Duration Of Hospitalization In Patients Research Articles

Does early granulocyte colony-stimulating factor administration in autologous peripheral blood stem cell transplantation shorten the duration of hospitalization in patients with multiple myeloma?

Aims: Autologous peripheral blood stem cell transplantation (PBSCT), performed with high-dose melphalan support following induction therapy is still the gold standard method of treatment for multipl myeloma (MM)patients suitable for transplantation. It was aimed, with this retrospective study, to investigate the effects of early (1 day after PBSCT) and late (5 days after PBSCT) initiation of granulocyte colony-stimulating factor (G-CSF) support following PBSCT on engraftment time, febrile neutropenia, and length of hospital stay (LOS) in MM patients. Methods: This study included 70 patients with MM, who underwent PBSCT in Erciyes University. Two groups were administered 5µg/kg filgrastim, subcutaneously, either 1 day or 5 days after PBSCT, until neutrophil engraftment was reached. Results: Both neutrophil and platelet engraftment occurred in significantly shorter times in the early G-CSF group compared to late G-CSF group; the median times to neutrophil engraftment were 10 (8-13) and 11 (7-15) days, respectively, and the median times to platelet engraftment were 11 (10- 16) and 13 (11- 21) days (p=0.001). Also, the median LOS was also significantly shorter in the early G-CSF group compared to late G-CSF group; 14 (10-22) vs 16 (11- 33) days, respectively (p=0.016). No significant difference was found between the groups in terms of frequency of febrile neutropenia. Conclusion: The initiation of G-CSF support early, following PBSCT in MM patients, accelerated neutrophil and platelet engraftment and shortened the LOS as compared to the initiation of G-CSF support late, with no significant difference in the frequency of febrile neutropenia.

Ensemble learning-assisted prediction of prolonged hospital length of stay after spine correction surgery: a multi-center cohort study

PurposeThis research aimed to develop a machine learning model to predict the potential risk of prolonged length of stay in hospital before operation, which can be used to strengthen patient management.MethodsPatients who underwent posterior spinal deformity surgery (PSDS) from eleven medical institutions in China between 2015 and 2022 were included. Detailed preoperative patient data, including demographics, medical history, comorbidities, preoperative laboratory results, and surgery details, were collected from their electronic medical records. The cohort was randomly divided into a training dataset and a validation dataset with a ratio of 70:30. Based on Boruta algorithm, nine different machine learning algorithms and a stack ensemble model were trained after hyperparameters tuning visualization and evaluated on the area under the receiver operating characteristic curve (AUROC), precision-recall curve, calibration, and decision curve analysis. Visualization of Shapley Additive exPlanations method finally contributed to explaining model prediction.ResultsOf the 162 included patients, the K Nearest Neighbors algorithm performed the best in the validation group compared with other machine learning models (yielding an AUROC of 0.8191 and PRAUC of 0.6175). The top five contributing variables were the preoperative hemoglobin, height, body mass index, age, and preoperative white blood cells. A web-based calculator was further developed to improve the predictive model's clinical operability.ConclusionsOur study established and validated a clinical predictive model for prolonged postoperative hospitalization duration in patients who underwent PSDS, which offered valuable prognostic information for preoperative planning and postoperative care for clinicians.Trial registration ClinicalTrials.gov identifier NCT05867732, retrospectively registered May 22, 2023, https://classic.clinicaltrials.gov/ct2/show/NCT05867732.

Intraoperative Prophylaxis with Palonosetron for Postoperative Nausea and/or Vomiting in Adults Undergoing Cardiothoracic Surgery Under General Anesthesia: A Single-Center Retrospective Study

This study assessed the efficacy of palonosetron, alone or with dexamethasone, in reducing postoperative nausea and/or vomiting (PONV) and its impact on hospitalization duration in patients who undergo adult cardiothoracic surgery (CTS) under general anesthesia. This retrospective analysis involved 540 adult patients who underwent CTS from a single-center cohort, spanning surgeries between September 2021 and March 2023. Sensitivity, logistic, and Cox regression analyses evaluated antiemetic effects, PONV risk factors, and outcomes. At the Virginia Mason Medical Center (VMMC), Seattle, WA. Adults undergoing cardiothoracic surgery at VMMC during the specified period. Patients were categorized into the following 4 groups based on antiemetic treatment: dexamethasone, palonosetron, dexamethasone with palonosetron, and no antiemetic. Primary outcomes encompassed PONV incidence within 96 hours postoperatively. Secondary outcomes included intensive care unit stay duration and postoperative opioid use. Palonosetron recipients showed a significantly lower PONV rate of 42% (v controls at 63%). The dexamethasone and palonosetron combined group also demonstrated a lower rate of 40%. Sensitivity analysis revealed a notably lower 0- to 12-hour PONV rate for palonosetron recipients (9% v control at 28%). Logistic regression found decreased PONV risk (palonosetron odds ratio [OR]: 0.24; dexamethasone and palonosetron OR: 0.26). Cox regression identified varying PONV hazard ratios related to female sex, PONV history, and lower body mass index. This single-center retrospective study underscored palonosetron's efficacy, alone or combined with dexamethasone, in managing PONV among adult patients who undergo CTS. These findings contribute to evolving antiemetic strategies in cardiothoracic surgery, potentially impacting patient outcomes and satisfaction positively.

Coronavirus infection after blood stem cell transplantation

Background. In March 2020, oncohematologists faced the problem of severe COVID-19 coronavirus infection in patients after a high-dose chemotherapy and autologous or allogeneic bone marrow transplantation. This required a review of issues related to the selection of patients for blood stem cell transplantation (HSCT), the development of new preventive and therapeutic tactics aimed at treating infectious and immunological complications in patients of this category, depending on the nature and status of the underlying disease and the timing of treatment.Aim. To assess the severity, most typical complications and course of COVID-19 in patients during early and late posttransplant periods.Materials and methods. We analyzed the data of patients after HSCT with active coronavirus infection hospitalized in the hematology department from 2020 to 2021. A total of 25 patients were hospitalized: 4 after allogeneic transplantation, 21 after autologous transplantation. According to the timing of HSCT, patients were divided into 2 groups: early period (ETP) (2-90 days after HSCT) - 14 patients, late period (LTP) (3-24 months after HSCT) - 11 patients.Results. Severe coronavirus infection (grades III-IV according to computed tomography) was more often observed in patients in the ETP group (65 %) than in the LTP group (18 %). The incidence of respiratory failure was 70 and 36 % in the ETP and LTP groups, respectively. In the ETP group, agranulocytosis and the development of severe infectious complications (bacterial, fungal and viral) were observed significantly more often than in the LTP group, which required the appointment of reserve groups antibacterial therapy and antifungal therapy. Mortality in the ETP group was 35 %, while no deaths were recorded in the LTP group. The median duration of hospitalization for patients in the ETP and LTP groups was 20 and 13 days, respectively.Conclusion. Patients early after HSCT are at higher risk of developing lower respiratory tract infections, are more likely to require hospitalization in the intensive care unit, and have a greater risk of death from COVID-19. Therapy with genetically engineered biological drugs is not contraindicated in the case of leukopenia and agranulocytosis in this group of patients.

A retrospective analysis of the clinical efficacy of pancreatic duct stent implantation in the management of acute biliary pancreatitis requiring ERCP

BackgroundThis study aimed to investigate the feasibility, effectiveness, and safety of pancreatic duct stenting in managing acute biliary pancreatitis (ABP) necessitating endoscopic retrograde cholangiopancreatography (ERCP). It further aimed to provide valuable insights for subsequent clinical diagnosis and treatment.MethodsThis research employs an observational retrospective case–control study design, encompassing patients with ABP who underwent ERCP at the hepatobiliary surgery department of the General Hospital of Ningxia Medical University between August 1, 2018, and December 31, 2020. A total of 229 cases were screened based on inclusion and exclusion criteria. Regardless of ABP severity, patients were categorized into the stent group (141) and the non-stent group (88). Changes in blood amylase (Amy), lipase (LIP), leukocyte count (WBC), total bilirubin (TBIL), alanine aminotransferase (ALT), hematocrit (HCT), and creatinine (CR) were compared between the two groups. Moreover, variables such as recovery time for oral feeding, hospitalization duration, hospitalization costs, local complications, systemic complications, and new organ failure were recorded to assess the therapeutic effect of pancreatic duct stenting.ResultsNo significant differences were observed in gender, age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, ABP severity grade, organ failure (OF), cholangitis, or biliary obstruction between the pancreatic stent and non-stent groups (P > 0.05). There was no significant difference in the incidence of complications related to acute pancreatitis between the two groups (P > 0.05). The median fasting and hospitalization times of patients in the stent group were significantly shorter than those in the non-stent group (P < 0.05). No significant differences between the groups were observed in hospitalization costs and in-hospital mortality (P > 0.05). There were no significant variations in white blood cell (WBC) count, TBIL, ALT, and creatinine (Cr) at admission, 72 h, and in the differences between the two groups (P > 0.05). The levels of Amy at admission and 72 h in the stent group were significantly higher than those in the non-stent group (P < 0.05). The differences in LIP and HCT in the stent group were considerably higher than in the non-stent group (P < 0.05). Although no significant differences were observed in mean Amy and LIP between the two groups (P > 0.05), the mean 72-h HCT in the stent group was 38.39% (95% confidence interval [CI] 37.82%–38.96%) was lower than that in the non-stent group (39.44%, 95% CI 38.70–40.17%) (P < 0.05).ConclusionIn the stent group, feeding time and hospital stay were significantly shorter than those in the non-stent group. No significant differences were observed between the two groups in the incidence of complications and mortality. The HCT value decreased more rapidly in the stent group. Early pancreatic stent implantation demonstrated the potential to shorten the eating and hospitalization duration of patients with ABP, facilitating their prompt recovery.Trial Registration: This study was registered as a single-center, retrospective case series (ChiCTR1800019734) at chictr.org.cn.

Vitamin D Deficiency in COVID-19 Patients and Role of Calcifediol Supplementation.

Hypovitaminosis D has been associated with worse outcome in respiratory tract infections, with conflicting opinions regarding its role in Coronavirus-19 disease (COVID-19). Our study aimed to evaluate the possible relationship between 25-OH vitamin D (25OHD) values and the following conditions in patients hospitalized for COVID-19: prognosis, mortality, invasive (IV) and non-invasive (NIV) mechanical ventilation, and orotracheal intubation (OTI). A further objective was the analysis of a possible positive effect of supplementation with calcifediol on COVID-19 severity and prognosis. We analyzed 288 patients hospitalized at the San Giovanni di Dio Hospital in Florence and the Santa Maria alle Scotte Hospital in Siena, from November 2020 to February 2021. The 25OHD levels correlated positively with the partial pressure of oxygen and FiO2 (PaO2/FiO2) ratio (r = 0.17; p < 0.05). Furthermore, when we analyzed the patients according to the type of respiratory support, we found that 25OHD levels were markedly reduced in patients who underwent non-invasive ventilation and orotracheal intubation (OTI). The evaluation of the length of hospitalization in our population evidenced a longer duration of hospitalization in patients with severe 25OHD deficiency (<10 ng/mL). Moreover, we found a statistically significant difference in the mortality rate between patients who had 25OHD levels below 10 ng/mL and those with levels above this threshold in the total population (50.8% vs. 25.5%, p = 0.005), as well as between patients with 25OHD levels below 20 ng/mL and those with levels above that threshold (38.4% vs. 24.6%, p = 0.04). Moreover, COVID-19 patients supplemented with calcifediol presented a significantly reduced length of hospitalization (p < 0.05). Interestingly, when we analyzed the possible effects of calcifediol on mortality rate in patients with COVID-19, we found that the percentage of deaths was significantly higher in patients who did not receive any supplementation than in those who were treated with calcifediol (p < 0.05) In conclusion, we have demonstrated with our study the best prognosis of COVID-19 patients with adequate vitamin D levels and patients treated with calcifediol supplementation.

Association of the risk of obstructive sleep apnoea with the severity of COVID-19.

Patients with coronavirus 2019 (COVID-19) and obstructive sleep apnoea (OSA) have a worse prognosis than COVID-19 patients without OSA. This study aimed to examine the relationship between OSA risk and the severity of COVID-19 in patients undiagnosed with OSA. Patients diagnosed with COVID-19 and hospitalized or admitted to a community hotel were recruited for the study after recovery during a clinic check-up visit 6-8 weeks after discharge. At this visit, they answered the Epworth Sleeping Scale (ESS) and Berlin questionnaire. Demographic and clinical details were collected from electronic medical records. OSA risk was observed in 37 of 119 included patients (31.1%). Patients with high OSA risk were male, significantly older, had a higher body mass index (BMI), and had higher rates of hypertension and snoring than patients with low OSA risk. Moreover, OSA risk was associated with COVID-19 severity; 48.6% of patients with high risk for OSA suffered from severe COVID-19 compared to 22% of patients with low risk for OSA (p = 0.007). The duration of hospitalization for patients with a high OSA risk was 10.97±9.43 days, while that for those with a low OSA risk was 4.71±6.86 days (p = 0.001). After adjusting for BMI, age, hypertension, and chronic disease, the odds ratio was 4.3 (95%CI, 1.2-16, p = 0.029). A high OSA risk was associated with severe COVID-19 and longer hospitalization. Thus, we recommend that the Berlin and ESS questionnaires be completed for every COVID-19-infected patient at hospitalization, especially in the presence of comorbidities.

Factors associated with COVID-19 length of hospitalization and mortality during four epidemic waves, March 2020-November 2021, Suriname.

To determine the sociodemographic risk factors associated with coronavirus disease 2019 (COVID-19) mortality in Suriname. This was a retrospective cohort study. All registered deaths from COVID-19 in Suriname (n=1112) between March 13, 2020 and November 11, 2021 were included. Data were collected from medical records and included demographic variables and hospitalization duration of patients who died. Descriptive statistics, chi-squared tests, ANOVA models, and logistic regression analyses were used to determine associations between sociodemographic variables, length of hospitalization, and mortality during four epidemic waves. The case fatality rate over the study period was 22 per 1 000 population. The first epidemic wave was from July to August 2020, the second from December 2020 to January 2021, the third from May to June 2021, and the fourth from August to September 2021. Significant differences were found in the number of deaths and hospitalization duration by wave (p<0.001). Patients were more likely to have a longer hospitalization during the first (OR 1.66; 95% CI: 0.98, 2.82) and third waves (OR 2.37; 95% CI: 1.71, 3.28) compared with the fourth wave. Significant differences in mortality were also seen between ethnicities by wave (p=0.010). Compared with the mixed and other group, people of Creole ethnicity (OR 2.7; 95% CI: 1.33, 5.29) and Tribal people (OR 2.8; 95% CI: 1.12, 7.02) were more likely to die during the fourth wave than the third wave. Tailored interventions are needed for males, people of Creole descent, Tribal and Indigenous peoples, and people older than 65 years.

Association between the beta-blockers, calcium channel blockers, all-cause mortality and length of hospitalization in patients with heart failure with preserved ejection fraction: A meta-analysis of randomized controlled trials.

To establish an association between beta-blockers (BBs), calcium channel blockers (CCBs), all-cause mortality, and hospitalization in patients with Heart failure with preserved Ejection Fraction (HFpEF). The present meta-analysis has been performed as per the guidelines of (PRISMA). An inclusive literature search was made without any limitations on language using the electronic databases Cochrane Library, EMBASE, and PubMed up to November 2022. The outcomes evaluated in this meta-analysis involved all-cause mortality and hospitalization due to heart failure. The number of patients with HFpEF and their positive outcomes was extracted and analyzed using RevMan software. In total, 10 articles were included in the present meta-analysis, with a pooled sample size of 12 940 HFpEF patients. In comparison with placebo, both BB and CCB substantially reduced the risk of all-cause mortality and hospitalization. However, BB are more effective because they provide a significant reduction in all-cause mortality (risk ratio (RR) = 0.60; 95% confidence interval [CI] = 0.43-0.83; p = .002] and hospitalization (RR = 0.54; 95% CI = 0.37-0.80; p = .002) as compared with CCB with a risk ratio of all-cause mortality (RR = 0.77; 95% CI = 0.60-0.98; p = .03) and hospitalization (RR = 0.63; 95% CI = 0.44-0.90; p < .00001). A random-effects model was used because of high heterogeneity between the studies (I2 > 70%). The current meta-analysis suggests that BBs were more beneficial than CCB in reducing all-cause mortality and hospitalization duration in patients with HFpEF.

Real-world duration of hospitalization for CAR-T treatment: U.S. patient experience in multiple hematologic malignancies.

e18896 Background: Since 2017, 6 CAR-t therapies have been approved to treat pediatric and adult hematologic malignancies (HM). Due to the complexity of administration and severe toxicity including cytokine release syndrome (CRS), CAR-t is usually administered in an inpatient setting. We sought to provide the first pan-cancer, U.S. based analysis of duration of hospitalization during CAR-t overall and for patients who experience CRS. Methods: Patients were identified from a large, US based EMR database including more &gt;40M patients, &gt;500 hospitals and 30 healthcare systems including both community/academic health systems. Patients with ≥1 procedure code for general administration of CAR-t therapy (e.g.: XW033C3, introduction of engineered autologous chimeric antigen receptor t-cell immunotherapy into peripheral vein) or a specific approved CAR-T (XW033K7, introduction of idecabtagene vicleucel immunotherapy into peripheral vein) between 2017 and 2022 and a diagnosis of a HM were selected. CRS was identified as the presence of any ICD-10 diagnosis code of D89.83X post-administration. Time from the date of CAR-t administration to hospital discharge was calculated overall, by cancer type, and for patients with and without a confirmed diagnosis of CRS. Results: A total of 212 patients (multiple myeloma [MM] = 64, b-cell lymphoma = 77, follicular lymphoma = 47, mantle cell lymphoma [MCL] = 13, acute lymphoblastic leukemia = 11) meeting selection criteria were identified. Cohort characteristics are shown in Table 1. Median duration of hospitalization was 12 days (range 1-56); shortest at 10 days for MM and longest at 15 days for MCL. Mean duration of hospitalization decreased slightly from 12.3 days (sd = 11) for patients treated in 2019 or earlier to 11.9 days (sd = 4.2) for patients treated in 2022 Median duration of hospitalization for patients with a CRS diagnosis (n = 100) was 12 (range 1-30) versus 11 days (range 1-56) for those without CRS (n = 112). Conclusions: CAR-t poses a unique set of administrative, logistical and clinical challenges. This study provides the first contemporaneous estimates of the length of hospital stays during CAR-t infusion which was found to be 12 days. Differences in length of hospitalizations did not decline significantly over time or were significantly different between those with and without CRS however further research to examine health system factors and patient factors (i.e., severity of CRS) are needed. [Table: see text]

Evaluation of the Incidence of Pharyngocutaneous Fistula after Total Laryngectomy.

Laryngeal squamous cell carcinoma is one of the most critical head and neck cancers. Total laryngectomy is one of the main options for treating laryngeal squamous cell carcinoma responsible for forming pharyngocutaneous fistula (PCF), which increases morbidity and mortality. This study aimed to determine PCF incidence and identify the factors associated with this complication. In a retrospective cohort study, 85 patients who underwent total laryngectomy at Imam Khomeini Hospital (Tehran, Iran) from 2011 to 2019 were selected as the study population. The presence/absence of PCF, weight, anemia status (Hb <12.5 g/dl), renal dysfunction status (GFR <90 mL/min/1.73m2), malnutrition status (Albumin <3.5 g/dl), and marginal involvement status was extracted from postoperative medical records. The data were analyzed using SPSS ver. 26.0. The overall incidence of PCF was 11.8%. The mean ±SD of the duration of hospitalization in patients with PCF was 32.40 ±14.75 days, and in patients without PCF was 16.89 ±7.05 days (P = 0.009). The mean ±SD of time to develop a fistula was 7.4 ±3.74 days. The statuses of anemia, malnutrition, renal dysfunction, surgical margin, history of radiotherapy, pharynx closure, gender, and age were unrelated to the incidence of PCF. Further studies with a larger sample size are recommended.

ВЛИЯНИЕ ПОКАЗАТЕЛЕЙ ВДЫХАЕМОГО ВОЗДУХА НА ТЕЧЕНИЕ БРОНХООБСТРУКТИВНОГО СИНДРОМА У ДЕТЕЙ

Recent studies have made it possible to establish diverse pathogenetic mechanisms involved in the development of broncho-obstructive syndrome in children. Nevertheless, the role of microclimate indicators in the pathogenesis of the disease is still not fully understood. The purpose of this research was to assess the effect of inhaled air properties on the course of broncho-obstructive syndrome in children. 100 patients with acute obstructive bronchitis were examined, who were divided into 2 groups of 50/each depending on the use of Air Purifier by GREE Electric Appliances, Inc. (China). There was a decrease in the concentrations of PM2.5 particles, PM10 was 3.5 and 4 times lower in patients in whose wards the hardware air purification was carried out compared to the patients without the use of air purification (P&lt;0.001). The level of Formaldehyde (CH2O) and volatile organic compounds (TVOCs) in the air was also significantly lower: by 1.9 and 1.8 times, respectively, in the air of the wards of patients who underwent air purification (P&lt;0.001). The air quality index (AQI) was reduced almost trice the average value of which was observed in the favorable zone (&lt;25), which was significantly less compared to G2 patients (P&lt;0.001). As a result of improved indicators of inhaled air, the recovery of patients was accelerated, therefore the normalization of the general condition, elimination of respiratory failure, reduction of cough and hospitalization duration in patients of G1 had been achieved faster compared to the patients of G2 (P&lt;0.01). Thus, the conducted study showed high prospects in studying of the positive effect of optimal microclimate on the course of acute obstructive bronchitis. Keywords: broncho-obstructive syndrome, children, acute obstructive bronchitis, microclimate, air purification, repeated episodes, prevention.

Inflammatory Markers as Predictors for Prolonged Duration of Hospitalization in Maxillofacial Infections.

Despite the progress made in diagnosing and treating maxillofacial infections, the course of infection can be unpredictable, leading to severe complications, prolonged hospitalization, and substantial financial costs to health care services. It is important to determine whether various serum inflammatory marker levels on admission may predict a prolonged hospital stay in these patients. To analyze the role of CRP, white blood cell count (WBC), and neutrophil-to-lymphocyte ratio (NLR) in predicting the prolonged duration of hospitalization in maxillofacial infections, we performed a retrospective study by collecting paper records data from 108 patients who met our inclusion criteria. The patients were divided into two groups according to the duration of hospitalization (group A < 5 days and group B ≥ 5 days). The predictor variables were CRP, WBC, and NLR, and the outcome variable was the duration of hospitalization. This study confirmed a positive linear correlation (p < 0.001) between the predictors and the outcome variable. The optimal cut-off values for WBC are 11,030 white blood cells/μL and 63 mg/L for CRP. Levels that exceed these optimal values predict a duration of hospitalization of over (≥) 5 days. Serum WBC and CRP on admission may predict the duration of hospitalization in patients with MFI.

1797. Evaluation of Intravenous vs Oral Antibiotic Therapy at Discharge for the Treatment of Urinary Source Gram-Negative Bacteremia

Abstract Background Retrospective studies demonstrate similar efficacy between oral (PO) and intravenous (IV) antibiotics at discharge for gram negative bacteremia (GNB), with reduced duration of hospitalization, hospital costs, and duration of therapy with PO. Understanding current physician discharge practices can help guide future antimicrobial stewardship initiatives. Methods A multicenter, retrospective cohort study was conducted on adult inpatients admitted between July 1, 2020 and June 30, 2021 with urinary source GNB. Patients with both blood and urine cultures positive for Escherichia coli, Klebsiella species, or Proteus mirabilis and a PO antibiotic available at discharge were included. The primary outcome was the percentage of patients discharged on PO antibiotics. Secondary outcomes included duration of hospitalization, total length of therapy, and 30-day readmission secondary to clinical failure or therapeutic complication in the IV and PO at discharge groups. Results Of the 157 included patients, 128 (82%) were discharged on PO antibiotics. Patients discharged on IV and PO had similar median quick Pitt bacteremia scores [1(IQR, 0 – 2) vs. 1 (IQR, 0 – 1), p=0.420]. Mean duration of hospitalization for patients discharged on IV vs. PO therapy was 5 (SD, 2.91) days vs. 4 (SD, 2.75) days, p=0.001, respectively. Mean total length of antibiotic therapy was 21.6 (SD, 13.80) days as compared to 13.5 (SD, 4.94) days, p=0.017, for the IV vs. PO arms, respectively. Thirty–day readmission rates were 11/29 (38%) and 23/128 (18%), p=0.035, in the IV and PO arms, respectively. Notably, 21/29 (72%) of the IV arm had an organism from blood culture that was susceptible to trimethoprim-sulfamethoxazole (TMP-SMX). Conclusion Most patients with urinary source GNB were discharged on PO antibiotics. Patients discharged on IV antibiotics were more likely to be readmitted within 30 days. Future efforts to decrease IV antibiotic use may focus on increasing TMP-SMX use at discharge. Disclosures Matthew Song, PharmD, BCIDP, Merck: Stocks/Bonds|ObsEva: Stocks/Bonds.

SGLT 2 Inhibitors and Hypertension: Mild but Effective. What can we expect ?

Sodium-glucose co-transporter-2 (SGLT2) inhibitors are a new class of medications used for the treatment of diabetes mellitus (DM). It has been shown that, in addition to a favorable metabolic effect, they significantly reduce atherosclerotic events, cardiovascular and total mortality, hospitalization duration in patients with heart failure and have a significant effect on reducing the progression of chronic kidney disease. It has been observed that in patients with diabetes mellitus, they lead to a reduction of blood pressure (BP). The aim of this article is to evaluate current knowledge about mechanisms of antihypertensive action and clinical benefits of SGLT2 inhibitors in reducing arterial blood pressure in patients with diabetes mellitus and arterial hypertension.

Abstract 13644: Hospitalization Outcomes for Patients With Heart Failure With Reduced Ejection Fraction and Iron Deficiency: Analysis of National Inpatient Sample

Introduction: Iron deficiency (ID) is associated with worse exercise tolerance in patients with HFrEF regardless of hemoglobin level. Intravenous iron replacement in these patients increases functional capacity, improves quality of life, and reduces recurrent hospitalizations. We examined a large inpatient database to explore the relationship between ID without anemia and outcomes in HFrEF patients. Methods: We queried the National Inpatient Sample (2016-2018) for adults with HFrEF as the principal diagnosis and ID as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes were length of stay, total hospital charges, combined supraventricular and ventricular tachycardia, and cardioversion. STATA software was used for analysis. Multivariate logistic and linear regression analyses were used accordingly to compare groups while adjusting for confounders. Results: Of 446,539 patients hospitalized with HFrEF, 0.16% had concomitant ID without anemia. There was no difference in mortality in HFrEF patients with ID compared to those without ID (2.8% vs 2.9%; aOR 0.97; p=0.94). Length of stay was significantly higher (8.0 vs 5.4 days; CI 0.46-4.5; p=0.02) and there was a non-significant increase in hospital charges ($80,292 vs $57,072; CI -$3,043-$39,821; p=0.09) for HFrEF patients with ID. Tachycardia occurred more frequently in HFrEF patients with ID (18.8% vs 10.3%; aOR 1.93; p=0.004), but there was no significant difference in cardioversion (1.39% vs 1.68%; aOR 0.82; p=0.78). Conclusions: We did not find an association between ID and inpatient mortality in HFrEF patients. Symptomatic improvement is an important factor for determining time of discharge in patients admitted for HFrEF and our analysis demonstrates significantly longer hospitalization in patients with ID. Further studies may elaborate on the effect of iron replacement on duration of hospitalization for patients admitted with HFrEF.

Use of ureteral catheter in uterine-sparing surgery for placenta accreta

Objective: The study aimed to investigate the effect of ureteral catheter use during surgery on the outcomes of obstetric and urinary complications in patients with placenta accreta spectrum (PAS) and placenta previa. Methods: The patients who were followed up at Meram Medical Faculty Hospital of Necmettin Erbakan University between January 2016 and November 2021 and diagnosed with PAS and placenta previa were included. Patients who underwent emergency and planned surgery were grouped as those with or without an intraoperative ureteral catheter. The primary outcome was determined as the rate of urinary system damage among these groups. The number of blood transfusions, preoperative and postoperative hemoglobin values and hemoglobin changes, length of hospitalization, patients who underwent uterine-sparing surgery or hysterectomy, urinary tract injury, and wound infection were compared regarding the use of catheters. Results: A total of 122 patients were included in the study. While an intraoperative ureteral catheter was placed in 56 (45.01%) patients, it was not used in 66 (54.09%) patients. Bladder injuries were determined in 31 (55.4%) patients with a catheter and 13 (19.7%) patients without a catheter, and no other urinary system injuries were found. The incidence of bladder injury was statistically significantly higher in the group with a catheter (p=0.001). The number of transfused erythrocyte suspensions, the hemoglobin change according to the preoperative hemoglobin level, and the mean duration of hospitalization in patients with a catheter were statistically significantly greater than the group without a catheter (p=0.001). Conclusion: Ureteral catheterization did not reduce urinary damage in patients with PAS and placenta previa who underwent uterine-sparing surgery and hysterectomy. However, we believe that the insertion of a catheter increases the possibility of diagnosing intraoperative damage.

PB2272: THERAPY AND HOSPITAL MORTALITY PREDICTORS IN HEMATOLOGICAL PATIENTS WITH 4 GRADE NEUTROPENIA AND CONCOMITANT CORONAVIRUS INFECTION

Background: According to published data, cancer patients are 5 times more likely to contract coronavirus infection (COVID-19) than non-cancer patients. Aims: To assess and identify predictors of hospital mortality in hematological patients with grade 4 neutropenia and concomitant coronavirus infection. Methods: A prospective study included 130 patients (55% women, 45% men) aged 18 to 91 years (median 59) with acute leukemia (AL) and lymphoproliferative diseases (LPD) who had grade 4 neutropenia and coronavirus infection (COVID-19) and were observed from April 2020 to December 2021 at Moscow City Clinical Hospital 52 (Russia). The study also included a reference group of 130 patients matched by sex, age and diagnosis, with AL/LPD and COVID-19, but without grade 4 neutropenia. The statistical analysis was an intention to treat analysis with adjustment for false discovery rate. Results: AML prevailed in the AL group (80.6%), aggressive non-Hodgkin’s lymphomas in the LPD group. Distribution by disease status: 62 patients (47.7%) on chemotherapy (CT), 19 (14.6%) in remission, 23 (17.8%) with disease progression, 19 (14.6%) with newly diagnosed disease, 7 (5.3%) with a relapse. The patients had a high NEWS score (7.5) and a high Charlson comorbidity index (5). The majority had moderate or severe lung tissue damage (CT2 in 44 (33%), CT3 in 25 (20%), CT4 in 13 (10%)). There were increases in the levels of C-reactive protein (> 100 g/L in 55% of patients, mean 241.5 g/L), LDH (506 U/L), D-dimer (1866), procalcitonin (> 0.5 ng/mL in 73%). IL-6 and IL-1b blockers were used for hypercytokinemia; the dose of IL blockers was reduced in view of grade 4 neutropenia. Empiric antibiotic therapy for complications was used in 91.5% of patients. Antifungal therapy was carried out in 65% of cases. Sepsis developed in 63 (48.5%) patients. The median duration of hospitalization in patients with grade 4 neutropenia was 18 days. Transfer to the ICU was required in 78 (60%) patients in the total group and in 41 patients (52.5%) among those older than 60 years. Mortality in ICU patients: 80.7%, mortality in patients older than 60 years: 92.7%. In non-ICU patients with AL and LPD younger than 60 years, the mortality rate was 0%. Mechanical ventilation was used in 48.5% of cases. Mortality was lower in vaccinated patients than in unvaccinated ones (40% vs 51%). The mortality rates in the main group (AL 48.6%, LPD 51.7%, Fig. 1) and the reference group (AL 37.5%, LPD 13.8%, Fig. 2) showed that the presence of grade 4 neutropenia increased the risk of death almost twofold: the relative risk was 1.9 (95% CI 1.3–2.6), p=0.0001. According to the results of multivariate analysis (logistic regression), the predictors of hospital mortality in the main group were ICU stay (odds ratio 12.1 (1.4–24.0), p=0.0001), sepsis (3.0 (1.1–7.7), p=0.001), and age > 65 (3.0 (0.9–7.5), p=0.001). Severe disease progression/relapse is also a predictor of mortality (close to statistical significance). Image:Summary/Conclusion: Coronavirus infection with severe neutropenia (caused by tumor progression and/or combination chemotherapy) is a significant adverse factor of hospital mortality in patients with hematological cancers. Predictors of hospital mortality are age over 60 years, sepsis, ICU stay, and the absence of remission.

The Prognostic Performance of Ferritin in Patients with Acute Myocardial Infarction: A Systematic Review.

The potential benefit of ferritin evaluation resides in its association with adverse outcomes in patients with various pathological conditions. We aimed to conduct the first systematic review evaluating the association between ferritin levels and adverse cardiovascular outcomes in patients with acute myocardial infarction (AMI) during short- or long-term follow-up. Seven studies investigating various endpoints (mortality, major adverse cardiovascular events-MACE, the decline of the left ventricular ejection fraction-LVEF, left ventricular aneurysm development-LVA) were included. AMI patients with low or increased ferritin values tended to have higher in-hospital and 30-day mortality rates. Low and high ferritin levels and chronic kidney disease were independently associated with increased risk of LVA formation. High ferritin concentrations were linked to an accentuated LVEF decline in ST-elevation myocardial infarction patients treated by percutaneous coronary intervention. Both low and high ferritin values were also associated with the duration of hospitalization in patients with AMI during hospital stay and at more extended follow-up. Ferritin evaluation represents a simple investigation that could identify high-risk patients with AMI who might benefit from closer monitoring and specific therapeutic interventions. These data should be confirmed in large trials in the context of currently available therapies for heart failure and AMI.

Abstract TP128: Do All Intracerebral Hemorrhage Need Intensive Care Unit Admission. The Influence Of Hospital Level Of Care

Background: Admission to intensive care unit has been the standard of care in many institutions. Level of care in intracerebral hemorrhage patients play an increasingly important role in outcome, but this relationship between level of care and outcome is unclear. Objective: To evaluate the outcomes of intracerebral patients admitted directly to step down unit. Methods: A single center review was performed when selected intracerebral hemorrhage patients were directly admitted to step down unit. The step down unit provided nursing evaluation every 04 hours without management of mechanical ventilation or intravenous infusions that required titration at hourly intervals or more frequently. Need for intubation, length of stay, and discharge disposition was evaluated. Results: A total of 84 (33.6%) patients among 250 patients with intracerebral hemorrhage were admitted to step down unit. Patients admitted to step down unit had higher admission Glasgow coma scale (median 13.7 versus 9.9, p=&lt;.0001) and were less likely to have hematoma volumes =&gt;30 cc (6% versus 53%, p=&lt;.0001) or intraventricular hemorrhage (16.3% versus 61%, p&lt;.0001). A total of 4 (4.8%) of 84 patients admitted to step down unit required intubation/ mechanical ventilation. The mean duration of hospitalization was significantly lower among patients admitted to step down unit compared with intensive care unit (5.6±5.7 versus 11.9±12.5 days, p &lt;.0001). The proportion of patients who were discharged home was significantly higher among those admitted to step down unit (45.2% versus 10.2%, p &lt;.0001). Conclusion: One third of the patients with intracerebral hemorrhage may not require intensive care unit admission. Step down unit admission may reduce the duration of hospitalization in patients with intracerebral hemorrhage.