Hospitalization For Other Causes Research Articles

The impacts of COVID-19 hospitalizations on non-COVID-19 deaths and hospitalizations: A panel data analysis using Brazilian municipalities.

The COVID-19 pandemic in Brazil has brought many challenges, particularly regarding the management of hospital capacity, and a new demand for healthcare that added to the preexisting demands, such as neoplasms, cardiovascular diseases and births. In this paper, we estimate the impact of the pandemic on the number of deaths and hospitalizations for other diseases. We construct a monthly panel data of deaths and hospitalizations for various causes by the municipality of residence and relate them to COVID-19 hospitalizations using regression models that control for municipalities fixed-effects and interactions between State and month fixed-effects. The standard errors are clustered at the municipality level. Our estimates imply that 100 more hospitalizations by COVID-19 is associated with a drop of 49 non-COVID-19 hospitalizations and an additional four deaths for other reasons (all measured per 100,000 pop.). The impact of intensive care units COVID-19 hospitalizations on mortality is larger. The groups most affected are the African Brazilians, less-educated and the elderly. Additional deaths occurred both at households and at hospitals. The main causes of additional deaths were diseases related to the circulatory and endocrine system. The decline in hospitalizations for other causes seems to be related to the overcrowding of hospitals in periods of surge in the COVID-19, alongside with the fall in the demand for care by the citizens who were afraid of COVID-19 infection. These mechanisms affected more strongly the vulnerable groups of the population. Our results highlight the importance of promoting the awareness of heightened risk of non-communicable chronic diseases during a health emergency context. This should be done preferably through already established channels with community outreach, such as the Family Health Program in Brazil.

Pediatric Hospitalizations and ICU Admissions Due to COVID-19 and Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 in England

Investigating how the risk of serious illness after SARS-CoV-2 infection in children and adolescents has changed as new variants have emerged is essential to inform public health interventions and clinical guidance. To examine risk factors associated with hospitalization for COVID-19 or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) among children and adolescents during the first 2 years of the COVID-19 pandemic and change in risk factors over time. This population-level analysis of hospitalizations after SARS-CoV-2 infection in England among children and adolescents aged 0 to 17 years was conducted from February 1, 2020, to January 31, 2022. National data on hospital activity were linked with data on SARS-CoV-2 testing, SARS-CoV-2 vaccination, pediatric intensive care unit (PICU) admissions, and mortality. Children and adolescents hospitalized with COVID-19 or PIMS-TS during this time were included. Maternal, elective, and injury-related hospitalizations were excluded. Previous medical comorbidities, sociodemographic factors, and timing of hospitalization when different SARS-CoV-2 variants (ie, wild type, Alpha, Delta, and Omicron) were dominant in England. PICU admission and death within 28 days of hospitalization with COVID-19 or PIMS-TS. A total of 10 540 hospitalizations due to COVID-19 and 997 due to PIMS-TS were identified within 1 125 010 emergency hospitalizations for other causes. The number of hospitalizations due to COVID-19 and PIMS-TS per new SARS-CoV-2 infections in England declined during the second year of the COVID-19 pandemic. Among 10 540 hospitalized children and adolescents, 448 (4.3%) required PICU admission due to COVID-19, declining from 162 of 1635 (9.9%) with wild type, 98 of 1616 (6.1%) with Alpha, and 129 of 3789 (3.4%) with Delta to 59 of 3500 (1.7%) with Omicron. Forty-eight children and adolescents died within 28 days of hospitalization due to COVID-19, and no children died of PIMS-TS (PIMS-S data were limited to November 2020 onward). Risk of severe COVID-19 in children and adolescents was associated with medical comorbidities and neurodisability regardless of SARS-CoV-2 variant. Results were similar when children and adolescents with prior SARS-CoV-2 exposure or vaccination were excluded. In this study of data across the first 2 years of the COVID-19 pandemic, risk of severe disease from SARS-CoV-2 infection in children and adolescents in England remained low. Children and adolescents with multiple medical problems, particularly neurodisability, were at increased risk and should be central to public health measures as further variants emerge.

Hospitalizations of children and adolescents with complex chronic conditions in Brazil: a temporal analysis from 2009 to 2020.

Access to advanced and sophisticated health technologies made it possible to increase the survival of children with complex chronic conditions. Thus, the profile of pediatric patients admitted to hospitals has changed in recent decades. In Brazil, there are few epidemiological studies on this subject. This study aims to evaluate the main characteristics and temporal trend of hospital admissions of children and adolescents with complex chronic conditions in Brazil, 2009-2020. This is a cross-sectional study with data on hospitalizations of children and adolescents with complex chronic conditions, extracted from the Hospital Information System of the Unified Health System, 2009-2020, in the 26 Brazilian states and the Federal District. The analysis included descriptive statistics and a generalized linear model. From 2009 to 2020, there were 1,337,120 hospitalizations of children and adolescents with complex chronic conditions, and of these, 735,820 (55.0%) were male. The percentage of hospital deaths during the analyzed period was 4.0%. The most recurrent diagnostic category was malignancy (41.0%), with an annual incidence increase of 2.61 (95% CI: 1.16-4.05). Between 2009 and 2019, the increase in hospitalizations for complex chronic conditions was 27.4% for boys and 25.2% for girls, and the reductions in the number of hospitalizations for other causes were 15.4% and 11.9% for boys and girls, respectively. Conclusions: Hospitalizations for complex chronic conditions in pediatrics are increasing in Brazil. This increase is a new challenge for the Brazilian public health system. What is Known: •The profile of pediatric patients admitted to hospitals has changed in recent decades, with a reduction in the total number of hospitalizations, but with an increase in the complexity and costs of these hospitalizations. •The world's scientific production on CCC is concentrated in the United States health care system. Epidemiological studies on the topic in universal health care systems are scarce. What is New: •This is the first study that evaluated the temporal trend of hospitalizations of children and adolescents with CCC in Brazil. •Hospitalizations for CCC in pediatrics are increasing in Brazil, with emphasis on the condition of malignancy, higher incidence in males and in children under one year of age. Furthermore, our study found a decrease in hospitalizations for other pediatric causes.

The Risk of Severe Hypoglycemia and Mortality in Patients With Type 2 Diabetes and Discharged With Acute Liver Injury.

To compare the risks of severe hypoglycemia and mortality between patients with type 2 diabetes (T2D) and discharged with and without acute liver injury. From 1 January 2000 to 31 December 2010, we identified patients with T2D and hospitalization for acute liver injury and hospitalization for other causes from the National Health Insurance Research Database of Taiwan. Multivariable-adjusted Cox proportional hazards models were used to compare the risks of severe hypoglycemia and mortality between the study and control groups. The incidence rates and adjusted hazard ratios (aHRs) for severe hypoglycemia within 90 days and 365 days after discharge were 12.28 and 5.59/1,000 person-years (aHR 1.92 [1.30-2.85]) and 7.35 and 2.9/1,000 person-years (aHR 1.98 [1.52-2.58]) for patients discharged with and without acute liver injury, respectively. The incidence rates and aHRs for mortality within 90 days and 365 days after discharge were 82.4 and 27.54/1,000 person-years (aHR 1.73 [1.46-2.05]) and 36.8 and 9.3/1,000 person-years (aHR 1.94 [1.69-2.24]) for patients discharged with and without acute liver injury, respectively. The subgroup analysis of hypoglycemia risk in patients discharged with acute liver injury revealed no significant interaction in risk factors of age, chronic kidney disease, and medications, except for sex difference, which has significant interaction. This cohort study demonstrated that patients with T2D and discharged with acute liver injury showed significantly higher risks of severe hypoglycemia and mortality within 90 days and 365 days after discharge than patients discharged with other causes.

Rising Pulmonary Artery Pressures Precede Hospitalizations For Heart Failure But Not For Other Causes During Ambulatory Hemodynamic Monitoring For Chronic Heart Failure

<h3>Introduction</h3> In patients with previous heart failure hospitalization (HFH), ambulatory hemodynamic monitoring reduced HFH by 57% in the CardioMEMS Post-Approval Study (PAS), which translated into a 27% reduction in all-cause hospitalization but no change in other causes of hospitalization. We compared the trajectories of pulmonary artery pressures (PAP) before and after breakthrough HFH and the non-HF hospitalizations (non-HFH) that occurred during chronic PAP monitoring. <h3>Methods</h3> The PAS was a single arm study of 1200 patients with NYHA 3 HF (all EF) and prior HFH within 12 months who underwent implantation of a CardioMEMS PA sensor. An independent clinical events committee adjudicated all hospitalizations with primary cause HF and non-HF. We analyzed PAP changes during the 6 weeks prior and 1 week following hospitalization for all pts with PAP data through the 7 weeks, excluding overlapping analysis periods. <h3>Results</h3> Analysis was available for 751 hospitalizations, only 199 (26.5%) were HFH and 552 were (73.5%) were non-HFH. The rising trajectory of PAP changes in advance of HFH was distinct from non-HFH with an increase in pressure from baseline beginning approximately 4 weeks prior to HFH and a decrease in pressure observed immediately after HFH but no change observed before or after non-HFH. <h3>Conclusion</h3> Among patients with chronic HF across a range of EF, PAP rise approximately 4 weeks in advance of HFH and fall by 7 days after, but do not change around non-HFH. These data demonstrate the consistent physiology of rising PAP for breakthrough HFH that occur despite hemodynamic monitoring and the stability of PAP without elevation around the more common hospitalizations for other causes.

Telemonitoring in Heart Failure - A Single Center Experience.

ResumoFundamentoA evolução natural da insuficiência cardíaca é uma pior progressiva e internações hospitalares recorrentes. São necessárias estratégias para se detectar descompensações em tempo hábil. O uso do telemonitoramento da insuficiência cardíaca é inconsistente.ObjetivosEste estudo tem o objetivo de avaliar o impacto desse programa de telemonitoramento (PTM) em internações hospitalares e admissões em serviços de emergência.MétodosEste é um estudo retrospectivo observacional que analisou dados de todos os pacientes que se cadastraram no PTM de janeiro a 2018 a dezembro de 2019. Foram coletados dados demográficos, clínicos e relacionados ao PTM. O número de internações hospitalares e admissões em serviços de emergência do ano anterior e posterior ao cadastro foram comparados, utilizando-se o teste de Wilcoxon. Um p-valor bilateral de <0,05 foi considerado significativo.ResultadosUm total de 39 pacientes foram cadastrados, com uma média de idade de 62,1 ± 14 anos e predominância de pacientes do sexo masculino (90%). As causas mais comuns de insuficiência cardíaca foram cardiomiopatia isquêmica e dilatada. A fração de ejeção média foi de 30% e o tempo mediano da duração da doença foi de 84 meses (FIQ 33-144). Pacientes que foram cadastrados por menos de um mês foram excluídos, com um total de 34 pacientes analisados. Os pacientes foram acompanhados no PTM por um período mediano de 320 dias. O número de admissões em serviços de emergência foi reduzido em 66% (p<0,001) e o número de internações hospitalares por insuficiência cardíaca foi reduzido em 68% (p<0,001). O PTM não teve impacto no número de internações hospitalares por outras causas.ConclusõesEste estudo sugere que o PTM poderia reduzir a utilização de serviços de saúde em pacientes com insuficiência cardíaca.

Venous Thromboembolism Post-COVID-19 Among Individuals with Sickle Cell Disease

Background: Individuals with sickle cell disease (SCD) are at risk of severe COVID-19 infection. Those with SCD are also known to be at risk of venous thromboembolism (VTE), with numerous mechanistic pathways likely at interplay. In general, prior studies indicate that COVID-19 infection is associated with a thromboembolic risk. However, it is unknown if COVID-19 infection increases the already high risk of VTE for individuals with SCD. Given the preexisting risk for thrombophilia associated with SCD, we hypothesized that COVID-19 infection would further increase the risk of a venous thromboembolic event. In this study, we leverage electronic health record data to determine, at a population level, whether individuals with SCD hospitalized for COVID-19 have higher VTE rates when compared to hospitalization for any other cause.Method: Using electronic health record data from a multisite research network, TriNetX (years 2010 - 2020) we identified two mutually exclusive cohorts of individuals with SCD between Jan 20, 2020 - Dec 31, 2020: 1) those with hospitalizations related to a diagnosis of COVID-19 and 2) those with hospitalization for other causes. COVID-19 related hospitalizations were defined as admissions occurring within a month of COVID-19 diagnosis. Overall, individuals were considered to have SCD if they had 3 or more instances of ICD coding for SCD during the time frame of years 2010 - May 20, 2021 and did not have any ICD code for sickle cell trait. The outcome of interest was VTE, which included either deep venous thrombosis (DVT), pulmonary embolism (PE) or both. We determined the VTE rates at 1 month, 3 months and 6 months post hospitalization. The VTE rates between the two groups were compared using measures of risk difference and risk ratios, along with the respective 95% confidence intervals. We also matched the groups using propensity scores based on the prevalence of VTE prior to the index event of hospitalization and compared the respective outcomes.Results: Within the TriNetX network, there were 223 (59% females) individuals with SCD hospitalized due to COVID-19, and 3,591 (54% females) hospitalized for causes other than COVID-19. Individuals with SCD hospitalized for COVID-19 were older than individuals with SCD hospitalized for other causes (mean age: 29.4 yrs, sd = 16.4 vs 26.3 yrs, sd = 16.8, p value = 0.006). A significantly higher proportion of individuals hospitalized for COVID-19 had a prior history of portal vein thrombosis (4% vs ~0%, p-value <0.001), phlebitis/thrombophlebitis (4% vs 2%, p-value = 0.026) and other VTE (16% vs 10%, p-value = 0.008). There were no significant differences in sex or proportion of those with prior history of PE between the two groups. Table 1 shows the VTE rates observed in the two groups 1, 3 and 6 months post-hospitalization, respectively. VTE rates were higher among individuals with SCD hospitalized for COVID-19 than among individuals with SCD hospitalized for other causes. After matching for previous history of VTE, individuals with SCD hospitalized for COVID-19 infection did not have significantly higher VTE rates compared to individuals with SCD hospitalized for other causes at any of the time points evaluated.Conclusions: These data suggest that immunothrombosis accompanying SARS-COV-2 infection in individuals with SCD does not exacerbate the underlying known thrombophilia associated with SCD and provide support for current clinical guidelines in this population. Future prospective studies controlled for anticoagulant therapy exposures may provide more direct evidence to guide thromboprophylaxis in this unique population. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Usefulness of administrative databases in identifying the predictive factors of repeated hospitalizations for heart failure.

to investigate heart failure (HF) hospitalizations, the following one-year follow-up, and any possible connection between rehospitalizations due to HF and patients' characteristics derived from administrative databases. retrospective longitudinal design. the study was conducted analyzing public hospital records of a district in Abruzzo Region (Central Italy), which counts more than 300,000 inhabitants. Patients hospitalized for HF from 01.01.2016 to 31.12.2017 (index event) were included in the study and followed-up for one year. frequency of repeated hospital admissions, time intervals from the index HF hospitalizations, and causes of readmissions were investigated. a total of 1,587 patients discharged alive after an index hospitalization for HF were included in the study. The mean age of the patients was 79.6 years and the majority of them were females (53.7%). The mean length of stay (LOS) for the index hospitalizations was 8.8 ±6.8 days. During the follow-up period, 336 (21.2%) patients underwent one to four repeated hospitalizations for HF. The first readmission due to HF occurred after a median time of 106.5 days from the index event discharge, and for 20.0% of all cases it occurred within 31 days; 453 patients (28.6%) were readmitted exclusively for other causes, and 67 (4.2%) died out of hospital without any previous HF re-hospitalization. When the outcome was considered as a composite endpoint (out-of-hospital death/HF re-hospitalization), age >=75 (HR 1.737; 95%CI 1.330-2.267), LOS at the index hospitalization >=8 days (HR 1.302; 95%CI 1.066-1.591), and repeated hospitalizations for other causes (HR 1.789; 95%IC 1.465-2.185) were associated with the risk of repeated hospitalizations for HF. this study shows that about one HF patient out of five experienced at least one re-hospitalization for HF within one year from index hospitalization. In addition to having a longer index hospitalization, these patients were older and frequently suffered from comorbidities which also led to hospitalizations. The results underline the need for a close and careful follow-up after the discharge of old HF patients with multiple pathologies in order to avoid further HF admissions in a short time.

Health in Men Study: is frailty a predictor of medication-related hospitalization?

Older adults are at high risk of medication-related hospitalizations. Frailty is a phenotype commonly observed in older people due to declining physiological functions. To examine the association of frailty with medication-related hospitalization among community dwelling older men. A prospective observational cohort study was conducted among community dwelling older men (mean age 75.6 years SD 5.9) from Western Australia (4324) who participated in the Health in Men Study. Participants were followed-up at 12 and 24 months to determine adverse drug event-related hospitalization, hospitalizations for other causes and mortality. The prevalence of frailty was 13.2%. At baseline, frailty was associated with exposure to polypharmacy, potentially inappropriate medication use and potential adverse drug-drug interactions with unadjusted odds ratios; [4.13 (3.48-4.89) P < 0.001], [2.46 (1.91-3.17) P < 0.001], [3.85 (3.03-4.90) P < 0.001], respectively. In unadjusted models, frail men were more likely to have non-accidental falls [OR 3.16 (2.51-3.99) P < 0.001], acute kidney injury [OR 3.37 (2.35-4.82) P < 0.001], ADE-related hospitalizations at 12 months [OR 6.83 (4.91-9.51)] and non-ADE-related hospitalizations [OR 2.63 (2.01-3.45)], or to be dead at 12 months [OR 2.97 (1.79-4.92)] and at 24 months [OR 3.14 (2.28-4.33)] when compared with non-frail men. After adjusting for age, living alone, cognitive decline, smoking status and comorbidity, frailty remained associated with ADE-related hospitalization [OR 3.60 (2.41-5.37)], non-ADE-related hospitalizations [OR 1.74 (1.29-2.36)] and death [OR 1.67 (1.15-2.41)]. The study suggests that frailty is a predictor of medication-related harm with poorer clinical outcomes including mortality.

Hospital-acquired rotavirus acute gastroenteritis in 10 consecutive seasons in Umbria (Italy).

Group A rotaviruses (RVA) are the leading cause of acute gastroenteritis (AGE) in young (aged <5 years) children. Several studies showed that RVA is one of the main cause of nosocomial gastroenteritis in hospitalized pediatric population worldwide, with an incidence ranging from 8 to 33 cases per 100 hospitalized children. Nosocomial infections, in which AGE symptoms develop at least 2 days after admission, may severely affect children already admitted to hospital for other causes. This study aimed to define the trends of the RVA genotypes through statistical analysis of the data obtained by the rotavirus surveillance in Umbria in 10 consecutive seasons, from 2007-2008 to 2016-2017, with update information on hospital-acquired RVA AGE. During RVA gastroenteritis surveillance in Umbria (Italy) in 2007 to 2017, a total of 741 RVA positive faecal samples were collected from children hospitalized with AGE, and RVA strains were genotyped following standard EuroRotaNet protocols. Of the 741 analyzed samples, 75 (10%) were reported to be hospital-acquired. Comparing the distributions of the RVA genotypes circulating in the community or associated with nosocomial infections, we observed a different distribution of genotypes circulating inside the hospital wards, with respect to those observed in the community except in 2010 to 2011, 2011 to 2012, and 2012 to 2013 when G1P[8], G4P[8] and the novel strain G12P[8] caused a large community- and hospital-acquired outbreak. Of the 741 analyzed samples, 75 (10%) were reported to be hospital-acquired. Comparing the distributions of the RVA genotypes circulating in the community or associated with nosocomial infections, we observed a different distribution of genotypes circulating inside the hospital wards, with respect to those observed in the community except in 2010 to 2011, 2011 to 2012, and 2012 to 2013 when G1P[8], G4P[8], and the novel strain G12P[8] caused a large community- and hospital-acquired outbreak. The information from this study will be useful to implement guidelines for preventing nosocomial RVA AGE, which should include an improved management of the hospitalized patients and an increase in vaccination coverage.

1203-P: Cause of Hospitalizations in Patients with Type 2 Diabetes Mellitus (T2DM) in the CANVAS Program

T2DM patients have multiple comorbidities and frequent hospitalizations. SGLT2 inhibitors have demonstrated decreased hospitalization for heart failure vs. standard of care, but data on hospitalization for other causes are limited. The CANVAS Program randomly assigned 10,142 participants with T2DM and prior history (secondary prevention; n = 6656) or risk (primary prevention; n = 3486) for cardiovascular disease to canagliflozin (CANA) or placebo (mean follow-up, 188 week). All-cause hospitalization analyses were prespecified, but analyses of specific causes of hospitalization were not. Microvascular complications included eye, nerve, and kidney and macrovascular complications included cardiac and vascular. CANA reduced overall hospitalization (HR [95% CI]: 0.94 [0.88, 1.00]; secondary prevention: 0.91 [0.84, 0.99]; primary prevention: 1.01 [0.88, 1.15]). The most common reasons for hospitalization were infection, other, metabolism, cardiovascular, and musculoskeletal (Figure). CANA reduced hospitalization for macrovascular complications (overall: 7.98% vs. 10.63%, P &amp;lt;0.0001; secondary prevention: 9.25% vs. 12.66%, P &amp;lt;0.0001; primary prevention: 5.86% vs. 7.02%, P = 0.005), but not for microvascular complications (overall: 1.99% vs. 2.20%, P = NS). CANA reduced all-cause hospitalization overall and macrovascular hospitalization in both primary and secondary prevention participants. Disclosure K.W. Mahaffey: Consultant; Self; Abbott, Ablynx, Baim Institute, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Cardiometabolic Health Congress, Elsevier, GlaxoSmithKline plc., Medergy, Medscape, Mitsubishi Tanabe Pharma Corporation, MyoKardia, Inc., Novo Nordisk Inc., Ocleuve, Portola Pharmaceuticals, Inc., Radiometer America, Springer Publishing, Theravance, UCSF. Research Support; Self; Afferent, Amgen Inc., Apple, Cardiva Medical, Inc, Daiichi, Ferring Pharmaceuticals, Google, Luitpold Pharmaceuticals, Inc., Medtronic, Sanofi, St.Jude, Tenax. Stock/Shareholder; Self; BioPrint Fitness. Other Relationship; Self; AstraZeneca, Johnson &amp; Johnson, Merck &amp; Co., Inc., National Institutes of Health, Novartis Pharmaceuticals Corporation. J. Ianus: Employee; Self; Janssen Scientific Affairs, LLC. C.V. Damaraju: Employee; Self; Janssen Scientific Affairs, LLC. B. Neal: Advisory Panel; Self; Janssen Research &amp; Development, Novartis Pharmaceuticals Corporation, Pfizer Inc., Roche Pharma, Servier. Research Support; Self; Abbott, Australian National Health and Medical Research Council, Janssen Research &amp; Development, Merck &amp; Co., Inc., Roche Pharma, Servier. D. de Zeeuw: Advisory Panel; Self; Bayer US, Boehringer Ingelheim Pharmaceuticals, Inc., Fresenius Medical Care, Mitsubishi Tanabe Pharma Corporation, Mundipharma. Other Relationship; Self; AbbVie Inc., Bayer US, Janssen Research &amp; Development. G. Fulcher: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Research &amp; Development, Merck Sharp &amp; Dohme Corp., Novo Nordisk Inc. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Research &amp; Development, Merck Sharp &amp; Dohme Corp., Novo Nordisk Inc. Research Support; Self; Novo Nordisk Inc. M. Pfeifer: Employee; Self; Janssen Scientific Affairs, LLC. D.R. Matthews: Advisory Panel; Self; Janssen Research &amp; Development, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Sanofi, Servier. Consultant; Self; Janssen Research &amp; Development, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Servier. Research Support; Self; Janssen Research &amp; Development. Speaker's Bureau; Self; Aché Laboratories, Janssen Research &amp; Development, Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Sanofi, Servier. Funding Janssen Research &amp; Development, LLC

390. Sociodemographic Factors Associated With Patients Hospitalized for Coccidioidomycosis in California and Arizona, State Inpatient Database 2005–2011

BackgroundCoccidioidomycosis is endemic in the Southwestern United States. Disseminated infection can be life-threatening and is responsible for hospitalization and healthcare resource utilization. There are limited data evaluating factors associated with coccidioidomycosis hospitalization.MethodsWe conducted a cross-sectional study to assess sociodemographic and comorbidity factors associated with hospitalization due to coccidioidomycosis in California and Arizona compared with hospitalization for other causes. We analyzed hospital discharge data obtained from the State Inpatient Dataset (SID) for both California and Arizona for years 2005–2011. Multivariable logistic regression modeling was used to analyze factors associated with coccidioidomycosis.ResultsA total of 23,758 hospitalizations due to coccidioidomycosis occurred during the study period in the two states. Arizona had an over six-fold higher coccidioidomycosis hospitalization incidence rate compared with California, 198.9 vs. 29.6/100,000 person-years. In the multivariable model patients aged (40–49) years had a higher odds of hospitalization due to coccidioidomycosis vs. young adults (18–29) years (aOR = 1.50 [95% CI 1.43–1.59]). African Americans had higher odds of hospitalization due to coccidioidomycosis vs. Caucasians (aOR = 1.98 [95% CI 1.89–2.06]). Residing in a large rural town had a higher odds of hospitalization due to coccidioidomycosis vs. residing in an urban area (aOR = 2.28; 95% [CI 2.19–2.39]). Higher comorbidities were associated with an increased odds for hospitalization due to coccidioidomycosis (aOR = 1.02 [95% CI 1.02–1.03]) for each point in the Elixhauser score). Uncomplicated diabetes and chronic pulmonary disease was also associated with hospitalization due to coccidioidomycosis (aOR = 1.47 [95% CI 1.41–1.52] and (aOR = 1.59 [95% CI 1.54–1.65]), respectively.ConclusionWe found sociodemographic factors and comorbidities associated with hospitalizations due to coccidioidomycosis compared with hospitalization due to other causes. Identifying persons at highest risk for hospitalization with coccidioidomycosis may be helpful for future prevention efforts.Disclosures All authors: No reported disclosures.

Evaluation of intoxicated patients hospitalized in a newly-opened level two pediatric intensive care unit.

The study aimed to retrospectively examine the demographic and etiological characteristics, prognosis and length of stay in intensive care unit of intoxicated patients hospitalized in Level two Pediatric Intensive Care Unit in Maternity and Child Health Hospital of Samsun. The study retrospectively examined the records of patients hospitalized between 14(th) March 2014 and 14(th) March 2015 in Level two Pediatric Intensive Care Unit in Maternity and Child Health Hospital of Samsun with respect to age, gender, cause of poisoning, time of emergency department admission, length of hospitalization and prognosis. Of 82 patients admitted to the Intensive Care Unit, 29 (35.3%) were male and 53 (64.6%) were female. The mean age of the male and female patients was 7.89±6.3 years and 11.2±5.7 years, respectively and the mean age of the study group was 10.04±6.1. Twenthy one (39,6%) of the female patients were at the age group of 0-14 years and 32 (60.4%) were at the age group of 14-18 years. Twenthy (68.9%) of the male patients were at the age group of 0-14 years and nine (31.1%) were at the age group of 14-18 years. The cause of poisoning was drug intoxication (antidepressants, antibiotics, painkillers and other drugs) in 64 patients (78%) and the remaining 18 patients (22%) were admitted to hospital for other causes (rat poison, mushroom, carbonmonoxide, scorpion stings, bonzai and pesticides). Thirthy eight (46.3%) of all the patients used such substances for suicidal purpose. Thirthy three (62.2%) of these were female and 32 were at the age group of 14-18 years. Fourty (48.7%) of the patients who ingested medication ingested one drug, while 24 (29.2%) ingested multiple drugs. Antidepressants were found to be the most commonly used drugs (31.2%). The mean hospital admission time was 3.41±2 hours and the mean time of intensive care unit stay was 2.89±1.04 days. No mortality was recorded. Thirthy patients (36.5%) were referred to the Pediatric Psychiatric Unit as outpatients after discharge and three patients (3.6%) were referred to Alcohol and Substance Abuse Treatment and Research Centre. Because the rate of drug intoxication was found to be substantially high in this study, we think that politics related with education of parents on this issue, packaging of drugs in such a way that children can not open these packages and drug supply should be reviewed.

Hospitalization charges for children with birth defects in Texas, 2001 to 2010.

State-specific information about hospitalizations of children with birth defects can improve understanding of changes in occurrence, treatment practices, and health care financing policies. This study analyzed aggregated data on hospital charges and length of stay for a large, diverse population. We extracted hospitalization data for children diagnosed with birth defects from the Texas Hospital Inpatient Discharge Public Use Data File (2001-2010). Analyses compared total charges and length of stay for children with and without a diagnosis code of any birth defect among 45 standard categories. We also examined trends for total charges by expected payer type. In Texas, 431,296 hospital stays were reported for children with birth defects, with total charges of $24.8 billion. Mean hospital stay for children with birth defects was more than twice that of those without, whereas mean of hospital total charges was approximately six times greater. Pyloric stenosis accounted for the largest number of hospitalizations, followed by certain cardiac defects. Pediatric hospitalizations for birth defects increased 273.7%, compared with a 214.7% increase overall. The percentage of charges with Medicaid as expected payer (2004-2010) ranged from 56.5 to 62.0%. Charges associated with these conditions are far greater than those associated with pediatric hospitalizations for other causes, whether in the newborn period or beyond. However, these charges vary depending on specific diagnoses, expected payer source, and year of treatment.

AB1069 Incidence of inpatient acute gouty arthritis flare and impact on length of hospital stay

BackgroundEpidemiologic studies suggest that gout is prevalent in 4% of the general population, increasing in incidence, and associated with morbidity and mortality. Gout has been shown to have a significant...

Ignoring the Obvious Missing Piece of Chronic Kidney Disease in HIV: Cigarette Smoking

The impact of tobacco use on the development of chronic kidney disease (CKD) in people living with HIV (PLWH) has been overlooked, despite remarkably higher rates of smoking in these individuals. The authors examined the association between smoking and the risk of CKD in a case-controlled study that included 75 PLWH with CKD and 461 PLWH consecutively admitted to the hospital for other causes. Significant differences in gender, race/ethnicity, hypertension, hepatitis B, CD4 cell counts, and smoking between cases and controls were reported, suggesting that these variables may be risk factors for CKD. In logistic regression analyses, smoking (OR=1.97, p=.003), hypertension (OR=2), and African ancestry, particularly for Black Caribbeans (OR=2.6), were independent factors associated with CKD. Moreover, the results pointed to a dose-response relationship between packs smoked per day and CKD. Smoking was reported to contribute a significant risk for CKD in these subjects.

Magnesium and C-reactive protein in heart failure: an anti-inflammatory effect of magnesium administration?

Little is known about the relationship between serum magnesium (Mg) and C-reactive protein (CRP) in heart failure (HF). To investigate the relationship, if any, between serum Mg and CRP in HF patients and, concomitantly, to test a hypothesis that Mg supplementation might affect serum CRP levels. Serum Mg and CRP were evaluated in 68 patients with chronic systolic HF leading to hospital admission and 65 patients requiring hospitalization for other causes. Following 5 weeks, serum Mg, CRP and intracellular Mg were reevaluated in 17 HF patients after administration of oral Mg citrate 300 mg/day (group A), and 18 untreated HF patients (group B). In order to obtain Gaussian distribution, logarithmic transformation of CRP was performed. Inverse correlation was found between serum Mg and log CRP (r = -0.28, P = 0.002). Compared to controls, patients with HF demonstrated higher baseline CRP levels, independent of coexisting conditions, and lower serum Mg values. Following Mg treatment, log CRP decreased from 1.4 +/- 0.4 to 0.8 +/- 0.3 in group A (P < 0.001). No significant changes in log CRP were demonstrable in group B. Serum Mg (mmol/l) rose significantly in group A (0.74 +/- 0.04-0.88 +/- 0.08, P < 0.001), and to a lesser extent in group B (0.82 +/- 0.08-0.88 +/- 0.08, P = 0.04). Intracellular Mg significantly increased only in Mg-treated group A (P = 0.01). Oral Mg supplementation to HF patients significantly attenuates blood levels of CRP, a biomarker of inflammation. Targeting the inflammatory cascade by Mg administration might prove a useful tool for improving the prognosis in HF.

Clinical diagnosis and treatment of small ovarian tumor in postmenopausal women

ObjectiveTo investigate the clinical symptom, ultrasonographic scan finding, serum CA125 value, histopathological type and treatment of small ovarian tumor (<5 cm) in postmenopausal women.MethodsRetrospective analysis was carried out for 52 clinical materials of ovarian tumor cases in women more than one year after menopausal between Jan 1997 and Dec 2004. The largest diameter of the ovarian mass is less than 5 cm.ResultsThere were 11 ovarian cancers and 1 borderline ovarian tumor among 52 small ovarian tumors (23.1%). 10 ovarian cancers were epithelial neoplasms and 2 were sex cord-stromal tumors, and 8 cases were in late stage according to FIGO staging system (33.3%). Compared with benign tumor, there is no significant difference in the onset age, interval after menopausal and duration of history. The main clinical feature is abdominal symptoms, such as abdominal pain and distension in the malignant cases. The patients with benign tumors often showed the ovarian mass during the annual screening or admitted into hospital for other causes. The ultrasonography finding and serum CA125 level showed much difference between benign and malignant cases. Unilocular smooth-walled ovarian cysts mostly were found in benign tumor and the CA125 values were always less than 35 U/ml; but the solid or complex sonographic structures (multilocular, or with a papillary projections on the wall) often indicated a high risk of cancer, especially there was ascites in the pelvic cavity. Serum CA125 level in many cancer cases was elevated (>35 U/ml), over 300 U/ml in more than half of the patients. Surgery is still the first choice to treat ovarian cancer, and chemotherapy would be an auxiliary method. Till now, 3 ovarian cancer patients died of complications of cancer and 2 cases had recurrence.ConclusionSmall ovarian tumor in postmenopausal women has a comparatively low malignant occurrence but more in later stage. Many are epithelial carcinoma. If there is complex or parenchymal sonographic structure accompanied with a high serum CA125 level, operation should be considered, while it can be followed up when the ultrasound shows a smooth cyst with normal CA125 value.

Economic Implications of Extended-Release Metoprolol Succinate for Heart Failure in the MERIT-HF Trial: A US Perspective of the MERIT-HF Trial

Background The MERIT-HF trial demonstrated improved survival and fewer hospitalizations for worsening heart failure with extended-release (ER) metoprolol succinate in patients with heart failure. This study sought to estimate the economic implications of this trial from a US perspective. Methods and Results A discrete event simulation was developed to examine the course of patients with heart failure. Characteristics of the population modeled, probabilities of hospitalization and death with standard therapy, and risk reductions with ER metoprolol succinate were obtained from Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF) and evaluated in weekly cycles. Direct medical costs were estimated from US databases in 2001 US dollars. Uncertainty in inputs was incorporated and analyses were carried out to estimate events prevented total and net costs. The model predicts that ER metoprolol succinate will prevent approximately 7 deaths and 15 hospitalizations from heart failure per 100 patients over 2 years. Compared with standard therapy alone, this translates to a cost reduction between $395 and $1112 per patient, depending on whether the costs of hospitalizations for other causes are included. Savings were maintained in 90% of the simulations. Conclusion This analysis predicts that the positive effect of ER metoprolol succinate on mortality and morbidity demonstrated in MERIT-HF leads to substantial savings.

The effect of hip replacement on prescribing of NSAIDs, ulcer healing drugs and hospitalization--a matched cohort study.

To assess the impact of total hip replacement on prescribing of non-steroidal anti-inflammatory drugs (NSAIDs), ulcer healing drugs (UHDs) and hospitalization. Observational matched cohort study. There were 282 subjects in the hip replacement cohort and 1691 in the comparator cohort. Dispensing of NSAIDs fell from 89% to 57% after hip replacement but increased from 36% to 39% in comparators. Dispensing of UHDs fell from 33% to 30% after hip replacement but increased from 16% to 23% in the comparators. Hospitalization for upper gastrointestinal events fell from 2.5% to 1.8% after hip replacement but increased from 1.4% to 1.7% in comparators. Hospitalization for other causes increased from 32% to 42% after hip replacement compared with 25% to 28% in comparators. Hip replacement is associated with reduced prescribing of NSAIDs and UHDs. However, any effect on GI admissions will be small compared with increased hospitalization for other causes.