Higher Odds Of In-hospital Mortality Research Articles

Association of in-hospital multimorbidity with healthcare outcomes in Swiss medical inpatients.

Multimorbidity poses a worldwide health- and socio-economic challenge, exacerbated by changing demographics. The association of multimorbidity with healthcare outcomes in hospitalised medical inpatients remains incompletely understood. To examine the prevalence and burden of in-hospital multimorbidity over a 6-year time period and its association with in-hospital mortality, intensive care unit admission, length of hospital stay and readmission rates. This cross-sectional study analysed Swiss hospital discharge records from 1 January 2012 to 31 December 2017. The study used population-based, administrative data from the Swiss Federal Statistical Office to investigate all adult medical cases in Switzerland. 2,220,000 population-based medical discharge records from 1,463,781 anonymised patients were included in the analysis. Multimorbidity was defined according to the World Health Organization as the presence of at least two chronic conditions. We applied the “Chronic Condition Indicator for the International Classification of Diseases (ICD-10-CM)”, which divides all ICD-10 codes into chronic and acute conditions, to define the number of chronic conditions. Time- and age-stratified prevalence of multimorbidity and its association with in-hospital mortality, ICU admission rate, length of stay, 30-day and 1-year all-cause readmission rates. Of the 2,220,000 cases, 51.3% were male with a mean age of 68.0 years (standard deviation 17.4). A total of 1,769,530 (79.7%) were multimorbid with a median of 4 (interquartile range 2–6) chronic conditions. The prevalence of multimorbidity increased by about 1.0% per year over the 6-year study period from 76.1% (2012) to 82.2% (2017). Multimorbidity was associated with higher odds of in-hospital mortality (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.28 to 1.34), ICU admission rate (OR 3.29, 95% CI 3.23 to 3.34), length of stay (+2.7 days, 95% CI 2.6 to 2.7), 30-day- (OR 1.92, 95% CI 1.89 to 1.94) and 1-year all-cause readmission rates (OR 1.70, 95% CI 1.68 to 1.71). The associations with in-hospital mortality and readmission were strongest in younger patients. Multimorbidity is highly prevalent in medical inpatients and has a relevant association with poor healthcare outcomes. Further investigation is needed to specify risk factors as well as to optimise the management of multimorbid patients to improve outcomes.

Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

Background and aimObesity paradox has aroused increasing concern in recent years. However, impact of obesity on outcomes in intracerebral haemorrhage (ICH) remains unclear. This study aimed to evaluate association of...

Frequency, Trend, Predictors, and Impact of Gastrointestinal Bleeding in Atrial Fibrillation Hospitalizations

Anticoagulation alone or in combination with other treatment strategies are implemented to reduce the risk of stroke in patients with atrial fibrillation (AF). Gastrointestinal bleeding (GIB) is a common complication of oral anticoagulation with a prevalence of 1% to 3% in patients on long term oral anticoagulation. We analyzed the national inpatient sample database from the year 2005 to 2015 to report evidence on the frequency, trends, predictors, clinical outcomes, and economic burden of GIB among AF hospitalizations. A total of 34,260,000 AF hospitalizations without GIB and 1,846,259 hospitalizations with GIB (5.39%) were included. The trend of AF hospitalizations with GIB per 100 AF hospitalizations remained stable from the year 2005 to 2015 (p value = 0.0562). AF hospitalizations with GIB had a higher frequency of congestive heart failure, long term kidney disease, long term liver disease, anemia, and alcohol abuse compared with AF hospitalizations without GIB. AF hospitalizations with GIB had a higher odds of in-hospital mortality (Odds ratio (OR) 1.47; 95% Confidence interval (CI): 1.46 to 1.48, p-value <0.0001), mechanical ventilation (OR 1.69; 95% CI: 1.68 to 1.70, p-value <0.0001), and blood transfusion (OR 7.2; 95% CI: 7.17 to 7.22, P-value <0.0001) compared with AF hospitalizations without GIB. AF hospitalizations with GIB had a lower odds of stroke (OR 0.51; 95% CI: 0.51 to 0.52, p-value <0.0001) compared with AF hospitalizations without GIB. Further, AF hospitalizations with GIB had a higher median length of stay and cost of hospitalization compared with AF hospitalizations without GIB. In conclusion, the frequency of GIB is 5.4% in AF hospitalizations and the frequency of GIB remained stable in the last decade as shown in this analysis. When GIB occurs, it is associated with higher resource utilization. This study addresses a significant knowledge gap highlighting national temporal trends of GIB and associated outcomes in AF hospitalizations.

Trends and outcomes of venous thromboembolism in adult hospitalizations with acute myeloid leukemia: analysis of nationwide inpatient sample from 2010 to 2014

ABSTRACT Background: Venous thromboembolism (VTE) occurs frequently in acute myeloid leukemia (AML) patients. There are no population-based studies from the United States (U.S.) analyzing this association. The study aims to analyze the trends, predictors of mortality, and outcomes of VTE in AML patients. Methods: We analyzed the publicly available Nationwide Inpatient Sample (NIS) for years 2010–2014. Hospitalizations due to AML were identified by previously validated International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes as the primary diagnosis. VTE was identified by ICD-9-CM codes as secondary diagnosis. Hospitalizations with age less than 18 years of age were excluded. The trends and outcomes were determined using Chi-squared (χ2) test and multivariate regression models. Results: From 2010 to 2014, there were 313,282 hospitalizations with a primary diagnosis of AML and 1,633 hospitalizations (0.1%) had VTE as a concurrent diagnosis. There was a significant increase in the proportion of AML hospitalizations with VTE from 0.47% in 2010 to 0.56% in 2014 (P = 0.014). Multivariable regression analysis showed that the odds of in-hospital mortality were not higher in AML hospitalizations with VTE (odds ratio [OR] 1.11; 95% confidence interval [CI] 0.81–1.52; P = 0.5) than those without VTE. Age group above 84 years carried the highest risk of mortality (OR 3.20; 95% CI 2.77–3.70; P < 0.0001) in AML-VTE patients. Black (OR 1.23; 95% CI 1.13–1.35; P < 0.0001) and uninsured patients (OR 1.50; 95% CI 1.31–1.73; P < 0.0001) were at significantly higher odds of in-hospital mortality amongst the AML-VTE hospitalizations. Conclusion: The proportion of AML hospitalizations with VTE continues to rise in the U.S. After adjusting for confounders, increasing age, Black race, and lack of insurance were found to have higher risk of in-hospital mortality in the AML-VTE cohort. The odds of in-hospital mortality in AML hospitalizations with VTE are not higher than those without VTE.

Arrhythmia in tumor lysis syndrome and associated in-hospital mortality: A nationwide inpatient analysis.

BackgroundTumor lysis syndrome (TLS) is a life‐threatening oncologic emergency associated with fatal complications including arrhythmia. The epidemiology and mortality outcomes of arrhythmia in TLS are scarcely studied in the literature.MethodsWe used the National Inpatient Sample (NIS) to study the prevalence and outcome of arrhythmia in patients hospitalized with TLS (ICD‐9 code 277.88) from 2009 to 2014. Baseline characteristics, burden of arrhythmia, and pertinent outcomes were analyzed. Multivariable regression analysis was performed to identify the impact of underlying malignancy in predicting TLS‐related mortality.ResultsA total of 9034 cases of arrhythmia among 37 861 TLS patients were identified. More than half of the arrhythmia cases (67%) were found among white old (>65) males admitted to large bed size and urban teaching hospitals. Arrhythmic cohort showed higher frequency of comorbidities such as fluid‐electrolyte disturbances, hypertension, congestive heart failure, renal failure, dyslipidemia, diabetes, pulmonary circulatory disorders, chronic pulmonary disease, coagulopathy, and deficiency anemia. The most common malignancies were leukemia, lymphoma, metastatic tumor, and solid tumor without metastasis. We found significantly higher odds of in‐hospital mortality among patients with TLS compared to general inpatient population on unadjusted (OR 9.69, 95% CI: 9.27‐10.13, P < .001) and adjusted (OR 4.62, 95% CI: 4.39‐4.85) multivariable analyses. Overall in‐hospital mortality (32% vs 21.3%), median length of stay (11 days vs 9 days), and hospital charges were higher among arrhythmic than nonarrhythmic patients.ConclusionWith the availability of more advanced cancer therapy in the US, nearly one in four inpatient encounters of TLS had arrhythmia. Arrhythmia in TLS patients was associated with higher odds of mortality and increased resource utilization. Therefore, strategies to improve the supportive care of TLS patients plus timely diagnosis and treatment of arrhythmia are of utmost importance in reducing mortality and health‐care cost.

Pre-stroke dementia and in-hospital outcomes in the Chinese Stroke Center Alliance

Little is known about the prevalence of pre-stroke dementia in China and whether this group is at higher risk of adverse in-hospital outcomes. We aimed to understand this association using data from the Chinese Stroke Center Alliance. Multivariable logistic regressions were conducted to assess the association between pre-stroke dementia status and ambulation at day 2, in-hospital mortality, and in-hospital complications. Covariates included age, sex, medical history, history of smoking, history of alcohol use, medication history (antiplatelet drugs, lipid-lowering drugs), stroke severity (measured by the National Institute of Health Stroke Scale), whether IV tPA was administered within 4.5 hours, and whether the patient received deep vein thrombosis prophylaxis as needed. Odds ratios and 95% confidence intervals were presented for the adjusted models. In the final analytic sample of 559,070 ischemic stroke patients with no prior stroke history enrolled across 1476 hospitals, 1511 (0.3%) had pre-stroke dementia, and they were older and more likely to be female. Patients with pre-stroke dementia had lower odds of ambulating at day 2, higher odds of having any complications and higher odds of in-hospital mortality compared to those without pre-stroke dementia, despite little difference in treatment received. Our findings may be explained by communication barriers experienced by patients with pre-stroke dementia that limited their ability to advocate for their own care needs. Further research is needed to determine whether a different care pathway or additional attention from clinicians is necessary for patients with pre-stroke dementia.

Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes

Despite nurses' responsibilities in recognition and treatment of sepsis, little evidence documents whether patient-to-nurse staffing ratios are associated with clinical outcomes for patients with sepsis. Using linked data sources from 2017 including MEDPAR patient claims, Hospital Compare, American Hospital Association, and a large survey of nurses, we estimate the effect of hospital patient-to-nurse staffing ratios and adherence to the Early Management Bundle for patients with Severe Sepsis/Septic Shock SEP-1 sepsis bundles on patients' odds of in-hospital and 60-day mortality, readmission, and length of stay. Logistic regression is used to estimate mortality and readmission, while zero-truncated negative binomial models are used for length of stay. Each additional patient per nurse is associated with 12% higher odds of in-hospital mortality, 7% higher odds of 60-day mortality, 7% higher odds of 60-day readmission, and longer lengths of stay, even after accounting for patient and hospital covariates including hospital adherence to SEP-1 bundles. Adherence to SEP-1 bundles is associated with lower in-hospital mortality and shorter lengths of stay; however, the effects are markedly smaller than those observed for staffing. Improving hospital nurse staffing over and above implementing sepsis bundles holds promise for significant improvements in sepsis patient outcomes.

End-stage renal disease and lower gastrointestinal bleeding-A propensity-matched analysis of nationwide inpatient sample.

We aim to determine the influence of lower gastrointestinal bleeding (LGIB) on mortality, morbidity, length of hospital stay and resource utilisation in end-stage renal disease (ESRD) patients. The National Inpatient Sample database (2016 &2017) was used for data analysis using the International Classification of Diseases, Tenth Revision codes to identify the patients with the principal diagnosis of ESRD and LGIB. We assessed the all-cause in-hospital mortality, morbidity, predictors of mortality, length of hospital stay (LOS) and total costs between propensity-matched groups of ESRD patients with LGIB versus ESRD patients. We identified 2187954 ESRD patients, of whom 242075 has LGIB, and 1945879 were ESRD patients. The in-hospital mortality was higher in ESRD with LGIB (OR 2.5, 95% CI 1.5-2.2; P=.00). ESRD with LGIB has higher odds of mechanical ventilation (OR 1.4, 95% CI 6.4-16.4; P=.00), and shock requiring vasopressor (OR 1.2, 95% CI 4.9-5.4; P=.002). Advanced age (OR 1.02 CI 1.02-1.03 P=.00), anaemia (OR 1.04 CI 1.59-1.91 P=.006), acute coronary syndrome (OR 1.8 CI 1.6-2.1, P=.00), acute respiratory failure (OR 1.29 CI 2.0-2.6, P=.00), mechanical ventilation (OR 1.9, CI 3.5-4.4, P=.00) and sepsis (OR 1.5, CI 4.1-5.08, P=.00) were identified as predictors of mortality in ESRD with LGIB. Mean LOS (10.8±14.9 vs 6.3±8.5, P<.01) and mean total charges (37054 $ vs 18080 $, P<.01) were also higher. In this propensity-matched analysis, ESRD with LGIB was associated with higher odds of in-hospital mortality, mechanical ventilation and shock requiring vasopressor. Mean LOS and resource utilisation were also higher.

Amyloidosis and 30-Day Outcomes Among Patients With Heart Failure: A Nationwide Readmissions Database Study

BackgroundThe burden of amyloidosis among hospitalized patients is increasing over time. However, amyloidosis remains an underdiagnosed cause of heart failure (HF) hospitalization among older adults. ObjectivesWe investigated the prevalence and prognostic implications of amyloidosis among patients hospitalized with HF. MethodsAll hospitalizations for primary diagnosis of HF between January 1, 2010, and August 31, 2015, identified in the Nationwide Readmissions Database were categorized into those with and without a secondary diagnosis of amyloidosis. HF hospitalizations with amyloidosis were then matched in a 3:1 fashion to HF hospitalizations without amyloidosis using the year of admission, discharge quarter, age, sex, and Charlson comorbidity index. Primary outcomes were inpatient mortality and 30-day readmission. Multivariable logistic regression was used to estimate the association between HF with amyloidosis and clinical outcomes. ResultsOf 1,593,360 HF hospitalizations that met inclusion criteria, 2,846 (0.18%) had HF with a secondary diagnosis of amyloidosis and were matched to 8,515 hospitalizations for HF without amyloidosis. Hospitalizations for HF with amyloidosis were associated with higher prevalence of kidney disease (56% vs. 45%), malignancy (20% vs. 4%), and higher inpatient mortality (6% vs. 3%) as compared with HF without amyloidosis. In adjusted analyses, HF with amyloidosis was associated with higher odds of in-hospital mortality (odds ratio: 1.46; 95% confidence interval [CI]: 1.17 to 1.82), 30-day readmission (odds ratio: 1.17; 95% CI: 1.05 to 1.31), and longer mean length of stay (least-squares mean difference: 1.46; 95% CI: 1.12 to 1.80). ConclusionsIn patients hospitalized with decompensated HF, presence of amyloidosis was associated with higher risk of inpatient mortality and 30-day readmission.

The ADAMTS13 Family: In-Patient Trends and Outcomes of Thrombotic Thrombocytopenic Purpura

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening disorder characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurological symptoms, renal dysfunction and other end organ failure. It is associated with inherited or acquired antibody-mediated deficiency of ADAMTS13 resulting in an inability to cleave von Willebrand factor. It occurs in approximately 3 in 1 million adults and 1 in 10 million children annually. First line therapy is plasmapheresis, typically coupled with steroids. Patients recovering from TTP may demonstrate persistent or intermittent ADAMTS13 deficiency without symptoms or thrombocytopenia. Most relapses of acquired TTP occur in the first week after stopping plasma exchange. There are multiple factors contributing to relapses, which include age &amp;gt; 60, severe neurological symptoms at presentation and a persistently elevated lactate dehydrogenase. Thus young patients with low ADAMTS13 activity are appropriate candidates for prophylactic treatment. The early initiation of immune-modulatory therapy targeting the antibody inhibitor of ADAMTS13 could potentially reduce the number of plasma exchange procedures required to achieve remission, increase the response rate and decrease the incidence of relapses in patients with TTP. Since TTP is a rare disease, the aim of our study was to outline the trends and outcomes of hospitalizations due to TTP using the nationally representative database for future use in risk stratification and treatment protocols. Methods: We performed retrospective study using the National Inpatient Sample database, a part of the Healthcare Cost and Utilization Project (HCUP) of the agency for Healthcare Research and Quality (AHRQ). We extracted the study cohort of adult admissions with TTP from 2007-2017 by using International Classification of Diseases (9th/10th editions) Clinical Modification diagnosis codes. In the final study cohort we only included patients who received plasmapheresis to restrict patient population with active TTP disease. This approach has been validated in prior publications from administrative databases. Other diagnosis of interests and other comorbidities were identified by ICD-9/10-CM codes and Elixhauser comorbidity software. We utilized Cochran Armitage trend test and survey logistic multivariable regression modeling to analyze trends and predictors of outcomes with weighted analysis. Statistical analyses were performed using SAS software, version 9.4. Results: There were a total 22,054 hospitalizations due to TTP, which increased from 1,620 in 2007 to 1,870 in 2017. The median age was 47-years (IQR:33-60) with 25% hospitalizations among the age group of 18-34 years, 66.1% were females, 46.7% were Caucasians followed by 39.2% African American race. The overall length of stay was 16-days which declined from 17-days in 2007 to 15-days is 2017 (pTrend&amp;lt;0.001). In the study cohort, 14.5% were discharged to a facility, and 9.8% died during the hospitalization. In trend analysis, in-hospital mortality decreased (13.4% in 2007 to 8.02% in 2017; pTrend&amp;lt;0.001) but discharge to facilities increased (8.9% in 2007 to 14.4% in 2017; pTrend&amp;lt;0.001). Furthermore, in multivariable regression analysis, increasing age (OR 1.4; 95%CI 1.3-1.5; p&amp;lt;0.001), Caucasians (OR 1.4; 95%CI 1.2-1.7; p&amp;lt;0.001), pneumonia (OR 1.8; 95%CI 1.4-2.5; p&amp;lt;0.001), septicemia (OR 3.4; 95%CI 2.6-4.5; p&amp;lt;0.001), cardiovascular events (OR 2.2; 95%CI 1.5-3.2; p&amp;lt;0.0001), electrolytes imbalance (OR 1.4; 95%CI 1.1-1.9; p=0.005), and liver disorders (OR 1.7; 95%CI 1.1-2.6; p=0.02) were associated with higher odds of in-hospital mortality. Conclusion: In this study, we described national trends of hospitalizations and outcomes of TTP. We observed in-hospital mortality has decreased coupled with an increase in discharge to facilities over the past decade. We also identified risk factors for poorer outcomes, including advanced age, caucasian background and associated sepsis, revealing higher odds of in-hospital mortality. Early identifications of these potential risk stratifiers may play a crucial role in initiating early treatment in addition to identifying populations who may benefit from immune-modulatory therapy along with prophylactic plasma exchange. Disclosures No relevant conflicts of interest to declare.

Epidemiology and Outcomes of Hospitalizations Due to Waldenstrom Macroglobulinemia: A National Perspective

Introduction:Waldenstorm's macroglobulinemia (WM) is a type of indolent B cell lymphoma characterized by immunoglobulin M monoclonal gammopathy and bone marrow infiltration by lymphoplasmacytic cells. Being an uncommon hematologic malignancy, studies on epidemiology of this disease are limited. Median survival is 5-11 years and depends on disease progression, treatment complication and transformation to high-grade lymphoma. In the nationally representative database, we aimed to find out the trends and outcomes of hospitalizations primarily due to WM. Methods:We used National Inpatient Sample (NIS) for the years 2007-2017 by Healthcare Cost and Utilization Project. We extracted a study cohort of adult hospitalizations due to WM using International Classification of Diseases (9th/10th editions) Clinical Modification diagnosis codes. Our primary and secondary objectives were to estimate the trends of hospitalization and outcomes as well as identify predictors of poor outcomes. Poor outcomes were defined as in-hospital mortality and discharge to facility. We utilized Cochran Armitage trend test and multivariable survey regression modeling to analyze trends and predictors of poor outcomes using SAS software, version 9.4 (SAS Institute, North Carolina, USA). Results:We studied a total of 7,379 patients who were hospitalized with WM during 2007-2017. Overall from 2007 to 2017 the burden of hospitalizations has decreased from 804 to 645 . The cohort consisted of elderly patients with a median age of 69-years (IQR:61-78), 60.2% were males, 78% Caucasians, and 10.5% African American. Mean length of stay was 7-days which remained stable over the period. A decline in the proportion of WM patients being discharged to facility (20.1% in 2007 to 13.9% in 2017; pTrend&amp;lt;0.001) and in-hospital mortality (4.7% in 2007 to 2.3% in 2017; pTrend&amp;lt;0.001) was observed. Furthermore, in multivariable logistic regression analysis, rural hospitals (OR 4.3; 95%CI 1.5-12.4; p&amp;lt;0.001), lower median household income (OR 4.1; 95%CI 1.4-12.2; p&amp;lt;0.05) and concurrent conditions like septicemia (OR 10.7; 95%CI 4.2-26.7; p&amp;lt;0.001), and pulmonary circulatory disease (OR 3.6; 95%CI 1.4-9.1; p&amp;lt; 0.001) were associated with higher odds of in-hospital mortality. Conclusion:In this nationally representative study, we observed that the hospitalizations due to WM had mildly declined and outcomes were improved during the study period which might be an indication of improvements in treatment modalities. WM in benign state is rarely a grave prognosis and does not require frequent hospitalization but mortality is usually due to other comorbidities and hyperviscosity. We were able to identify several risk predictors that were associated with poor outcomes which require further studies to better risk stratification and develop preventive measures. Disclosures No relevant conflicts of interest to declare.

Disparities in Outcomes of Hospitalizations Due to Multiple Myeloma: A Nationwide Comparison

Introduction: Multiple myeloma (MM) is a rare plasma cell dyscrasia originating from post germinal lymphoid B-cell lineage. It is the second most common hematologic malignancy. Yearly almost half a million people are affected world-wide. Multiple Myeloma is more prevalent in males, in patients' age &amp;gt; 60, and has a median survival of 6-7 months without treatment. Due to advancement in treatment approaches for MM, the five-year-survival rate is approximately 49% with treatment. Given the extent of the disease, as well as the heavy morbidity burden due to this illness, we seek to estimate trends of hospitalizations and outcomes in MM patients from nationally representative database. Methods : We used the National Inpatient Sample database to extract the study cohort of admissions due to MM from 2007-2017 using previously validated International Classification of Diseases (9th/10th editions) Clinical Modification diagnosis codes (ICD-9-CM/ICD-10-CM). Our primary objective was to estimate the hospitalization and outcomes trends. Secondary objective was to identify predictors of poor outcomes. Poor outcomes were defined as in-hospital mortality and discharge to other than home (adverse discharge). We utilized Cochran Armitage trend test and multivariable survey regression modeling to analyze trends and predictors of poor outcomes. We generated national estimates by using weights provided by Healthcare Cost and Utilization Project (HCUP). Results : Between 2007-2017 a total of 196,433 hospitalizations occurred due to primary diagnosis of MM. Burden of hospitalizations increased from 17,100 in 2007 to 19,490 in 2017. Median age was 64-years (IQR:56-72), 62.76% were Caucasians and 55.47% were males. Among hospitalized patients, overall in-hospital mortality was 6.5% which declined from 8.4% in 2007 to 4.9% in 2017 (pTrend&amp;lt;0.001). However adverse discharge remained stable 20% in 2007 to 18% in 2017 (pTrend=0.08). Furthermore, in multivariable logistic regression analysis, increasing age (OR 1.5; 95%CI 1.3-1.5; p&amp;lt;0.0001), rural hospital (OR 2.6; 95%CI 1.9-2.7; p&amp;lt;0.0001), rural non-teaching urban hospital (OR 1.4; 95%CI 1.2-1.5; p&amp;lt;0.0001), no/self-pay insurance (OR 2.6; 95%CI 2.1-3.3; p&amp;lt;0.0001) and small bed size hospital (OR 1.3; 95%CI 1.2-1.5; p&amp;lt;0.0001) were associated with higher odds of in-hospital mortality. Also, in-hospital complications like septicemia (OR 4.1; 95%CI 3.6-4.8; p&amp;lt;0.0001), pneumonia (OR 2.5; 95%CI 2.2-2.8; p&amp;lt;0.0001) and comorbidities like CHF (OR 1.6; 95%CI 1.4-1.8; p&amp;lt;0.0001), renal failure (OR 1.4; 95%CI 1.3-1.6; p&amp;lt;0.0001), and weight loss (OR 1.4; 95%CI 1.2-1.5; p&amp;lt;0.0001) were associated with increased odds of in-hospital mortality. Conclusion : We observed increased MM hospitalizations with a decline in in-hospital mortality, however adverse discharge remained stable during the study period. These differences became more evident based on the type of hospital (urban teaching vs urban non-teaching vs. rural) and hospital bed size (small vs. medium vs large), as well as insurance status. Detailed description of hospital types and bed size classification is avalivale on NIS Description of Data Elements (1). We were also able to identify several modifiable risk predictors of poor outcomes like septicemia, pneumonia, renal failure and CHF which requires optimization. Further studies are required to elucidate the strategies for better risk stratifications and management in order to further improve the outcomes of MM patients.

Impact of Obesity on Outcomes of Patients With Hip Osteoarthritis Who Underwent Hip Arthroplasty.

BackgroundWhile obesity has been clearly established as a risk factor for osteoarthritis (OA), there is a scarcity of studies comparing outcomes between obese and non-obese patients with hip OA who underwent hip arthroplasty.MethodsThis study involved adults with hip OA who had hip replacement procedures. Data was sourced from the Nationwide Inpatient Sample (NIS) database for 2016 and 2017. The primary outcome was inpatient mortality. Secondary outcomes included the development of non-ST segment elevation myocardial infarction (NSTEMI), sepsis, post-procedure site infection, pneumonia, acute kidney failure, deep vein thrombosis (DVT), pulmonary embolism, need for transfusion of blood products, complications involving orthopedic devices as well as mean length of hospitalization and mean total hospital charges.ResultsObese patients did not have higher odds of in-hospital mortality (adjusted odds ratio [aOR]: 0.65, 95% CI 0.303-1.381, p=0.260), had increased mean length of hospitalization (0.11, 95% CI 0.083-0.134, p<0.001) and higher odds of developing DVT (aOR: 1.62, 95% CI 1.187-2.222, p<0.001), acute kidney failure (aOR: 1.64, 95% CI: 1.488-1.807, p<0.001) and pressure-related injuries (aOR: 1.64, 95% CI 1.081-2.483, p=0.020), compared with non-obese patients. Obese patients were found to have a lower aOR of having NSTEMI (aOR: 0.57, 95% CI 0.332-0.986, p=0.044), and need for blood product transfusion (aOR: 0.80, 95% CI 0.726-0.875, p<0.001).ConclusionAlthough there is no difference in mortality among obese and non-obese patients who had hip arthroplasty, obese adults have increased odds of morbidity and perioperative complications. Hence, obese adults likely require better perioperative management to decrease the incidence of these complications.

External validation of a clinical risk score to predict hospital admission and in-hospital mortality in COVID-19 patients

Background Identification of patients with novel coronavirus disease 2019 (COVID-19) requiring hospital admission or at high-risk of in-hospital mortality is essential to guide patient triage and to provide timely treatment for higher risk hospitalized patients. Methods A retrospective multi-centre (8 hospital) cohort at Beaumont Health, Michigan, USA, reporting on COVID-19 patients diagnosed between 1 March and 1 April 2020 was used for score validation. The COVID-19 Risk of Complications Score was automatically computed by the EHR. Multivariate logistic regression models were built to predict hospital admission and in-hospital mortality using individual variables constituting the score. Validation was performed using both discrimination and calibration. Results Compared to Green scores, Yellow Scores (OR: 5.72) and Red Scores (OR: 19.1) had significantly higher odds of admission (both p < .0001). Similarly, Yellow Scores (OR: 4.73) and Red Scores (OR: 13.3) had significantly higher odds of in-hospital mortality than Green Scores (both p < .0001). The cross-validated C-Statistics for the external validation cohort showed good discrimination for both hospital admission (C = 0.79 (95% CI: 0.77–0.81)) and in-hospital mortality (C = 0.75 (95% CI: 0.71–0.78)). Conclusions The COVID-19 Risk of Complications Score predicts the need for hospital admission and in-hospital mortality patients with COVID-19. Key points: Can an electronic health record generated risk score predict the risk of hospital admission and in-hospital mortality in patients diagnosed with coronavirus disease 2019 (COVID-19)? In both validation cohorts of 2,025 and 1,290 COVID-19, the cross-validated C-Statistics showed good discrimination for both hospital admission (C = 0.79 (95% CI: 0.77–0.81)) and in-hospital mortality (C = 0.75 (95% CI: 0.71–0.78)), respectively. The COVID-19 Risk of Complications Score may help predict the need for hospital admission if a patient contracts SARS-CoV-2 infection and in-hospital mortality for a hospitalized patient with COVID-19.

Cardiovascular and Hematological Risk Factors and Mortality Risk in Pediatric Arterial Ischemic Stroke: Analysis Report From Hospitals in the United States.

ObjectiveWe aimed to analyze the differences in demographics, comorbidities, and the risk of in-hospital mortality in pediatric arterial ischemic stroke (PAIS) inpatient population by hematological (HEM) and cardiovascular (CV) risk factors.MethodsA total of 4,036 inpatients (1-18 years of age) from the Nationwide Inpatient Sample (NIS) with a primary diagnosis of PAIS were included. Descriptive statistics, linear-by-linear association test, and logistic regression models were utilized to analyze differences in demographics, comorbidities, and their impact on mortality in PAIS inpatients by CV and HEM risk factors.ResultsThe cumulative in-hospital mortality rate in the entire PAIS inpatient cohort was 3.6%. The mortality rate was higher in the CV cohort (57.4%) as compared to the HEM cohort (29.7%). When compared with the cohort with no risk factors, HEM and CV were associated with four times (95% CI: 2.36-8.03) and seven (95% CI: 4.03-12.61) times higher odds for in-hospital mortality respectively. CV risk factors like cardiomyopathy and diabetes, and HEM risk factors like blood disorders, coagulation disorders, and deficiency anemias were associated with a significantly increased risk of in-hospital mortality.ConclusionThe in-hospital mortality risk in PAIS patients was increased by 613% by CV risk factors and by 336% by HEM risk factors. Early identification and effective management of associated CV and HEM risk factors in the PAIS patient population can pave the way for increased survival and improved clinical outcomes.

Red Blood Cell Transfusions and Outcomes After Intracerebral Hemorrhage

BackgroundLow red blood cell (RBC) levels are associated with worse intracerebral hemorrhage (ICH) outcomes. However, relationships of RBC transfusions on ICH outcomes are unclear given the overlap of RBC transfusion, comorbidities, and disease severity. We investigated RBC transfusion relationships on ICH outcomes while accounting for comorbidities and disease severity. MethodsICH hospitalizations between 2002 and 2011 and RBC transfusion exposure were identified from the Nationwide Inpatient Sample using ICD-9-CM codes. Logistic regression was used to study the relationship between RBC transfusion on outcomes after adjusting for demographics, baseline comorbidities, and markers of disease severity. Additional sensitivity analyses stratified by comorbidity burden and disease severity were performed. ResultsOf 597,046 ICH hospitalizations, RBC transfusions were administered in 22,904 (4%). RBC transfusion was associated with higher odds of in-hospital mortality (adjusted OR: 1.22 [95%CI: 1.10-1.35]). In sensitivity analyses, RBC transfusions resulted in poor outcomes regardless of the comorbidity burden, but attenuation in this relationship was notable with lower comorbidities (adjusted OR 1.43 [95%CI: 1.34-1.51] vs 1.18 [95%CI: 1.10-1.29]). There were no associations of RBC transfusions with poor outcomes in hospitalizations without mechanical ventilation (adjusted OR 0.88 [95%CI: 0.83-1.13]) and in cases requiring ventriculostomy drains (adjusted OR 1.05 [95%CI: 0.97-1.10]). ConclusionsIn a large, nationally representative sample, RBC transfusion was associated with poor ICH outcomes. However, there were variations in this relationship based on comorbidities and disease severity. Additional prospective studies are required to assess direct risks and benefits from RBC transfusions in ICH.

Predictability of CRP and D-Dimer levels for in-hospital outcomes and mortality of COVID-19

ABSTRACT Background Systemic inflammation elicited by a cytokine storm is considered a hallmark of coronavirus disease 2019 (COVID-19). This study aims to assess the clinical utility of the C-reactive protein (CRP) and D-Dimer levels for predicting in-hospital outcomes in COVID-19. Methods A retrospective cohort study was performed to determine the association of CRP and D-Dimer with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI), respectively. Results A total of 176 patients with confirmed COVID-19 diagnosis were included. On presentation, the unadjusted odds for the need of IMV (OR 2.5, 95% CI 1.3–4.8, p = 0.012) and upgrade to ICU (OR 3.2, 95% CI 1.6–6.5, p = 0.002) were significantly higher for patients with CRP (>101 mg/dl). Similarly, the unadjusted odds of in-hospital mortality were significantly higher in patients with high CRP (>101 mg/dl) and high D-Dimer (>501 ng/ml), compared to corresponding low CRP (<100 mg/dl) and low D-Dimer (<500 ng/ml) groups on day-7 (OR 3.5, 95% CI 1.2–10.5, p = 0.03 and OR 10.0, 95% CI 1.2–77.9, p = 0.02), respectively. Both high D-Dimer (>501 ng/ml) and high CRP (>101 mg/dl) were associated with increased need for upgrade to the ICU and higher requirement for IMV on day-7 of hospitalization. A multivariate regression model mirrored the overall unadjusted trends except that adjusted odds for IMV were high in the high CRP group on day 7 (aOR 2.5, 95% CI 1.05–6.0, p = 0.04). Conclusion CRP value greater than 100 mg/dL and D-dimer levels higher than 500 ng/ml during hospitalization might predict higher odds of in-hospital mortality. Higher levels at presentation might indicate impending clinical deterioration and the need for IMV.

Perioperative Allogeneic Red Blood Cell Transfusion and Wound Infections: An Observational Study.

It remains unclear whether the benefits of performing perioperative allogeneic red blood cell (RBC) transfusion outweigh the risks of postoperative wound infection. The aim of this study was to assess the impact of perioperative RBC transfusion as well as dose-response relationship on wound infections in surgical patients in a large cohort. As a retrospective observational study, the national Hospital Quality Monitoring System database was used to retrieve information about in-hospital surgical patients without limitations on surgical types in the People's Republic of China between 2013 and 2018. Patients were divided into the perioperative RBC transfusion and non-RBC transfusion groups, and wound infection rates (the primary end point) were compared. Secondary end points included in-hospital mortality, nosocomial infections, and length of hospital stay. Furthermore, patients who underwent RBC transfusion were subdivided into 6 groups based on the volume of transfused RBCs to investigate the dose-response relationship between RBC transfusions and wound infections. The association between RBC transfusion and patient outcomes were analyzed using multivariable logistic regression models adjusted for potential confounders. A total of 1,896,584 patients from 29 provinces were included, among whom 76,078 (4.0%) underwent RBC transfusions; the overall wound infection rate was 0.7%. After adjusting for confounding factors, perioperative RBC transfusion was associated with higher odds of wound infection (odds ratio [OR] = 2.24, 95% confidence interval [CI], 2.09-2.40; P < .001). As the volume of transfused RBCs increased, so did the odds of wound infection with a clear dose-response relationship (OR of >0 and ≤1 U, >1 and ≤2 U, >2 and ≤4 U, >4 and ≤8 U, >8 U transfusion compared with no RBC transfusion were 1.20, 95% CI, 0.76-1.91; 1.27, 95% CI, 1.10-1.47; 1.70, 95% CI, 1.49-1.93; 2.12, 95% CI, 1.83-2.45 and 3.65, 95% CI, 3.13-4.25, respectively). RBC transfusion was also found to be associated with higher odds of in-hospital mortality, nosocomial infection, and longer hospital stay. RBC transfusion was associated with an increased odd of postoperative wound infection in surgical patients, and a significant dose-related relationship was also observed. While there are still essential confounders not adjusted for and the results do not necessarily indicate a causal relationship, we still recommend to lessen perioperative blood loss and optimize blood conservation strategies.

The association between race/ethnicity and peripartum hysterectomy and the risk of perioperative complications.

To compare perioperative outcomes by patient race/ethnicity. A retrospective cohort study identified 7 331 638 childbirth hospitalizations for women aged 12-55years in the USA between 2004-2014. Peripartum hysterectomy, in-hospital mortality, perioperative complications, length of stay, and cost of hysterectomy data were analyzed using SAS. Among childbirth hospitalizations (52.9% white, 13.5% black, 23.0% Hispanic, 5.2% Asian, and 5.4% other), peripartum hysterectomy occurred in 6619. The incidence of peripartum hysterectomy was 90.3 (95% confidence interval [CI] 87.7-93.0) per 100 000 hospitalizations, and higher for black (111.0, 95% CI 104.5-117.4), Hispanic (104.9, 95% CI 99.1-110.8), and Asian women (119.6, 95% CI 109.1-130.2) compared to whites (75.7, 95% CI 72.8-78.5). After adjustment, Hispanic women had an 18% higher odds of undergoing peripartum hysterectomy (odds ratio [OR] 1.18, 95% CI 1.08-1.29; P=0.004) than white women. Non-white women had a 2-3-fold higher odds of in-hospital mortality (ORblack 2.76, 95% CI 1.44-5.30; ORHispanic 1.99, 95% CI 1.04-3.82; ORAsian+other 2.44, 95% CI 1.11-5.40. Black and Asian/other women were more likely to undergo blood transfusions. Women of color have higher rates of peripartum hysterectomy and experience higher rates of poor perioperative outcomes and mortality.

Trends and outcomes of peptic ulcer disease in patients with cirrhosis

ABSTRACT Background Peptic ulcer disease (PUD) is more prevalent in cirrhotic patients and it has been associated with poor outcomes. However, there are no population-based studies from the United States (U.S.) that have investigated this association. Our study aims to estimate the incidence trends, predictors, and outcomes PUD patients with underlying cirrhosis. Methods We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data for years 2002–2014. Adult hospitalizations due to PUD were identified by previously validated ICD-9-CM codes as the primary diagnosis. Cirrhosis was also identified with presence of ICD-9-CM codes in secondary diagnosis fields. We analyzed trends and predictors of PUD in cirrhotic patients and utilized multivariate regression models to estimate the impact of cirrhosis on PUD outcomes. Results Between the years 2002–2014, there were 1,433,270 adult hospitalizations with a primary diagnosis of PUD, out of which 70,007 (4.88%) had cirrhosis as a concurrent diagnosis. There was a significant increase in the proportion of hospitalizations with a concurrent diagnosis of cirrhosis, from 3.9% in 2002 to 6.6% in 2014 (p < 0.001). In an adjusted multivariable analysis, in-hospital mortality was significantly higher in hospitalizations of PUD with cirrhosis (odd ratio [OR] 1.78; 95% confidence interval [CI] 1.63–1.97; P < 0.001), however, there was no difference in the discharge to facility (OR 1.00; 95%CI 0.94 − 1.07; P = 0.81). Moreover, length of stay (LOS) was also higher (6 days vs. 4 days, P < 0.001) among PUD with cirrhosis. Increasing age and comorbidities were associated with higher odds of in-hospital mortality among PUD patients with cirrhosis. Conclusion Our study shows that there is an increased hospital burden as well as poor outcomes in terms of higher in-hospital mortality among hospitalized PUD patients with cirrhosis. Further studies are warranted for better risk stratification and improvement of outcomes.