Higher Inpatient Mortality Research Articles

Emergence of infective endocarditis due to Serratia spp.: Results of a multicenter cohort

Abstract Background Infective endocarditis due to Serratia spp. (S-IE) has historically been considered a rare entity. Typically linked to injection drug use (IDU), S-IE appears to be a growing problem as the harms of unsafe drug use proliferate. However, guidance on therapy for gram-negative IE remains limited. Methods This was a retrospective analysis of adults treated for S-IE at 4 academic health systems in different US states from 2015-2021. Multivariable logistic regression analyzed the association of inpatient mortality with procedural management and combination antibiotic treatment. Results 159 cases of S-IE were identified with a qualitative overall increase across the period, and a peak in 2019, although trends varied by site. 75% were due to IDU, 57% involved a single left-sided valve and inpatient mortality was 21%. In adjusted analyses, including 117 cases from 3 sites, lower inpatient mortality was associated with procedural intervention (OR 0.14, 95% CI 0.03-0.64) and combination antibiotic therapy (OR 0.15, 95% CI 0.03-0.74). Discussion In this multicenter study, we found that S-IE may be increasing, commonly associated with IDU, is treated with varying strategies and carries high inpatient mortality. Procedural intervention and combination antibiotics were associated with lower mortality. Our study is limited by varying methods of case identification and a lack of data on clinical severity and surgical indications. Further study is urgently needed to define best management practices.

Ten-year trends in clinical characteristics and outcome of children hospitalized with severe wasting or nutritional edema in Malawi (2011-2021): Declining admissions but worsened clinical profiles.

Severe acute malnutrition (SAM) constitutes a substantial burden in African hospitals. Despite adhering to international guidelines, high inpatient mortality rates persist and the underlying contributing factors remain poorly understood. We evaluated the 10-year trend (2011-2021) in clinical factors and outcomes among children with severe wasting and/or nutritional edema at Malawi's largest nutritional rehabilitation unit (NRU). This retrospective study analyzed trends in presentation and outcomes using generalized additive models. The association between clinical characteristics and mortality or readmission was examined and key features were also related to time to either mortality or discharge. 1497 children (53%, females) were included. Median age at admission (23 months, IQR 14, 34) or anthropometry (i.e., weight-for-age, height-for-age and weight-for-height) did not change over the 10-years. But the prevalence of edema decreased by 40% whereas dehydration, difficulty breathing, and pallor became more common. Yearly HIV testing increased but positive-detection remained around 11%. Reporting of complete vaccination dropped by 49%, and no reduction in 'watch' antibiotic usage was detected. Overall admissions declined but mortality remained around 23% [95%CI; 21, 25], and deaths occurred earlier (5.6 days [95%CI; 4.6, 6.9] in 2011 vs. 3.5 days [95%CI; 2.5, 4.7] in 2021; p<0.001). Duration of hospitalization was shortened and readmissions surged from 4.9% [95%CI; 3.3, 7.4] in 2011 to 25% [95%CI; 18, 33] in 2021 (p<0.001). Age, wasting, having both dehydration and diarrhea, or having vomiting, cough, or difficulty breathing were associated with mortality but these associations did not show any interaction over time. Over 10 years, mortality risk remained high among hospitalized children with SAM and coincided with worsened clinical presentation at admission and increased readmission. Longitudinal data from major NRUs can identify shifts in clinical profiles or outcomes, and this information can be leveraged to promote earlier care-seeking, improved risk stratification, and implementation of more patient-centered treatments.

Abstract 4147609: Hypoalbuminemia as predictor of poor functional status in hospitalized patients with advanced heart failure

Introduction: Timely involvement of palliative care services for patients with advanced heart failure (HF) improves symptom burden, functional status, and resource utilization. The Karnofsky Performance Scale (KPS) is an objective tool used by palliative care specialists to assess physical ability and guide palliative interventions. Patients with lower KPS have poor outcomes, however evidence linking clinical parameters such as New York Heart Association (NYHA) class, ejection fraction (EF), and albumin with KPS remains limited. Goals: To identify clinical parameters associated with poor functional status in hospitalized patients with advanced HF Methods: Individuals with acute decompensated HF admitted between 2021-2023, ineligible for advanced cardiac therapies, and referred to palliative care were included. Data collected encompassed demographic variables, clinical parameters (NYHA classification, KPS, comorbidities, EF, Brain natriuretic peptide (BNP), albumin, creatinine), and palliative care interventions (family meetings, advanced care planning discussions). Bivariate and multivariate analyses, utilizing Kruskal-Wallis and chi-square tests along with adjusted regression models, were conducted using R to compare characteristics, with a low KPS (≤40) as the primary outcome. Results: A total of 97 individuals were included, with a mean age of 68 ± 17.7 years, 32 (33.0%) were female. Hypoalbuminemia was directly associated with KPS. Patients with albumin levels ≤3 g/dL were more likely to have KPS ≤40 (OR 2.6 [CI 1.03-6.7], p=0.04). NYHA class, EF, serum creatinine, and comorbid conditions (chronic kidney disease, stroke, chronic obstructive pulmonary disease, dementia) were not significantly associated with KPS. Those with lower KPS scores had higher utilization of palliative care services for family meetings, although did not differ significantly in advanced care planning status. Conclusions: In our analysis of hospitalized patients with advanced HF, hypoalbuminemia had the highest predictive value for low functional status. Low KPS score was associated with increased utilization of palliative care services and higher rates of inpatient mortality.

Abstract 4130368: Outcomes of Patients with Critical Limb Ischemia and Chronic Kidney Disease: A National Perspective

Background: Studies exploring the relationship between peripheral arterial disease (PAD), critical limb ischemia (CLI), and chronic kidney disease (CKD) and its effect on in-hospital outcomes are limited. Objectives: We aimed to analyze the outcomes of patients with CKD and PAD who are admitted for CLI. Methods: We utilized the National Inpatient Sample (NIS) to capture hospitalizations for CLI from 2016-2020 and then identified cases with concomitant CKD. The primary outcome was mortality, and secondary outcomes were cerebrovascular accident, major bleeding, vasopressor requirement, percutaneous coronary intervention, cardiac arrest, acute respiratory failure, transfusion, length of stay (LOS), and total hospital charges. Multivariable logistic regression was performed to adjust for covariates. Results: A total of 441,245 patients with CLI were identified, of which 122,370 (27.7%) reported concomitant CKD. Patients with CKD had a higher in-patient mortality (OR 1.68, CI, 1.17-1.68, p &lt; 0.001), vascular complications (OR 1.31, 95% CI, 1.17-1.48, p&lt;0.001), acute kidney injury requiring hemodialysis (OR 3.17, 95% CI, 2.64-3.80, p&lt; 0.001) and major bleeding (OR 1.12, 95% CI 1.05-1.19, p&lt;0.001). Patients with CKD underwent conservative (31.08% vs 36.73%, p&lt;0.0001) and invasive procedures (14.73% vs 23.55%, p&lt;0.0001) less often. PAD-CLI with CKD was associated with major (20.54% vs. 16.17%, OR 1.04; p&lt;0.0001) and minor (26.87% vs. 19.53%, OR 1.2, p&lt;0.0001) amputations more often. Conclusion: Patients admitted for PAD-CLI with concomitant CKD have significantly higher in-hospital mortality as compared to patients without CKD. Moreover, patients with CKD and PAD-CLI are less likely to receive revascularization and more likely to undergo amputation

Clinical Outcomes for Female Patients Following Hematopoietic Stem Cell Transplant: An Analysis of the National Inpatient Sample

Background: As hematopoietic stem cell transplant (HSCT) grows in accessibility and utility, it remains imperative to understand outcomes for its recipients. Limited data is available on the sex-based correlations for this steadily increasing patient population. We sought to examine the National Inpatient Sample (NIS) database to describe in-hospital outcomes among the female population who have received a HSCT. Methods: Data were extracted from the NIS Database from 2019 and 2020. The NIS was searched for hospitalizations of all patients greater than 18 years old who had previously received a HSCT and were hospitalized thereafter. We then analyzed the outcomes of female patients. Multivariate logistic regression analysis was used to adjust for confounders; SPSS software was used for statistical analysis. The primary outcome was inpatient mortality and secondary outcomes are listed below. Results: This study included 8,302 patients who had received a HSCT, of which 3636 (43.8%) were identified as female. Female recipients of a HSCT had a slightly higher prevalence of obesity (7.5% versus 7.0%, p&amp;lt;0.001), as well as lower prevalence of smoking (16.5% versus 20.5%, p&amp;lt;0.001), hypertension (21.8% versus 23.7%, p&amp;lt;0.001), and chronic kidney disease (19.3% versus 21.3%, p&amp;lt;0.001). Multivariate regression demonstrated that female recipients of a HSCT had higher inpatient mortality (OR 1.721, CI 1.572-1.884, p&amp;lt;0.001). On secondary analysis, female HSCT recipients were found to be more likely to have anemia (OR 1.790, CI 1.746-1.836, p&amp;lt;0.001), thrombocytopenia (OR 1.692, CI 1.621-1.765, p&amp;lt;0.001), hypertension (OR 1.674, CI 1.615-1.736, p&amp;lt;0.001), acute kidney failure (OR 1.698, CI 1.635-1.764, p&amp;lt;0.001), all-cause arrhythmias (OR 1.588, CI 1.502-1.680, p&amp;lt;0.001), all-cause heart block (OR 1.441, CI 1.323-1.570, p&amp;lt;0.001), all-cause sepsis (OR 1.859, CI 1.789-1.932, p&amp;lt;0.001), all-cause coagulopathies (OR 1.744, CI 1.605-1.895, p&amp;lt;0.001), and acute heart failure (OR 1.734, CI 1.658-1.815, p&amp;lt;0.001). Conclusion: In this nationally-representative, population-based retrospective cohort study, female patients who have received a HSCT and were subsequently hospitalized were associated with higher mortality and worse outcomes.

Clinical Outcomes for Hematopoietic Stem Cell Transplant Recipients with Thrombocytopenia: An Analysis of the National Inpatient Sample

Background: As hematopoietic stem cell transplant (HSCT) grows in accessibility and utility, it remains imperative to understand outcomes for its recipients. Limited data is available on the comorbid correlations for this steadily increasing patient population. We sought to examine the National Inpatient Sample (NIS) database to describe in-hospital outcomes among patients who received a HSCT and developed thrombocytopenia. Methods: Data were extracted from the NIS Database from 2019 and 2020. The NIS was searched for hospitalizations of all patients greater than 18 years old who had previously received a HSCT and were hospitalized thereafter. We then analyzed the outcomes of these patients who developed thrombocytopenia. Multivariate logistic regression analysis was used to adjust for confounders; SPSS software was used for statistical analysis. The primary outcome was inpatient mortality and secondary outcomes are listed below. Results: This study included 8,302 patients who had received a HSCT, of which 1470 (17.7%) were found to have thrombocytopenia. Thrombocytopenic recipients of a HSCT had higher prevalences of smoking (21.2% versus 20.5%, p&amp;lt;0.001), hypertension (26.1% versus 23.7%, p&amp;lt;0.001), and chronic kidney disease (23.8% versus 21.3%, p&amp;lt;0.001). Multivariate regression demonstrated that thrombocytopenic recipients of a HSCT had higher inpatient mortality (OR 1.378, CI 1.291-1.471, p&amp;lt;0.001). On secondary analysis, thrombocytopenic HSCT recipients were found to be more likely to have anemia (OR 1.272, CI 1.254-1.291), systemic lupus erythematosus (OR 1.143, CI 1.003-1.303, p&amp;lt;0.001), non-alcoholic fatty liver disease (OR 1.265, CI 1.163-1.377, p&amp;lt;0.001), peripheral artery disease (OR 1.249, CI 1.173-1.329, p&amp;lt;0.001), hypertension (OR 1.242, CI 1.216-1.270, p&amp;lt;0.001), acute kidney failure (OR 1.284, CI 1.253-1.315, p&amp;lt;0.001), all-cause arrhythmias (OR 1.249, CI 1.204-1.295, p&amp;lt;0.001), all-cause shock (OR 1.356, CI 1.243-1.478, p&amp;lt;0.001), acute pancreatitis (OR 1.148, CI 1.065-1.237, p&amp;lt;0.001), all-cause heart block (OR 1.202, CI 1.135-1.274, p&amp;lt;0.001), pericarditis (OR 1.338, CI 1.236-1.447, p&amp;lt;0.001), sepsis (OR 1.293, CI 1.264-1.322, p&amp;lt;0.001), hematuria (OR 1.273, CI 1.191-1.360, p&amp;lt;0.001), esophagitis (OR 1.198, CI 1.174-1.223, p&amp;lt;0.001), Crohn's disease (OR 1.206, CI 1.050-1.386, p&amp;lt;0.001), systemic sclerosis (OR 1.171, CI 1.032-1.330, p&amp;lt;0.001), coagulopathies (OR 1.520, CI 1.418-1.629, p&amp;lt;0.001), chronic pulmonary disease (OR 1.190, CI 1.156-1.225, p&amp;lt;0.001), pulmonary hypertension (OR 1.292, CI 1.209-1.382, p&amp;lt;0.001), severe liver disease (OR 1.239, CI 1.177-1.303, p&amp;lt;0.001), acute heart failure (OR 1.239, CI 1.208-1.272, p&amp;lt;0.001), and myocardial infarction (OR 1.206, CI 1.158-1.225, p&amp;lt;0.001). Conclusion: In this nationally-representative, population-based retrospective cohort study, thrombocytopenic patients who have received a HSCT and were subsequently hospitalized were associated with higher mortality and worse outcomes.

Clinical profile of herpes zoster-related hospitalizations and complications: A French population-based database study

To estimate the incidence of hospitalization with a diagnosis of herpes zoster (HZ) and post-herpetic neuralgia (PHN) in France between 2013 and 2020, overall and stratified by age-group and immune status. Retrospective observational, database study, using the French hospital discharge database, which includes private and public data for all day-care and inpatient stays. Adults aged ≥18 years, hospitalized between January 1, 2013, and December 31, 2020, with a diagnosis of HZ or PHN, were included. Overall, 62 077 adults had a first hospitalization with a diagnosis of HZ or PHN during the observation period. HZ and/or PHN incidence ranged between 14.6 and 16.3 hospitalizations/100 000 persons and was highest in people aged ≥80 years (97.6 hospitalizations/100 000 persons). The immunocompromised (IC) population accounted for 22% of the overall study population. IC patients had longer lengths of stay for HZ per episode compared with non-IC patients (15.5±19.4 days vs 12.2±13.5 days) and higher in-patient mortality (8% vs 4%). Average annual hospitalization costs per patient were higher in the IC vs non-IC population (€8018 vs €5603). Older age increases hospitalization rates up to 6-fold and IC status increases in-patient mortality up to two-fold. The study was conducted by HEVA and data were provided by ATIH according to French regulatory and data protection procedures.

Acute kidney injury stage 2/3 during acute heart failure admission - clinical contributors and outcomes

Abstract Introduction Acute Heart failure (AHF) may be complicated by acute kidney injury (AKI) as a result of cardiorenal syndrome.(1) However other factors may contribute to AKI. AKI stage 2 or 3 predicts negative inpatient outcomes in the general population.(2) We have reported data in a contemporary cohort on AKI in AHF. This study looks at a larger cohort in 5 previous years to test whether those findings were consistent. Better understanding of this clinical scenario may lead to improvements in care. Aim To assess the clinical factors associated with AKI 2/3 in AHF inpatients. Methods This study used retrospective data from a single teaching hospital collected for inclusion in the UK National Heart Failure National Audit. All AHF admissions over a 5-year period, from April 2017 – April 2022 inclusive, were analysed. Renal function on admission and discharge/death were assessed. AKI stage was defined according to KDIGO guidelines based on serum creatinine levels. Electronic patient records were reviewed and the clinical course leading up to and following AKI 2/3 was reviewed. Reported mode of death was also collected. Results 3219 AHF admissions (2360 unique patients) were assessed. 257 patients died during admission (8% admission mortality, 10.9% patients). 157 (4.9%) admissions had AKI 2/3 on admission/discharge. 85 (54.1%) AKI 2/3 died during their hospital admission vs 6.1% mortality in admissions without AKI 2/3. Baseline population characteristics are summarised in Table 1. Admissions with AKI 2/3 who died were older (77.6±11.5 vs 71.5 ±15.8) and had higher rates of atrial fibrillation (48.2% vs 39.9%), diabetes (40% vs 36%), ischaemic cardiomyopathy (56.5% vs 41.7%) and LVEF &amp;lt;35% (38.8% vs 27.7%). The most frequent contributors to AKI 2/3 were sepsis (55, 64.7%) and congestive cardiac failure/cardiorenal syndrome (48, 56.6%). Hypotension (25, 29.4%), over-diuresis (17, 20%), radioiodine contrast (10, 11.8%) and aminoglycosides (8, 9.4%) were less common factors in development of AKI 2/3. ≥2 contributors were present in 49, 57.6%. The dominant contributor for AKI 2/3 was adjudicated to be sepsis in 33 (38.8%) of admissions, followed by cardiorenal syndrome (congestive heart failure with AKI) in 29 (34.1%), and cardiogenic shock in 7 (8.2%). AKI 2/3 contributors are summarised in Table 2. In AKI 2/3 cases who died, 35 (41.2%) involved renal specialist input; 60 (70%) involved heart failure specialist review. Conclusion AKI in AHF is associated with high inpatient mortality. Despite this, specialist renal input was uncommon. AKI 2/3 was usually multifactorial. Cardiorenal syndrome accounted for one third of cases and may not be preventable. In keeping with our findings from a smaller contemporary cohort, sepsis was the most common dominant cause of severe AKI. Prevention, early identification, and treatment of infection could reduce this risk. Awareness of the high mortality of AKI in AHF and specialist review may improve outcomes in AHF.

In Patients Presenting with an ST-Elevation Myocardial Infarction, Overweight and Obese Patients Have the Lowest Inpatient Mortality whereas Cachexia Patients Have the Highest Inpatient Mortality Followed by Patients with Morbid Obesity

Introduction: The obesity paradox has been observed in patients with cardiovascular disease. The goal of this study was to evaluate whether obesity has a protective effect in patients presenting with an ST elevation myocardial infarction (STEMI). Method: Using the large Nationwide Inpatient (NIS) sample database, we evaluated the mortality in patients with a STEMI based on weight categories. Results: A total of 2,161,640 STEMI patients were found in the database over age 18. We found that overweight and obesity had the lowest mortality using univariate (overweight mortality of 5% vs. obesity mortality of 6.5% vs. 10.9% for normal weights) and multivariate analyses (overweight OR: 0.52, CI: 0.43–063; p &lt; 0.001 and obesity OR: 0.7, CI: 0.67–0.74; p &lt; 0.001), whereas cachexia was associated with the highest mortality in the univariate (cachexia 24.5%) and multivariate (OR: 2.28, CI: 2.13–2.44; p &lt; 0.001) analyses, followed by morbid obesity in the multivariate analysis (OR: 1.07, CI: 1.02–1.12; p = 0.004). Conclusions: We observed a partial obesity paradox in patients with a STEMI showing that overweight have the best survival rates followed by obesity. Cachexia followed by morbid obesity had the lowest survival rates.

TCT-811 Overweight and Obesity Have the Lowest Mortality, Whereas Cachexia Has the Highest Inpatient Mortality, Followed by Morbid Obesity in Patients Presenting With ST-Segment Elevation Myocardial Infarction

TCT-811 Overweight and Obesity Have the Lowest Mortality, Whereas Cachexia Has the Highest Inpatient Mortality, Followed by Morbid Obesity in Patients Presenting With ST-Segment Elevation Myocardial Infarction

Incidence of bradycardia with the use of remdesivir for coronavirus disease of 2019 and risk factor analysis.

Remdesivir is commonly used for inpatient treatment of coronavirus disease of 2019 (COVID-19) and may be associated with bradycardia. The objective is to investigate the incidence of bradycardia in patients with COVID-19 receiving remdesivir and evaluate potential risk factors associated with bradycardia. This single-center, retrospective, cohort study evaluated the incidence of bradycardia during and up to 48 h after remdesivir administration in adults admitted to the medical center for treatment of COVID-19. Secondary endpoints included time to bradycardia after remdesivir administration, incidence of severe bradycardia, incidence of early remdesivir discontinuation due to bradycardia, interventions to treat bradycardia, and inpatient mortality. Univariate analyses were performed to determine factors associated with remdesivir-related bradycardia. Risk factors significant at the 0.20 level in the univariate analysis were entered into a stepwise backward regression analysis to evaluate potential risk factors. Bradycardia occurred in 61 (49.2%) of patients with a median nadir of 50 bpm. Median baseline heart rate (HR) was lower in patients who developed bradycardia (79 [67-89] vs. 91 [80-100] P < 0.001). Patients who developed bradycardia had a trend for more nonblack race, higher severity of illness, concurrent acute respiratory distress syndrome diagnosis, history of liver disease, and less hypomagnesemia. Only baseline HR as measured before remdesivir initiation was independently associated with bradycardia by multivariate analysis. Patients who developed bradycardia had a higher inpatient mortality (26.2% vs. 11.1%, P = 0.03). Remdesivir-associated bradycardia is common. Baseline HR was identified as an independent risk factor for bradycardia in hospitalized patients being treated with remdesivir for COVID-19.

Impact of Constipation on Health Outcomes in Medically Hospitalized Patients: A Prospective Study on Laxative Use and Health Care Outcomes

Background and Objectives: Constipation affects health-related quality of life and increases hospital visits. We conducted this prospective cohort study to assess laxative use, health outcomes of constipation in medically hospitalized patients, and related health outcomes. Materials and Methods: A prospective single-center study included all adult patients admitted under the General Internal Medicine Unit from 1 February 2022, to 31 August 2022. Constipation was defined using the Constipation Assessment Scale (CAS). Patients were assessed for 28 days during their hospital stay and up to 90 days post-discharge. Result: Among the included patients, 62.45% experienced constipation, which was associated with poor health outcomes including delirium (p = 0.048), intensive care admission (p &lt; 0.01), cardiopulmonary arrest (p &lt; 0.01), inpatient mortality (p &lt; 0.01), longer hospital stay (p &lt; 0.01), 90-day mortality (p &lt; 0.01), and 90-day hospital readmission (p &lt; 0.01). Laxative treatment was administered to only 33.93% of patients with constipation and was more commonly used among older patients (p &lt; 0.01), those with high CAS scores (p &lt; 0.01), longer hospital stays (p &lt; 0.01), and critically ill patients (intensive care admission) (p = 0.01), as well as those who had cardiopulmonary arrest (p &lt; 0.01) and high inpatient mortality (p &lt; 0.01). Conclusions: This study identified several associations between constipation and poor health outcomes and highlighted the underutilization of laxatives in treating constipation. It is vital to interpret our results with caution. Therefore, we believe that a randomized controlled trial will help enhance our understanding of the interaction between constipation, laxative use, and poor health outcomes.

Clinical profiles and mortality predictors of hospitalized patients with COVID-19 in Ethiopia

BackgroundStudying the characteristics of hospitalized Coronavirus Disease 2019 (COVID-19) patients is vital for understanding the disease and preparing for future outbreaks. The aim of this study was to analyze and describe the clinical profiles and factors associated with mortality among COVID-19 patients admitted to Jimma Medical Center COVID-19 Treatment Center (JMC CTC) in Ethiopia.MethodsAll confirmed COVID-19 patients admitted to JMC CTC between 17 April 2020 and 05 March 2022 were included in this study. Socio-demographic data, clinical information, and outcome variables were collected retrospectively from medical records and COVID-19 database at the hospital. Bivariable and multivariable analyses were performed to determine factors associated with COVID-19 severity and mortality. A P-value < 0.05 was considered statistically significant.ResultsA total of 542 confirmed COVID-19 patients were admitted to JMC CTC, of which 322 (59.4%) were male. Their median age was 48 years (IQR 32–64). About 51% (n = 277) of them had severe COVID-19 upon admission. Patients with hypertension [AOR: 2.8 (95% CI: 1.02–7.7, p = 0.046)], diabetes [AOR: 8.8 (95% CI: 1.2–17.3, p = 0.039)], and underlying respiratory diseases [AOR: 18.8 (95% CI: 2.06–71.51, p = 0.009)] were more likely to present with severe COVID-19 cases. Overall, 129 (23.8%) died in the hospital. Death rate was higher among patients admitted with severe disease [AHR = 5.5 (3.07–9.9) p < 0.001)] and those with comorbidities such as hypertension [AHR = 3.5 (2.28–5.41), p < 0.001], underlying respiratory disease [AHR = 3.4 (1.97–5.94), p < 0.001], cardiovascular disease (CVDs) [AHR = 2.8 (1.73–4.55), p < 0.001], and kidney diseases [AHR = 3.7 (2.3–5.96), p < 0.001].ConclusionAbout half of COVID-19 cases admitted to the hospital had severe disease upon admission. Comorbidities such as hypertension, diabetes, and respiratory diseases were linked to severe illness. COVID-19 admissions were associated with high inpatient mortality, particularly among those with severe disease and comorbidities.

Outcomes of Patients with Critical Limb Ischemia and Chronic Kidney Disease: A National Perspective

Introduction: Studies exploring the relationship between peripheral arterial disease (PAD), critical limb ischemia (CLI), and chronic kidney disease (CKD) and its effect on in-hospital outcomes are limited. We aimed to analyze the outcomes of patients with CKD and PAD who are admitted for CLI. Methods: We utilized the National Inpatient Sample (NIS) to capture hospitalizations for CLI from 2012 to 2020 and then identified cases with concomitant CKD. The primary outcome was mortality, and secondary outcomes were cerebrovascular accident, major bleeding, vasopressor requirement, percutaneous coronary intervention, cardiac arrest, acute respiratory failure, transfusion, length of stay, and total hospital charges. Multivariable logistic regression was performed to adjust for covariates. Results: A total of 441,245 patients with CLI were identified, of which 122,370 (27.7%) reported concomitant CKD. Patients with CKD had higher in-patient mortality (odds ratio [OR] 1.68, 95% confidence interval [CI], 1.17–1.68, p < 0.001), vascular complications (OR 1.31, 95% CI, 1.17–1.48, p < 0.001), acute kidney injury requiring hemodialysis (OR 3.17, 95% CI, 2.64–3.80, p < 0.001), and major bleeding (OR 1.12, 95% CI, 1.05–1.19, p < 0.001). Patients with CKD underwent minimally invasive endovascular therapy (31.08% vs. 36.73%, p < 0.0001) and invasive procedures (14.73% vs. 23.55%, p < 0.0001) less often. PAD-CLI with CKD was associated with major (20.54% vs. 16.17%, OR 1.04; p < 0.0001) and minor (26.87% vs. 19.53%, OR 1.2, p < 0.0001) amputations more often. Conclusion: Patients admitted for PAD-CLI with concomitant CKD have significantly higher in-hospital mortality as compared to patients without CKD. Moreover, patients with CKD and PAD-CLI are less likely to receive revascularization and more likely to undergo amputation.

Inpatient outcomes of NSTEMI among patients with immune thrombocytopenia: a propensity matched national study.

Patients with immune thrombocytopenia (ITP) admitted for non-ST elevation myocardial infarction (NSTEMI) present a unique therapeutic challenge due to the increased risk of bleeding with antiplatelet and anticoagulation therapies. There is limited evidence studying hospital mortality and complications in this population. The study included a patient cohort from the 2018-2021 National Inpatient Sample database. Propensity score matched NSTEMI patients with and without ITP using a 1:1 matching ratio. Outcomes analyzed were in-hospital mortality, rates of diagnostic angiogram, percutaneous coronary intervention (PCI), acute kidney injury (AKI), congestive heart failure (CHF), cardiogenic shock, cardiac arrest, mechanical ventilation, tracheal intubation, ventricular tachycardia (VT), ventricular fibrillation (VF), major bleeding, need for blood and platelet transfusion, length of stay (LOS), and total hospitalization charges. A total of 1,699,020 patients met inclusion criteria (660,490 females [39%], predominantly Caucasian 1,198,415 (70.5%); mean [SD] age 67, [3.1], including 2,615 (0.1%) patients with ITP. Following the propensity matching, 1,020 NSTEMI patients with and without ITP were matched. ITP patients had higher rates of inpatient mortality (aOR 1.98, 95% CI 1.11-3.50, p 0.02), cardiogenic shock, AKI, mechanical ventilation, tracheal intubation, red blood cells and platelet transfusions, longer LOS, and higher total hospitalization charges. The rates of diagnostic angiogram, PCI, CHF, VT, VF, and major bleeding were not different between the two groups. Patients with ITP demonstrated higher odds of in-hospital mortality for NSTEMI and need for platelet transfusion with no difference in rates of diagnostic angiogram or PCI.

Community Privilege and Unplanned Surgery for Access-Sensitive Surgical Conditions.

We sought to define the association of privilege on rates of unplanned surgery and perioperative outcomes for access-sensitive surgical conditions. Social determinants of health (SDOH) are critical in influencing timely access to healthcare. Privilege represents a right, benefit, advantage, or opportunity that positively influences all SDOH. The California Department of Health Care Access and Information (HCAI) database identified patients who underwent abdominal aortic aneurysm repair, ventral hernia repair, or colectomy for colon cancer between 2017 and 2020 and was merged using ZIP codes with the Index of Concentration of Extremes, a validated measure of racial and economic privilege obtained from the American Community Survey. Clustered multivariable regression was performed to assess the association between privilege and outcomes. Among 185,316 patients who underwent a surgical procedure for one of three access-sensitive surgical conditions, roughly 1 in 5 individuals resided in areas with the highest (Q5; n=37,308; 20.1%) or lowest (Q1; n=36,352, 19.6%) privilege. Nearly one-half of the surgeries were unplanned (n=88,814, 46.9%), and colectomy for colon cancer was the most performed emergent procedure. Patients residing in the lowest privileged areas had higher rates of unplanned surgery compared with those residing in the highest privilege (Q1; 55.4% vs. 39.4%; referent: Q5; adjusted odds ratio [OR], 1.23, 95%CI 1.16-1.31; P<0.001). For each access-sensitive surgical condition, patients in the least privileged areas were more likely to experience higher rates of inpatient mortality (Q1; 3.1% vs. 2.1%; referent: Q5; adjusted OR, 1.41, 95%CI 1.24-1.60; P<0.001), perioperative complications (Q1; 30.4% vs. Q5; 23.8%; referent: Q5; adjusted OR, 1.24, 95%CI 1.18-1.31; P<0.001) and extended hospital stays (Q1; 26.3% vs. 20.1%; referent: Q5; adjusted OR, 1.16, 95%CI 1.09-1.22; P<0.001). Privilege was associated with rates of unplanned surgery and adverse clinical outcomes. This indicates the role privilege as a key SDOH that influences patient access to and quality of surgical care.

Abstract Mo027: Impact of Ventricular Arrhythmias On Outcomes of Patients with Follicular Lymphoma

Background: Follicular lymphoma (FL) is typically a slow-growing form of non-Hodgkin lymphoma (NHL) that arises from B-lymphocytes. Large-scale studies are lacking for the outcomes of patients with ventricular arrhythmias and FL. We retrospectively reviewed FL patients with ventricular tachycardia utilizing the National Inpatient Sample (NIS) database. Our analysis aimed to identify risk factors that worsen outcomes in patients with FL and ventricular arrhythmias and evaluate the impact of ventricular arrhythmias on in-hospital outcomes of patients with FL. Methods: Data were extracted from the National Inpatient Sample (NIS) 2016-2019 Database. The NIS was searched for hospitalizations for adult patients with FL as the principal discharge diagnosis with and without ventricular arrhythmias as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis. Results: This study included 15,795 patients with FL of which 225 had ventricular arrhythmias. Patients with both FL and an associated ventricular arrhythmia had higher inpatient mortality (OR 5.44, CI 2.48-11.93, p&lt;0.0001), hospital length of stay (LOS) (+5.48 days, CI 3.27-7.68, p&lt;0.0001) and total hospital charges (TOTHCG) (+$109,117.3, CI $65,702.9- $152,531.7, p&lt;0.0001). In this patient population, the secondary analysis revealed that mortality was increased if patients had a cardiac arrest (OR 25.62, CI 1.36-484.48, p&lt;0.031). LOS was increased in the presence of an acute kidney injury (+0.34 days, 0.04-0.64, p&lt;0.026). Conclusions: Our study revealed that patients with FL and ventricular arrhythmias had increased mortality, hospital LOS, and TOTHCG, as well as much higher rates of complications, including cardiac arrest and acute kidney injury, compared to those without ventricular arrhythmias. Efforts to prevent, monitor, and aggressively manage ventricular arrhythmias in patients with FL will improve overall outcomes.

Relationships between sex and in-hospital outcomes of patients with acute cardiogenic shock receiving mechanical circulatory support

BackgroundCardiovascular disease is the leading cause of mortality in women. Despite this there is a paucity of data on the impact of sex on utilization and outcomes of temporary mechanical circulatory support (tMCS) in patients hospitalized with Acute Myocardial Infarction (AMI) Cardiogenic Shock (CS). MethodsWe examined the 2016–2019 National Inpatient Sample database to identify cases of AMI-CS. Men were used as our control group, while women comprised our cohort. The primary outcome was in-hospital mortality. Secondary outcomes included the use of tMCS including; left ventricular assist device (LVAD) use, Impella use, and Intra-Aortic Balloon Pump (IABP) use, length of stay (LOS) and total hospitalization cost (THC). Multivariate linear and logistic regression models were used to adjust for confounders. ResultsAmong patients hospitalized for AMI (N = 2,622,939), 37.7 % were Female. A Female sex was associated with a higher inpatient mortality (adjusted OR [aOR] 1.06, p < 0.001), a lower likelihood of LVAD use (2.3 % vs. 2.9 % and p < 0.001), IABP use (3.0 % vs. 4.4 % and p < 0.001), Impella use (1.0 % vs. 1.5 % and p < 0.001), a longer mean LOS (4.4 vs 4.3 days and p < 0.001) and lower THC ($88,097 vs. $104,101, p < 0.001) compared to male patients for AMI-CS. ConclusionFemale patients admitted for AMI-CS were less likely to receive tMCS despite a higher mortality rate and a slightly longer LOS compared to male patients. Further studies are necessary to confirm these findings and elucidate clearer causality for such disparities.

Unplanned 30-Day Readmissions After Hospitalization for Irritable Bowel Syndrome.

Background Irritable bowel syndrome (IBS) continues to posesignificant healthcare challengesdue to its broad differential diagnosis and the often extensive yet inconclusive workup. We investigated the rates and characteristics of unplanned 30-day readmissions in adult patients hospitalized with IBS. In addition, weidentified factors that predict readmission within 30 days of initial discharge. Methods We analyzed the 2020 Nationwide Readmission Database. Using the International Classification of Diseases, Tenth Revision, Clinical Modification code, we identified hospitalizations in adult patients with IBS. We excluded hospitalizations for minors and planned or elective readmissions. To compare baseline characteristics between readmissions and index hospitalizations, χ2 tests were employed. We used multivariate Cox regression analyses to identify independent predictors of readmissions. Results A total of 5,729 adult hospitalizations with IBS as the primary diagnosis were discharged alive, and 638(11.1%) readmissions occurred within 30 days. The most common diagnoses associated with readmission were noninfective gastroenteritis and colitis, sepsis, enterocolitis due to Clostridium difficile, and irritable bowel syndrome with or without diarrhea. Patients in readmissions had a mean age of 56.3 years, similar to index hospitalizations (54.5 years, p=0.093). Readmissions had a higher burden of comorbidity (Charlson comorbidity index (CMI) scores ≥3: 26.7%, 170 cases vs. 16.6%, 953 cases;p<0.001) and were mostly Medicare beneficiaries (49.5%, 316% vs. 44.9%, 2,578) compared with index hospitalizations. Readmissions had a longer mean length of stay (LOS) (5.2 vs. 3.6 days, p<0.0001), higher inpatient mortality (0.8%, 5% vs. 0.2%, 11; p=0.032), and higher mean hospital costs ($47,852 vs. $34,592; p<0.0001) compared with index admissions. Secondary diagnoses of ulcerative colitis (adjusted hazard ratio (AHR), 2.82; p<0.0001), interstitial cystitis (AHR, 5.37; p=0.007), peripheral vascular disease (AHR, 1.59; p=0.027), and discharge to short-term hospitals (AHR, 1.03; p<0.0001) were significantly associated with ahigher likelihood of readmission within 30 days. Conclusion IBS readmissions have poorer outcomes than index hospitalizations. Patients with an existing history of ulcerative colitis, interstitial cystitis, and peripheral vascular disease and those discharged to short-term hospitals following index hospitalization are more likely to be readmitted within 30 days.

Incidence and risk factors of blood transfusion after total knee arthroplasty: A retrospective nationwide inpatient sample database study

IntroductionCommon postoperative complications of total knee arthroplasty (TKA) include blood transfusion. Although risk factors and incidence of blood transfusion have been studied through national databases, the relative impact of each risk factor needs to be synthesized over a longer time period into a new model need to be revised. Material and methodsPatient data were extracted from the National Inpatient Sample (NIS), which is the largest hospital care database in the US, and analyse patient data retrospectively from 2010 through 2019. The final data included the patients undergoing TKA. The final analysis assessed the demographics of patients, type of insurance, type of hospital, length of stay (LOS), preoperative comorbidities, total charge, inpatient mortality, medical-surgical postoperative complications. ResultsAfter extracting data from the NIS database, a total of 1,250,533 patients with TKA were included in the analysis, and the rate of transfusion was 6.60 %. TKA patients who receive blood transfusion had longer LOS (from 2-3 days to 3–4 days), more preoperative comorbidities, higher inpatient mortality rate, and increased total charge (P < 0.001). Moreover, postoperative complications associated with inpatients included sepsis, acute myocardial infarction and shock. Elective admission and private insurance were also regarded as protective factors. ConclusionBlood transfusion could bring postoperative complications to patients, which were also linked to health costs and risks. It was also a common preoperative comorbidities for older patients who underwent TKA. Through better blood management strategies, we could reduce patient transfusion rates and improve clinical outcomes.Level of Evidence: Diagnostic Level Ⅲ.