global Health instrument: raw scores are converted to a mental (MH) and physical health (PH) subscale T-score (population mean 50/SD 10). Comorbidities were scored with a published post allo-HCT morbidity index. Associations between MH and PH-related QoL, comorbidities, and patient/transplant-related variables were investigated with linear regression. Patient and sibling comparisons were made with paired sample and chi-square tests. A significance level of &amp;lt;0.05 was statistically significant &amp; a difference in QoL T-score of 5 was clinically significant. Results: Of 330 patients approached during their clinic visit, 320 consented to participate (97%). To date, 105 siblings of 57 recipients have been sent surveys and 47 siblings (45%) of 32 recipients (56%) have completed the survey. Among all recipients, median age at HCT is 47 (IQR 35-57) with 21% ≥60 years old, 48% are female, 78% are Caucasian, 69% are college educated or more &amp; 51% are working full/part-time. Median time post-HCT is 9 years (IQR 6-14). The mean PH T-score is 48.5 (SD 8.6). In the multivariable model, total number of comorbidities (p&amp;lt;0.01) and a work status of disability (p&amp;lt;0.01) are associated with inferior PH QoL. The mean MH T-score was 49.1 (SD 8.4). In the multivariable model, total number of comorbidities (p&amp;lt;0.01) and a work status of disability (p&amp;lt;0.01) are associated with inferior MH QoL. HCT characteristics, including history of moderate-severe cGVHD, and demographic characteristics are not associated with either QoL subscale. Among all recipients, the median number of comorbidities is 3 (IQR 1.5-4). The most common comorbidities include hyperlipidemia (39%), hypertension (25%) &amp; hypothyroidism (24%). At least one severe comorbidity (vascular disease, chronic heart/lung/liver/kidney disease or subsequent malignancy) is present in 23% of patients. In multivariable analysis, a greater number of years post-HCT is associated with a greater number of comorbidities (p=0.03) and full/part-time work status is associated with fewer comorbidities (p=0.01). In the sibling-recipient comparison, median age of siblings and recipients is 55 (IQR 37-66) &amp; 54 (IQR 40-64), respectively. The MH QoL of recipients is statistically, but not clinically, better than their siblings: T-score 52.9 (SD 7.1) versus 49.9 (SD 6.9), respectively, p=0.04. The PH QoL of recipients was not significantly different than their siblings: T-score 52.6 (SD 5.6) versus 50.7 (SD 8.2), respectively, p=0.23. Recipients are suffering from significantly more comorbidities vs. their siblings: median 2.5 (IQR 1.8-4) versus 1 (IQR 0-3), respectively, p=0.03. The prevalence of ≥1 severe comorbidity is greater in recipients vs. siblings, but not statistically significant (13% vs. 2%, p=0.06). Conclusion: Adult recipients of allo-HCT, living without cGVHD or relapse and conditioned without high dose TBI, in aggregate experience similar QoL but suffer excess chronic health conditions as compared to their siblings. One in 4 recipients are suffering from ≥1 severe chronic health condition(s). Time post-HCT is associated with comorbidities, suggesting that recipients continue to accumulate health conditions in the years post-HCT. Number of comorbidities, rather than transplant and demographic factors (including prior cGVHD), is associated with impaired MH and PH QoL. Preventative care after allo-HCT is critical, even in those receiving HCT in adulthood without high dose TBI.

Outcomes in Incidentally Versus Screening Detected Stage I Lung Cancer Surgery Patients

IntroductionAlthough the importance of lung cancer screening for early diagnosis is established, because of poor enrollment, incidental findings still play a role in diagnosis of patients who qualify. Nevertheless, analysis of this incidental cohort is lacking. We present a retrospective analysis comparing patients with thoracic surgery with incidental versus screening detected stage I lung cancer. MethodsThoracic surgery cases at Mount Sinai Hospital from March, 1, 2012, to June, 30, 2022, were queried for patients eligible for lung cancer screening and a stage I diagnosis. The basis of lung nodule detection (incidental versus screening detected) was identified. We compared demographic variables, comorbidities, tumor staging, procedure details, and postoperative outcomes between the cohorts. ResultsOf the patients eligible for screening with lung cancer resection and stage I diagnosis at Mount Sinai, 153 were identified incidentally and 67 through screening. The patients in the incidental cohort were older (p = 0.005), more likely to have quit smoking (p = 0.04), and had a greater number of comorbidities (p = 0.0002). There was no statistically significant difference between the groups with regard to pack-year smoking history, lung cancer histological type, location or size of tumor, and surgical approach, length of surgery or stay, number of postoperative outcomes, and survival. ConclusionsIn stage I lung cancers, no significant differences were identified between incidentally and screening detected lung nodules with regard to tumor characteristics, surgical approach, and postoperative outcomes. Imaging conducted for other reasons should be considered as a valid and important diagnostic tool, similar to traditional low-dose computed tomography, in patients who qualify for screening.

Abstract 12361: Predictors and Utilization of Ultrasound Enhancing Agents for Echocardiography in the Outpatient Setting

Background: The national utilization of ultrasound enhancing agents (UEAs) for transthoracic (TTE) or stress (SE) echocardiography in the outpatient setting and their association with downstream utilization of care remains uncertain. Methods: In a set of large, all-payer claims databases (ACTICS Open and Closed Claims) encompassing 90% of the US population, we evaluated rates, predictors of use, and association of UEAs with downstream utilization using linear mixed effects models amongst adult outpatients receiving TTE or SE, 2019-2022. Amongst those with recent hospitalization for AMI, we evaluated the association of UEA receipt and downstream healthcare utilization. Results: A total of 11,270,268 individuals receiving TTE and 744,175 adults receiving SE across 2,407 sites were included (mean age 63, 54.8% female), of which 6.8% receiving TTE and 21.0% receiving SE received UEAs. Patients receiving UEAs were more frequently older, male, and had a greater number of comorbidities. Sites performing UEAs were more frequently large, rural, nonprofits, and teaching facilities. Use varied widely by state ( Figure; 19.7% in Minnesota vs. 1.1% in Delaware) and was not explained by patient or site characteristics (median odds ratios = 4.35). Amongst those receiving TTE after AMI, UEA use was associated with a reduction in cardiac non-stress imaging (adjusted RR 0.77, 95% CI 0.64-0.92, p = 0.004), but no substantial differences in cost, days alive at home, readmission rates, cardiac catheterization, or stress imaging (p &gt; 0.05 for all). Conclusions: In this large, nationally representative cohort study, UEAs were used in 6.8% of TTEs and 21.0% of SEs performed in the outpatient setting but use varied widely across sites, unexplained by patient or site characteristics. Amongst outpatients, UEA receipt after AMI was associated with a reduction in cardiac stress imaging, but not other outcomes.

Identification of sleep quality clusters among stroke patients: A multi-center Latent Profile Analysis study

BackgroundQuality sleep plays a crucial role in maintaining good health. Nevertheless, sleep disruption is a common and complex issue after a stroke. It can increase the likelihood of stroke recurrence by influencing modifiable risk factors. However, there is currently a lack of research on the latent classes or clusters of sleep quality and its predictive factors among stroke patients. ObjectivesThis study aims to identify latent classes of sleep quality and explore the predictive factors associated with different sleep quality clusters among stroke patients. MethodsA total of 500 participants were recruited through cluster random sampling from January 2023 to May 2023. Latent profile analysis was conducted to identify latent classes of sleep quality within the sample of stroke patients. Additionally, multinomial regression analyses were employed to investigate the predictors associated with the different latent classes identified in the analysis. ResultsOut of the 500 participants, 458 (91.6 %) completed the survey, and 71 % of them reported experiencing sleep problems. The analysis revealed three latent profile classes: the “good sleep quality-deficient duration” group (65.4 %), the “moderate sleep quality-more disturbances” group (14.1 %), and the “poor sleep quality-low efficiency” group (20.5 %). Factors associated with sleep quality were identified. Protective factors for sleep quality included being male, having the TOAST type of large-artery atherosclerosis, having a good education, high household income, no family history of stroke, residing in rural areas, and having better environmental and social support (all p < 0.05). Risk factors for sleep quality included smoking, high perceived stress, and a greater number of comorbidities (all p < 0.05). ConclusionsThis study has successfully identified three distinct latent profile classes of sleep quality and their associated predictors among stroke patients in China. The findings offer both theoretical guidance and practical insights for the development of targeted intervention programs aimed at enhancing the sleep quality of stroke patients.

Cost analysis and clinical outcomes of anatomic pre-contoured locking versus conventional plates for distal fibula ankle fractures.

To analyze differences in union, complication rates and cost from surgical fixation of distal fibula fractures with fibular plating implants. In total, 380 adult patients from 2012 to 2015 treated with 12 fibular plates from 4 different manufacturers utilized by 9 surgeons were retrospectively reviewed. They were stratified into a conventional one-third tubular fibular plate group, pre-contoured anatomic locking plate group, or a heterogeneous group including 3.5-mm reconstruction, one-third tubular locking, composite, and limited compression plates. The outcomes included failure of fixation, deep infection requiring debridement, time to union, anatomic reduction, superficial infection, hardware removal, and post-traumatic arthritis. Plate and screw costs were calculated from hospital billing records. Pre-contoured locking plates were used in older, female patients with a greater number of comorbidities. Open injuries and OTA 44B fractures were more likely to be an indication for pre-contoured plates. There was no difference noted in time to union between the different plating groups. Risk factors for deep infection requiring debridement included a history of tobacco use, open fractures, and pre-contoured locking plates relative to the conventional plating group. The pre-contoured plating group was on average $586 more expensive compared to the conventional group. Pre-contoured locking plates achieved similar radiographic outcomes compared to conventional plates with an increased risk of complications and higher cost. Surgeons should consider their choice of implant based on the patient's fracture pattern, underlying comorbidities, and risk for infection.

ANCOC Score to Predict Mortality in Different SARS-CoV-2 Variants and Vaccination Status.

More than three years after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic outbreak, hospitals worldwide are still affected by coronavirus disease 19 (COVID-19). The availability of a clinical score that can predict the risk of death from the disease at the time of diagnosis and that can be used even if population characteristics change and the virus mutates can be a useful tool for emergency physicians to make clinical decisions. During the first COVID-19 waves, we developed the ANCOC (age, blood urea nitrogen, C-reactive protein, oxygen saturation, comorbidities) score, a clinical score based on five main parameters (age, blood urea nitrogen, C-reactive protein, oxygen saturation, comorbidities) that accurately predicts the risk of death in patients infected with SARS-CoV-2. A score of less than -1 was associated with 0% mortality risk, whereas a score of 6 was associated with 100% risk of death, with an overall accuracy of 0.920. The aim of our study is to internally validate the ANCOC score and evaluate whether it can predict 60-day mortality risk independent of vaccination status and viral variant. We retrospectively enrolled 843 patients admitted to the emergency department (ED) of our hospital with a diagnosis of COVID-19. A total of 515 patients were admitted from July 2021 to September 2021, when the Delta variant was prevalent, and 328 in January 2022, when the Omicron 1 variant was predominant. All patients included in the study had a diagnosis of COVID-19 confirmed by polymerase chain reaction (PCR) on an oropharyngeal swab. Demographic data, comorbidities, vaccination data, and various laboratory, radiographic, and blood gas parameters were collected from all patients to determine differences between the two waves. ANCOC scores were then calculated for each patient, ranging from -6 to 6. Patients infected with the Omicron variant were significantly older and had a greater number of comorbidities, of which hypertension and chronic obstructive pulmonary disease (COPD) were the most common. Immunization was less common in Delta patients than in Omicron patients (34% and 56%, respectively). To assess the accuracy of mortality prediction, we constructed a receiver operating characteristic (ROC) curve and found that the area under the ROC curve was greater than 0.8 for both variants. These results suggest that the ANCOC score is able to predict 60-day mortality regardless of viral variant and whether the patient is vaccinated or not. In a population with increasingly high vaccination rates, several parameters may be considered prognostic for the risk of fatal outcomes. This study suggests that the ANCOC score can be very useful for the clinician in an emergency setting to quickly understand the patient's evolution and provide proper attention and the most appropriate treatments.

Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry

BackgroundInvestigation for the presence of asthma comorbidities is recommended by the Global Initiative for Asthma because their presence can complicate asthma management. ObjectiveTo understand the prevalence and pattern of comorbidities and multimorbidity in adults with severe asthma and their association with asthma-related outcomes. MethodsThis was a cross-sectional study using data from the International Severe Asthma Registry from 22 countries. A total of 30 comorbidities were identified and categorized a priori as any of the following: (1) potentially type 2–related comorbidities, (2) potentially oral corticosteroid (OCS)–related comorbidities, or (3) comorbidities mimicking or aggravating asthma. The association between comorbidities and asthma-related outcomes was investigated using multivariable models adjusted for country, age at enrollment, and sex (ie male or female). ResultsOf the 11,821 patients, 69%, 67%, and 55% had at least 1 potentially type 2–related, potentially OCS-related, or mimicking or aggravating comorbidities, respectively; 57% had 3 or more comorbidities, and 33% had comorbidities in all 3 categories. Patients with allergic rhinitis, nasal polyposis, and chronic rhinosinusitis experienced 1.12 (P = .003), 1.16 (P < .001), and 1.29 times (P < .001) more exacerbations per year, respectively, than those without. Patients with nasal polyposis and chronic rhinosinusitis were 40% and 46% more likely (P < .001), respectively, to have received long-term (LT) OCS. All assessed potential OCS-related comorbidities (except obesity) were associated with a greater likelihood of LTOCS use (odds ratios [ORs]: 1.23-2.77) and, except for dyslipidemia, with a greater likelihood of uncontrolled asthma (ORs: 1.29-1.68). All mimicking or aggravating comorbidities assessed were associated with more exacerbations (1.24-1.68 times more), all (except bronchiectasis) with increased likelihood of uncontrolled asthma (ORs: 1.57-1.81), and all (except chronic obstructive pulmonary disease) with increased likelihood of LTOCS use (ORs: 1.37-1.57). A greater number of comorbidities was associated with worse outcomes. ConclusionIn a global study, comorbidity or multimorbidity is reported in most adults with severe asthma and is associated with poorer asthma-related outcomes. Clinical Trial RegistrationThe International Severe Asthma Registry database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization Studies (European Network Centres for Pharmacoepidemiology and Pharmacovigilance [ENCEPP]/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EMA 2014; EUPAS44024) and with all applicable local and international laws and regulations, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=48848). Governance was provided by ADEPT (registration number: ADEPT1121).

The Severity of Pain and Comorbidities Significantly Impact the Dependency on Activities of Daily Living among Musculoskeletal Patients in Jizan, Saudi Arabia.

Limited research has been carried out on the effects of pain, comorbidity, and impaired function in musculoskeletal patients in Jizan, Saudi Arabia. A cross-sectional study was conducted on 115 patients (aged ≥ 55 years) with physician-diagnosed musculoskeletal conditions in Jizan to investigate the association between pain severity, comorbidities, and dependence on activities of daily living (ADLs). Self-reported questionnaires were used to collect data on pain, comorbidities, and physical function measured by ADLs. In ADLs, participants were categorized as dependent (n = 36) or independent (n = 79). Logistic regression analysis was employed to determine the predictors of dependence. The results showed that higher pain severity (adjusted odds ratio (OR): 1.69, 95% confidence interval (CI): 1.21-2.38, p = 0.002) and a greater number of comorbidities (adjusted OR: 1.52, 95% CI: 1.06-2.17, p = 0.021) were independently associated with dependence in ADLs. These associations remained significant even after controlling for covariates. This study concluded that patients with musculoskeletal conditions in Jizan who experience high levels of pain and comorbidities are at risk of dependence on basic daily activities. Therefore, addressing pain and comorbidities is crucial for maintaining independence and improving quality of life. Personalized rehabilitation programs are needed to manage these conditions in this region.

The Value of Neutrophil-to-Lymphocyte Ratio and Epicardial Adipose Tissue Thickness in Heart Failure With Preserved Ejection Fraction.

Background Using epicardial adipose tissue thickness (EATt) and neutrophil-to-lymphocyte ratio (NLR) as individual indicators provides beneficial insight into the prognosis of patients suffering from heart failure with preserved ejection fraction (HFpEF). Aim In our study, we aimed to evaluate whether the combined evaluation of NLR and EATt would provide an advantage for identifying high-risk HFpEF patients according to hospitalization for heart failure (HHF) and left ventricular diastolic dysfunction (LVDD). Method A total of 168 outpatients with HFpEF were retrospectively analyzed. The predictive performance of two inflammatory variables was assessed by the receiver operating characteristic curve and a one-way analysis of variance (ANOVA) test. The patients were stratified into three distinct risk categories based on the established cut-off values for EATt and NLR as follows: Group I, high risk; Group II, middle risk; and Group III, low risk. Results Patients in Group I had the highest risk for HHF and the presence of LVDD (p=0.001 for HHF, p=0.011 for LVDD). Patients in Group I also exhibited more symptomatic and a greater number of comorbidities. In Group I, more structural remodeling (enlargedleft ventricular end-systolic volume index (LVESVI) and left atrial volume index (LAVI)) and associated signs of increased intracardiac pressure (elevated E/A ratio, medial E/e') were observed. Conclusion The results of our study indicate that the use of both EATt and NLR among patients with HFpEF may provide better accuracy in predicting HHF and LVDD compared to the use of either EATt or NLR alone.

Long-term health care use and diagnosis after hospitalization for COVID-19: a retrospective matched cohort study.

Knowledge pertaining to the health and health care utilization of patients after recovery from acute COVID-19 is limited. We sought to assess the frequency of new diagnoses of disease and health care use after hospitalization with COVID-19. We included all patients hospitalized with COVID-19 in Alberta between Mar. 5 and Dec. 31, 2020. Additionally, 2 matched controls (SARS-CoV-2 negative) per case were included and followed up until Apr. 30, 2021. New diagnoses and health care use were identified from linked administrative health data. Repeated measures were made for the periods 1-30 days, 31-60 days, 61-90 days, 91-180 days, and 180 and more days from the index date. We used multivariable regression analysis to evaluate the association of COVID-19-related hospitalization with the number of physician visits during follow-up. The study sample included 3397 cases and 6658 controls. Within the first 30 days of follow-up, the case group had 37.12% (95% confidence interval [CI] 35.44% to 38.80%) more patients with physician visits, 11.12% (95% CI 9.77% to 12.46%) more patients with emergency department visits and 2.92% (95% CI 2.08% to 3.76%) more patients with hospital admissions than the control group. New diagnoses involving multiple organ systems were more common in the case group. Regression results indicated that recovering from COVID-19-related hospitalization, admission to an intensive care unit, older age, greater number of comorbidities and more prior health care use were associated with increased physician visits. Patients recovered from the acute phase of COVID-19 continued to have greater health care use up to 6 months after hospital discharge. Research is required to further explore the effect of post-COVID-19 conditions, pre-existing health conditions and health-seeking behaviours on health care use.

Independent association of hypovitaminosis d with non-alcoholic fatty liver disease in people with chronic spinal cord injury: a cross-sectional study.

Non-alcoholic fatty liver disease (NAFLD) and hypovitaminosis D are highly prevalent in people with spinal cord injury (SCI) and could exert an unfavorable influence on cardiovascular profile and rehabilitation outcomes. We aimed to assess the independent association between low 25-hydroxy vitamin D (25(OH)D) levels and NAFLD in people with chronic (> 1year) SCI. One hundred seventy-three consecutive patients with chronic SCI (132 men and 41 women) admitted to a rehabilitation program underwent clinical/biochemical evaluations and liver ultrasonography. NAFLD was found in 105 patients (60.7% of the study population). They were significantly older and exhibited a poorer leisure time physical activity (LTPA) and functional independence in activities of daily living, a greater number of comorbidities and a higher prevalence of metabolic syndrome (MetS) and its correlates, including lower HDL and higher values of body mass index (BMI), systolic blood pressure, HOMA-index of insulin resistance and triglycerides. 25(OH)D levels were significantly lower in NAFLD (median: 10.6ng/ml, range: 2.0-31.0) than in non-NAFLD group (22.5ng/ml, 4.2-51.6). When all these variables were included in a multiple logistic regression analysis, a significant independent association with NAFLD only persisted for lower 25(OH)D levels, a greater number of comorbidities and a poorer LTPA. The ROC analysis revealed that 25(OH)D levels < 18.25ng/ml discriminated patients with NAFLD with a sensitivity of 89.0% and a specificity of 73.0% (AUC: 85.7%; 95%CI: 79.6-91.7%). NAFLD was exhibited by 83.9% of patients with 25(OH)D levels < 18.25ng/ml and by 18% of those with 25(OH)D levels ≥ 18.25ng/ml (p < 0.0001). In people with chronic SCI, 25(OH)D levels < 18.25ng/ml may represent a marker of NAFLD independent of MetS-related features. Further studies are warranted to define the cause-effect relationships of this association.

Association Between Fuchs Endothelial Corneal Dystrophy, Diabetes Mellitus, and Multimorbidity.

The aim of this study was to assess risk for demographic variables and other health conditions that are associated with Fuchs endothelial corneal dystrophy (FECD). We developed a FECD case-control algorithm based on structured electronic health record data and confirmed accuracy by individual review of charts at 3 Veterans Affairs (VA) Medical Centers. This algorithm was applied to the Department of VA Million Veteran Program cohort from whom sex, genetic ancestry, comorbidities, diagnostic phecodes, and laboratory values were extracted. Single-variable and multiple variable logistic regression models were used to determine the association of these risk factors with FECD diagnosis. Being a FECD case was associated with female sex, European genetic ancestry, and a greater number of comorbidities. Of 1417 diagnostic phecodes evaluated, 213 had a significant association with FECD, falling in both ocular and nonocular conditions, including diabetes mellitus (DM). Five of 69 laboratory values were associated with FECD, with the direction of change for 4 being consistent with DM. Insulin dependency and type 1 DM raised risk to a greater degree than type 2 DM, like other microvascular diabetic complications. Female sex, European ancestry, and multimorbidity increased FECD risk. Endocrine/metabolic clinic encounter codes and altered patterns of laboratory values support DM increasing FECD risk. Our results evoke a threshold model in which the FECD phenotype is intensified by DM and potentially other health conditions that alter corneal physiology. Further studies to better understand the relationship between FECD and DM are indicated and may help identify opportunities for slowing FECD progression.

Potentially Preventable Readmissions After Acute Inpatient Rehabilitation.

The aim of the study is to identify causes and risk factors for potentially preventable readmissions of patients discharged from an inpatient rehabilitation facility. Our hospital billing database was used to identify patients discharged from our inpatient rehabilitation facility between 2013 and 2018 and experienced a potentially preventable readmission within 90 days ( n = 75). Retrospective chart review was completed to obtain clinical data. Of the patients discharged from the inpatient rehabilitation facility who did not experience a potentially preventable readmission, a group of age- and sex-matched controls ( n = 75) was randomly selected. The two study groups were compared using univariate and multivariate analyses. Our study found that individuals who discharged from acute inpatient rehabilitation were more likely to be readmitted with a potentially preventable readmission if they have a greater number of comorbidities, were admitted initially with a spinal cord injury, or have lower admission or discharge Functional Independence Measure motor scores. The most common potentially preventable readmission diagnoses were sepsis, renal failure, respiratory problems, and urinary tract infection. Identifying patients with the common causes for potentially preventable readmissions, in addition to the noted risk factors, is an important consideration for inpatient rehabilitation discharge planning.

Fall Risk in Elderly with Insomnia in Western Romania-A Retrospective Cross-Sectional Study.

Background and Objectives: Falls are frequent among the elderly, imply large social and economic costs, and have serious outcomes. The purpose of this study was to investigate the links between insomnia, comorbidities, multisite pain, physical activity, and fall risk in the elderly. Materials and Methods: This retrospective cross-sectional study included persons recruited from nursing homes for the elderly in Timisoara. We separated the participants into two groups by the absence (group I) or presence of fractures (group II) starting with the age of 65 years. Participants were asked how they feel about their sleep using one item on a 4-point scale from the Assessment of Quality of Life questionnaire. The risk of fall was evaluated using the Falls Risk Assessment Tool. Results: The study enrolled 140 patients with a mean age of 78.4 ± 2.4 years (range 65-98 years), 55 of them being males (39%). By comparing the two groups, we found that the elderly with a history of fractures had a greater number of comorbidities, a higher risk of fall, and more severe sleep disturbances. When using univariate logistic regression, the occurrence of fractures in the elderly was significantly associated with the number of comorbidities, the risk of fall, and the presence of sleep disturbances (p < 0.0001). The multivariate regression analysis selected four independent parameters significantly linked to fractures, and these were the number of comorbidities (p < 0.03), the risk of fall score (p < 0.006), and the sleep disturbances of type 3 (p < 0.003) and 4 (p = 0.001). Conclusions: A fall-risk score over 14 and a number of comorbidities over 2 were notably associated with the occurrence of fractures. We also found strong positive correlations between the type of sleep disturbance and the risk of fall score, the number of comorbidities, and the number of fractures in the elderly.