Inpatient Mortality In Patients Research Articles

The Influence of Arrhythmias and Metabolic Profile on Inpatient Mortality in Patients with Left Ventricular Assist Devices.

Background: In patients with end-stage heart failure, durable Left Ventricular Assist Devices (LVADs) can be used as a bridge to transplant or destination therapy. LVADs have been shown to improve survival for patients with heart failure (HF). HF is associated with electrolyte abnormalities and the development of sustained arrhythmias. However, data on the influence of arrhythmias and electrolyte imbalances on inpatient outcomes in LVAD patients are lacking. Furthermore, previous works assessing inpatient outcomes focused mainly on the role of chronic comorbidities in those outcomes. Methods: In this cross-sectional study, we used discharge data from the National Inpatient Sample from 2019 to 2020 to assess the influence of acute arrhythmias on inpatient mortality in patients with LVADs. We also investigated the relationship between acute medical conditions and mortality. Results: There were 9418 (not survey-adjusted) hospitalizations with LVAD, among which 2539 (27%) died during the hospitalization. Univariate analysis of arrhythmias showed that ventricular arrhythmias (VAs)-ventricular fibrillation/flutter and ventricular tachycardia-as well as complete heart block were associated with significantly higher odds of mortality. Follow-up multivariable logistic analysis showed that these arrhythmias retain their increased association with death. Hyperkalemia and acidosis had increased adjusted odds of death (1.54 (95% confidence interval: 1.28-1.85) (p < 0.001) and 2.44 (CI: 2.14-2.77) (p < 0.001), respectively). Conclusions: VAs, complete heart block, hyperkalemia, and acidosis were associated with increased odds of all-cause mortality. Females had higher odds of inpatient mortality. These findings suggest that electrolyte management, maintenance of optimal acid-base balance, and interventions to treat sustained ventricular arrhythmias may be suitable therapeutic targets to reduce mortality in hospitalized patients with LVADs.

Systemic sclerosis is associated with increased in-patient mortality in patients hospitalized for heart failure.

We aimed to analyse the characteristics and in-hospital outcomes of patients hospitalized for heart failure (HF) with co-morbid systemic sclerosis (SSc) and compare them to those without SSc, using data from the National Inpatient Sample from years 2016 to 2019. International Classification of Diseases, Tenth Revision diagnosis codes were used to identify hospitalized patients with a primary diagnosis of HF and secondary diagnoses of SSc from the National Inpatient Sample database from 2016 to 2019. Patients were divided into two groups: those with and without a secondary diagnosis of SSc. Baseline characteristics including demographics and co-morbidities, outcomes of mortality, length of stay (LOS), and costs were compared between the two groups. Multivariable logistic regression analysis was performed to adjust for confounders and assess the impact of SSc on in-hospital mortality, cost, and LOS. A total of 4709724 hospitalizations for HF were identified, with 8150 (0.17%) having a secondary diagnosis of SSc. These patients were predominantly female (82.3% vs. 47.8%; P=0.01), younger (mean age of 67.4 vs. 71.4; P<0.01), and had significantly lower rates of traditional cardiovascular risk factors such as coronary artery disease (35.8% vs. 50.6%; P<0.01), hyperlipidaemia (39.1% vs. 52.9%; P<0.01), diabetes (22.5% vs. 49.1%; P<0.01), obesity (13.2% vs. 25.0%; P<0.01), and hypertension (20.2% vs. 23.8%; P<0.01). Higher rates of co-morbid pulmonary disease in the form of interstitial lung disease (23.1% vs. 2.0%; P<0.01) and pulmonary hypertension (36.6% vs. 12.7%; P<0.01) were noted in the SSc cohort. Unadjusted in-hospital mortality was significantly higher in the HF with SSc group [5.1% vs. 2.6%; odds ratio: 1.99; 95% confidence interval (CI): 1.60-2.48; P<0.001]. Unadjusted mortality was also higher among female (86.7% vs. 47.0%; P<0.01), Black (15.7% vs. 13.0%; P<0.01), and Hispanic (13.3% vs. 6.9%; P<0.01) patients in the SSc cohort. After adjusting for potential confounders, SSc remained independently associated with higher in-hospital mortality (adjusted odds ratio: 1.81; 95% CI: 1.44-2.28; P<0.001). Patients with HF and SSc also had longer LOS (6.4 vs. 5.4; adjusted mean difference [AMD]: 0.37, 95% CI: 0.05-0.68; P=0.02) and higher hospitalization costs ($67363 vs. $57128; AMD: 198.9; 95% CI: -4780 to 5178; P=0.93). In patients hospitalized for HF, those with SSc were noted to have higher odds of in-hospital mortality than those without SSc. Patients with HF and SSc were more likely to be younger, female, and have higher rates of co-morbid interstitial lung disease and pulmonary hypertension at baseline with fewer traditional cardiovascular risk factors.

The value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism: A cross sectional analysis

IntroductionPulmonary embolism (PE) is a significant global cause of mortality, ranking third after myocardial infarction and stroke. ECG findings may play a valuable role in the prognostication of patients with PE, with various ECG abnormalities proving to be reasonable predictors of haemodynamic decompensation, cardiogenic shock, and even mortality. This study aims to assess the value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism, as diagnosed with computed tomography pulmonary angiogram. MethodThis study was a cross sectional analysis based at Tygerberg Hospital, Cape Town, South Africa. Eligible patients were identified from all CT-PA performed between 1 January 2017 and 31 December 2019 (2 years). The ECGs were independently screened by two blinded emergency physicians for predetermined signs that are associated with right heart strain and higher pulmonary artery pressures, and these findings were analysed to in-hospital mortality. ResultsOf the included 81 patients, 61 (75 %) were female. Of the 41 (51 %) patients with submassive PE and 8 (10 %) with massive PE, 7 (17 %) and 3 (38 %) suffered inpatient mortality (p = 0.023) respectively. Univariate ECG analysis revealed that complete right bundle branch block (OR, 8.6; 95 % CI, 1.1 to 69.9; p = 0.044) and right axis deviation (OR, 5.6; 95 % CI, 1.4 to 22.4; p = 0.015) were significant predictors of inpatient mortality. ConclusionEarly identification of patients with pulmonary embolism at higher risk of clinical deterioration and in-patient mortality remains a challenge. Even though no clinical finding or prediction tool in isolation can reliably predict outcomes in patients with pulmonary embolism, this study demonstrated two ECG findings at presentation that were associated with a higher likelihood of inpatient mortality. This single-centre observational study with a small sample precludes concrete conclusions and a large follow-up multi-centre study is advised.

Renal replacement therapy prior to liver transplant and inpatient mortality in patients without advanced kidney disease: A nationwide study.

The utility of renal replacement therapy (RRT) before liver transplant (LT) in patients without end-stage renal disease (ESRD) or advanced chronic kidney disease (CKD-IV/V) is debatable and lacks data support. We aimed to evaluate the impact of RRT on patients undergoing LT. We used the National Readmission Database (2016-2019) to identify all index hospitalizations undergoing RRT before LT (cases). A matched comparison cohort of similar hospitalizations without RRT before LT was identified (controls) after 1:1 propensity score matching for age, gender, and available comorbidities. We matched 364 cases (RRT before LT) to 364 controls (LT without prior RRT). There was no statistical difference in all-cause inpatient mortality (4.9% vs 3.6% P = 0.4). A significantly greater proportion of cases were associated with ICU admission (40.7% vs 17.0%, P < 0.001) and RRT requirement post LT (100% vs 17%, P < 0.001). There was no difference in 30- (hazard ratio [HR] 1.1, 0.4-2.6), 60- (HR 0.9, 0.4-1.8), or 90-day (HR 0.8, 0.4-1.6) inpatient mortality between the groups. Also, 180-day survival estimates were comparable (P = 0.5). The results were similar in patients with no chronic kidney disease (CKD) and CKD-III. RRT prior to LT, in patients without advanced CKD or ESRD, was associated with greater instances of ICU stay and need for future RRT. Also, 30-, 60-, and 90-day inpatient mortality rates were similar, and 180-day survival estimates were comparable.

Evaluating mortality and 6-month functional outcomes of patients with dural venous sinus thrombosis in traumatic brain injury.

Patients with dural venous sinus thrombosis (DVST) in select populations following traumatic brain injury (TBI), including those with blunt mechanism or depressed skull fractures, have been shown to have an increased risk of mortality. The purpose of this study was to assess these findings in a mixed population of head trauma patients. The authors performed a case-control study using propensity score matching by reviewing 17 years (2004-2021) of data from their institutional trauma registry. Patients with imaging-confirmed DVST were matched to a control group of TBI patients without identified DVST based on age, sex, postresuscitation Glasgow Coma Scale (GCS) score, and Injury Severity Score. All age groups and injury mechanisms were included with a head Abbreviated Injury Scale score ≥ 3. Data on demographics, injury and radiographic characteristics, and patient outcomes were collected. Multivariable logistic regression was performed to identify predictors of inpatient mortality. An additional subgroup analysis of patients with concurrent DVST and blunt cerebrovascular injury (BCVI) was planned a priori. The authors identified 9875 patients who presented to their institution over the study period with TBIs, with a 1.64% incidence of DVST. Concurrent BCVI was diagnosed in 23.5% of patients with a DVST. Following matching, the presence of DVST itself was not significantly associated with inpatient mortality (OR 0.68, 95% CI 0.24-1.88). On regression analysis, penetrating injuries (8.19, 95% CI 1.21-80.0) and lower postresuscitation GCS scores (0.69, 95% CI 0.53-0.84) were independently associated with inpatient mortality for patients with traumatic DVST. Significantly worse functional outcomes were observed in those with DVST at 3 months, with no significant difference at 6 months. The authors observed a prevalence of traumatic DVST of 1.64% in a mixed population of head-injured patients, with 23.5% of patients with DVST having concurrent BCVI. Traumatic DVST alone was not associated with a significantly increased risk of inpatient mortality.

Abstract 265: Sex-Based Differences in Clinical Outcomes of Out-of-Hospital Cardiac Arrest Patients

Introduction: Historically, studies have shown lower overall survival rates for women following out of hospital cardiac arrests (OHCA). Despite advancements in resuscitation care over recent years, it is not clear if sex-based differences in inpatient mortality and postresuscitation outcomes have improved. Aims: We aim to investigate if gender disparities still exist in the clinical outcomes of OHCA patients. Methods: A national cohort of patients primarily hospitalized for cardiac arrest was identified using the 2019 National Inpatient Sample database. The study cohort was divided into male and female populations. The primary outcome was inpatient mortality. Secondary endpoints assessed length of stay and discharge to home rates (as a surrogate to functional status on discharge). Results: A total of 28,890 admissions were identified during the study period. Of them, 63.6% (n = 18,365) were males and 36.4% (n = 10,510) were females. The overall unadjusted inpatient mortality rate was 52.2% (n = 15,065) and was lower in females than males [48% (n = 5,040) vs 54.6% (n = 10,025), p &lt; 0.001]. However, after adjusting for potential confounders in Table 1, the female sex was associated with higher adjusted inpatient mortality (aOR 1.085, 95% CI 1.023-1.150, p = 0.007). The average LOS for those who survived to hospital discharge was 5.0 days (IQR 2-10) and was similar between both groups (p = 0.703). Of those who survived to hospital discharge, disposition to home was significantly higher in males (49.3%, n = 4,940) than in females (41.3%, n = 2,080), (p &lt; 0.001). Conclusions: Female sex remains an independent predictor of inpatient mortality in patients admitted with OHCA. Discharge to home after successful resuscitation was lower in females than males, suggestive of worsened functional status on discharge.

S11 Cholecystectomy Reduces the Odds of Inpatient Mortality in Patients With Acute Biliary Pancreatitis

S11 Cholecystectomy Reduces the Odds of Inpatient Mortality in Patients With Acute Biliary Pancreatitis

#4820 RISK FACTORS FOR INPATIENT MORTALITY IN PATIENTS WITH NON-DIALYSIS CHRONIC KIDNEY DISEASE ADMITTED FOR COVID-19 USING A US NATIONAL SAMPLE

Abstract Background and Aims Several studies reported that the COVID-19 pandemic has disproportionately affected socioeconomically vulnerable populations. No study evaluated risk factors for inpatient mortality in patients with non-dialysis chronic kidney disease (CKD) admitted with the diagnosis of Covid-19, using a US nationwide sample. This study aimed to elucidate risk factors for mortality in patients with CKD during Covid-19 admissions. Method We extracted data from the National Inpatient Sample year 2020, the largest nationally representative inpatient-care database in the US. We created a cohort of all adults with CKD hospitalized for Covid-19 by ICD-10 codes. The outcome was inpatient mortality. We excluded patients with end stage kidney disease on maintenance dialysis and transplant patients. We compared baseline characteristics and used multiple logistic regression to determine risk factors for inpatient mortality in this cohort. Results Total of 201,460 admissions with a diagnosis of Covid-19 were detected in patients with non-dialysis CKD. Table 1 showed the baseline characteristics. The mean age was 72.8±0.2 years and females accounted for 43.6%. Of all, White accounted for 52.3%, followed by Black (26.1%) and Hispanic (14.6%). Inpatient mortality was 20.9%. Table 2 showed the results of the multivariable logistic model. Older patients, Males, higher Charlson Comorbidity Index scores were associated with a higher risk of inpatient mortality. White patients had a higher risk compared to Black patients and Native Americans had the highest risk, followed by other ethnic minorities, Hispanic, and Asians. Those from the lowest income households had the highest risk. Admission to a rural, publicly owned hospital and those located in the West and Northeast had higher odds of inpatient mortality. Conclusion Our study showed males, race, commercial payment type, lower income, and hospital settings such as regions and location were risk factors for inpatient mortality in patients with non-dialysis CKD. Further studies are needed to evaluate whether differences in clinical practice underly some of these risks.

Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States.

Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p=0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.

719 Decreased Morbidity in Patients with Hidradenitis Suppurativa Insured by Medicaid or Medicare

Abstract Introduction Hidradenitis suppurativa (HS) is a chronic condition that is defined by recurring inflammation and fibrosis of intertriginous areas. Patients with HS have had increasing inpatient hospitalization rates over the years. Our study investigates inpatient mortality and morbidity factors in patients with HS by primary payer status. We hypothesized that patients who are uninsured or insured by Medicaid or Medicare will have worse in-hospital mortality rates when compared to those insured by private insurance. Methods Using a national database, we performed a cross-sectional study of patients hospitalized from 2017-2019 with a primary diagnosis of HS. The sample size included 12,365 patients with HS. The independent variable was primary payer status, and the dependent variables were age, gender, race, and zip code income quartiles. The primary outcome was in-hospital mortality. The secondary outcomes were morbidity factors (infection and wound dehiscence rates, postoperative complications), time from admission to first procedure, and resource utilization (total hospitalization charges and costs, and length of hospitalization). Statistical analyses were performed to determine frequencies, odds ratios, and significance. Statistical significance was set at p&amp;lt; 0.05. We controlled for the above-defined dependent variables in the logistic regression analysis. Results Primary payer status was not associated with inpatient mortality in patients with HS (p=0.092). From 2017-2019, there were a total of five (0.04%) of in-patient mortalities in patients with HS, with all five being insured by Medicaid and occurring in 2017. Compared with private insurance, Medicare was associated with significantly lower incidences of wound dehiscence (aOR=0.21 (0.06-0.70); p=0.011) and longer time from admission to first procedure (mean days=1.85 vs 1.23; p=0.01). Medicaid was associated with significantly lower incidences of infection (aOR=0.21 (0.08-0.58); p=0.002) and longer time from admission to first procedure (mean days=1.73 vs 1.23; p=0.024). The only difference observed in the uninsured, when compared to privately insured, was significantly lower total costs ($10601.78 vs $13658.37; p=0.030). Conclusions Our study demonstrates that in patients with HS, inpatient morbidity factors are overall better in those who are publicly insured over those privately insured. However, publicly insured patients face a longer wait to first procedure from admission over those privately insured. Applicability of Research to Practice By raising awareness in treatment outcomes and resource utilization for patients with HS in inpatient settings, the medical team caring for these patients can begin to identify reasons for the disparities shown by insurance status.

519 Weekend Admission for Patients with Hidradenitis Suppurativa Have Better Outcomes than Weekday Admission

Abstract Introduction Hidradenitis suppurativa (HS) is a condition that involves recurring inflammation and fibrosis of intertriginous areas. With increasing inpatient hospitalization rates in patients with HS, our study sought to examine differences in outcomes between weekend and weekday admission. The authors hypothesized that patients admitted on a weekend will have worse in-hospital mortality rates when compared to those admitted on a weekday. Methods We used a national database to perform a cross-sectional study focusing on 12,365 patients with a primary diagnosis of HS from 2017-2019. The variables measured were weekend or weekday admission, age, gender, race, and zip income quartiles, with the latter four identified as confounding factors controlled for in the logistic regression analysis. Descriptive analyses were performed to determine frequencies, means, and significance. Statistical significance was set at p&amp;lt; 0.05.The multivariate binomial logistic regression was used to calculate the odds ratio (OR) for the identified outcomes. The primary outcome was in-hospital mortality. The secondary outcomes were morbidity factors (infection and wound dehiscence rates, postoperative complications), time from admission to first procedure, and resource utilization (total hospitalization charges and costs, and length of hospitalization). Results Weekend admission is not associated with worse inpatient mortality in patients with HS (p=0.345). From 2017-2019, 5 patients died, all of whom were admitted on a weekday. Compared to weekday, weekend admission had significantly lower incidences of wound dehiscence (0.38% vs 0%; p=0.007) and postoperative complications (0.24% vs 0%; p=0.035). No significant difference was observed for incidence of infection in weekday (0.43%) vs weekend admission (0.27%) (p=0.311). Weekend admission was also not found to have significant difference in the odds of contracting an infection (OR=0.74 (0.29-1.90); p=0.536). Weekend admission had significantly lower length of stay (mean days=6.40 vs 4.94; p=0.001), total charge ($64598.94 vs $44616.44; p&amp;lt; 0.001), and total cost ($14441.22 vs $10082.79; p&amp;lt; 0.001). Conclusions In contrast to previous studies focused on other pathologies that have shown increased morbidity, treatment metrics, and resource utilization on weekend admission, our study demonstrates that specifically for patients with HS, weekend admission is associated with lower rates of morbidity, length of stay, and charge. Applicability of Research to Practice Given that patients with HS who have a weekday admission have worse outcomes than a weekend admission, it is imperative for the medical team providing care to this group of patients on a weekday to be aware of this and begin to identify any potential factors.

PD34-10 IMPACT OF SEPSIS ON ADMISSIONS, RE ADMISSIONS AND MORTALITY FOLLOWING URETEROSCOPY

You have accessJournal of UrologyCME1 Apr 2023PD34-10 IMPACT OF SEPSIS ON ADMISSIONS, RE ADMISSIONS AND MORTALITY FOLLOWING URETEROSCOPY Naeem Bhojani, Brian Eisner, Rutugandha Paranjpe, Benjamin Cutone, Manoj Monga, and Ben H. Chew Naeem BhojaniNaeem Bhojani More articles by this author , Brian EisnerBrian Eisner More articles by this author , Rutugandha ParanjpeRutugandha Paranjpe More articles by this author , Benjamin CutoneBenjamin Cutone More articles by this author , Manoj MongaManoj Monga More articles by this author , and Ben H. ChewBen H. Chew More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003327.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-ureteroscopy sepsis is a morbid condition that requires significant healthcare utilization. We investigated all-cause inpatient mortality, rates of intensive care unit (ICU) and inpatient admissions and readmissions. We also examine the yearly trends in sepsis and inpatient mortality in patients undergoing ureteroscopy (URS) in the United States (US). METHODS: Retrospective analyses were conducted using the IBM MarketScan Database to identify patients ≥18 years who underwent URS. Three cohorts were analyzed: non-sepsis (control), non-severe sepsis, and severe sepsis (sepsis + organ dysfunction). All-cause inpatient mortality and healthcare utilization including ICU admissions, inpatient admissions and readmissions were reported. Annual trends for sepsis events and inpatient mortality post-URS were examined from 2015-2019. RESULTS: 109,496 URS patients were identified. 5.6% developed sepsis within 30 days of URS. Of the 5.6%, 4.1% developed non-severe sepsis and 1.5% developed severe sepsis. The 30-day all-cause inpatient mortality for the non-sepsis, non-severe sepsis and severe sepsis cohorts was 0.03%, 0.27% and 2.5%, respectively (p<0.001). Severe sepsis substantially increased the risk of 30-day all-cause inpatient mortality compared to patients who did not develop sepsis (HR: 49.5; 95% CI: 28.9-84.7; p<0.001). ICU admission rates were 1.5%, 19.8% 52.4% for the non-sepsis, non-severe sepsis, and severe sepsis cohorts, respectively (p<0.001). Inpatient admissions were 18.3%, 74.9%, and 76.9% (p<0.001), while readmissions were 7.1%, 12.0%, and 15.9% (p<0.001), for the non-sepsis, non-severe sepsis, and severe sepsis cohorts, respectively. From 2015 to 2019, the annual prevalence of sepsis post URS increased significantly yearly from 4.7%, 5.1%, 5.7%, 6.0%, to 6.6% (p<0.001), however the rate of inpatient mortality remained stable (Figure 1). CONCLUSIONS: Sepsis post-URS significantly increases the risk of 30-day all cause inpatient mortality and leads to a significant increase in hospital admissions, ICU admissions, and readmissions. Over the 5-year study period, the prevalence of sepsis post-URS increased by 40%. Urologists should be aware of the increasing prevalence of this potentially deadly post-operative complication. Source of Funding: Boston Scientific © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e924 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naeem Bhojani More articles by this author Brian Eisner More articles by this author Rutugandha Paranjpe More articles by this author Benjamin Cutone More articles by this author Manoj Monga More articles by this author Ben H. Chew More articles by this author Expand All Advertisement PDF downloadLoading ...

Association between ivermectin treatment and mortality in COVID-19: A hospital-based case-control study.

This study was designed to test the hypothesis that exposure to ivermectin in early disease prevents mortality due to COVID-19. A secondary objective was to see if the drug has any impact on the length of hospital stay among the survivors. It was a hospital-based retrospective case-control study conducted at a tertiary teaching hospital in India. All patients with a diagnosis of COVID-19 who were admitted between 1st April and 15th May 2021 and received inpatient care were included. Important variables like demographic details, dates of admission and discharge or death, symptoms at the time of admission, comorbidities, severity of illness at the time of admission, whether ivermectin was administered or not during the course of the illness and other treatments received as part of the standard of care were retrieved from the medical records. Of the 965 patients who received inpatient care, 307 died during their hospital stay while 658 were successfully discharged. The proportion of cases treated with ivermectin was 17.26% among the non-survivors (53/307) and 17.93% among the survivors (118/658). The effect was statistically insignificant (crude OR = 0.954; 95% CI: 0.668-1.364, P = 0.80). Among the survivors, the median length of stay was 11 days for patients who received ivermectin (IQR: 7-15) as well as for those who did not (IQR: 7-16). This study did not show any effect of ivermectin on in-patient mortality in patients with COVID-19 and there was no effect of the drug on the length of hospital stay among the survivors.

Predicting In-Hospital Mortality After Acute Myeloid Leukemia Therapy: Through Supervised Machine Learning Algorithms

Despite careful patient selection, induction chemotherapy for acute myeloid leukemia (AML) is associated with a considerable risk for treatment-related mortality (5%-20%). We evaluated machine learning (ML) algorithms trained using factors available at the time of admission for AML therapy to predict death during the hospitalization. We included AML discharges with age > 17 years who received inpatient chemotherapy from State Inpatient Database from Arizona, Florida, New York, Maryland, Washington, and New Jersey for years 2008-2014. The primary objective was to predict inpatient mortality in patients undergoing chemotherapy using covariates present before initiation of chemotherapy. ML algorithms logistic regression (LR), decision tree, and random forest were compared. 29,613 hospitalizations for patients with AML were included in the analysis each with 4,177 features. The median age was 58.9 (18-101) years, 13,689 (53.7%) were male, and 20,203 (69%) were White. The mean time from admission to chemotherapy was 3 days (95% CI, 2.9 to 3.1), and 2,682 (9.1%) died during the hospitalization. Both LR and random forest models achieved an area under the curve (AUC) score of 0.78, whereas decision tree achieved an AUC of 0.70. The baseline LR model with age yielded an AUC of 0.62. To clinically balance and minimize false positives, we selected a decision threshold of 0.7 and at this threshold, 51 of our test set of 5,923 could have potentially averted treatment-related mortality. Using readily accessible variables, inpatient mortality of patients on track for chemotherapy to treat AML can be predicted through ML algorithms. The model also predicted inpatient mortality when tested on different data representations and paves the way for future research.

End-Stage Renal Disease is Associated with Increased Inpatient Mortality in Patients Admitted for Atrial Fibrillation: Analysis of the National Inpatient Sample

IntroductionEnd-stage renal disease (ESRD) has been shown to affect different heart pathologies through its underlying pathogenesis of unabating chronic inflammation. Our study sought to estimate the impact of ESRD on clinical outcomes of hospitalizations for atrial fibrillation (AF) using a national database. Methods: We queried the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalization of adult patients with AF as a principal diagnosis with and without ESRD as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality, while the secondary outcomes were length of hospital stay (LOS), total hospital cost (THC), and Myocardial infarction (MI). Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results821,629 patients were admitted for AF; 2.5% (20,744) had underlying ESRD. Cohorts with ESRD vs No ESRD had a mean age of 67.4 years [CI 67.0 - 67.8] vs 70.9 years [CI 70.8 - 71.0]; male (51.6% vs 48.4%) and female (48.4% vs 51.6%). Compared to patients without ESRD, patients admitted with ESRD had a statistically significant increase in mortality (2.5% vs 0.9%, P<0.0001) and MI (5.9% vs 2.3%, P= <0.0001). ESRD also had greater LOS (4.7 days vs 3.3 days, P<0.0001) and THC ($55,677 vs $38,734, P<0.0001). ConclusionIn conclusion, ESRD resulted in increased mortality, LOS, THC, and MI in patients hospitalized with AF. Early kidney transplant in patients with concomitant AF may be needed to improve outcomes

#1324267: The Effect of Chronic Kidney Disease on the Clinical and Cardiovascular Outcomes of Hospital Admissions for Implantable Cardioverter Defibrillator or Cardiac Resynchronization Therapy Implantations

Implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) are, consecutively, the primary and secondary prevention strategies to accomplish sufficient dysrhythmias management. We aim to investigate the influence of chronic kidney disease (CKD) on cardiovascular outcomes and inpatient mortality in patients who are hospitalized for ICD or CRT implantations.

Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach.

Data are lacking on predicting inpatient mortality (IM) in patients admitted for inflammatory bowel disease (IBD). IM is a critical outcome; however, difficulty in its prediction exists due to infrequent occurrence. We assessed IM predictors and developed a predictive model for IM using machine-learning (ML). Using the National Inpatient Sample (NIS) database (2005-2017), we extracted adults admitted for IBD. After ML-guided predictor selection, we trained and internally validated multiple algorithms, targeting minimum sensitivity and positive likelihood ratio (+LR)≥80% and ≥3, respectively. Diagnostic odds ratio (DOR) compared algorithm performance. The best performing algorithm was additionally trained and validated for an IBD-related surgery sub-cohort. External validation was done using NIS 2018. In 398426 adult IBD admissions, IM was 0.32% overall, and 0.87% among the surgical cohort (n=40784). Increasing age, ulcerative colitis, IBD-related surgery, pneumonia, chronic lung disease, acute kidney injury, malnutrition, frailty, heart failure, blood transfusion, sepsis/septic shock and thromboembolism were associated with increased IM. The QLattice algorithm, provided the highest performance model (+LR: 3.2, 95% CI 3.0-3.3; area-under-curve [AUC]:0.87, 85% sensitivity, 73% specificity), distinguishing IM patients by 15.6-fold when comparing high to low-risk patients. The surgical cohort model (+LR: 8.5, AUC: 0.94, 85% sensitivity, 90% specificity), distinguished IM patients by 49-fold. Both models performed excellently in external validation. An online calculator (https://clinicalc.ai/im-ibd/) was developed allowing bedside model predictions. An online prediction-model calculator captured >80% IM cases during IBD-related admissions, with high discriminatory effectiveness. This allows for risk stratification and provides a basis for assessing interventions to reduce mortality in high-risk patients.

A New Insight Into Nonbacterial Thrombotic Endocarditis: A Systematic Review of Cases.

Nonbacterial thrombotic endocarditis is characterized by the presence of organized thrombi on cardiac valves, often associated with hypercoagulable states. There is a paucity of data regarding the predictors of mortality in patients with nonbacterial thrombotic endocarditis. Our primary aim was to identify predictors of in-hospital mortality in patients with nonbacterial thrombotic endocarditis. A systematic literature review of all published cases and case series was performed until May 2018 according to Preferred Reporting Items for Systematic Review and Meta-analyses statement guidelines. We applied random forest machine learning model to identify predictors of in-patient mortality in patients with nonbacterial thrombotic endocarditis. Our search generated a total of 163 patients (mean age, 46 ± 17 years; women, 69%) with newly diagnosed nonbacterial thrombotic endocarditis. The in-hospital mortality rate in the study cohort was 30%. Among the patients who died in the hospital, initial presentation of pulmonary embolism (12.2 vs. 2.6%), splenic (38.7 vs. 10.5%), and renal (40.8 vs. 9.6%) infarcts were higher compared to patients alive at the time of discharge. Higher rates of malignancy (71.4 vs. 39.4%, P = .0003) and lower rates of antiphospholipid syndrome (8.1 vs. 48.2%, P = .0001) were noted in deceased patients. Random forest machine learning analysis showed that older age, presence of antiphospholipid syndrome, splenic infarct, renal infarct, peripheral thromboembolism, pulmonary embolism, myocardial infarction, and mitral valve regurgitation were significantly associated with increased risk of in-hospital mortality. Patients admitted with nonbacterial thrombotic endocarditis have a high rate of in-hospital mortality. Factors including older age, presence of antiphospholipid syndrome, splenic/renal infarct, lower limb thromboembolism, pulmonary embolism, myocardial infarction, and mitral valve regurgitation were significantly associated with increased risk of in-hospital mortality in patients with nonbacterial thrombotic endocarditis.

S1080 Utilization of Endoscopic Retrograde Cholangiopancreatography (ERCP) in a Nationwide Cohort of Patients Admitted With Acute Biliary Pancreatitis With Cholangitis

Introduction: Acute pancreatitis (AP) is the most common gastrointestinal cause of hospital admissions in the United States, with biliary pancreatitis being the most common cause of acute pancreatitis. Acute Cholangitis is a bacterial infection of the biliary system and is most commonly caused by a complete or partial obstruction of the biliary tree by gall stones. One of the most important prognostic factors for acute cholangitis is the timing of biliary drainage. ACG guidelines for acute pancreatitis recommend that patients with AP and concurrent acute cholangitis should undergo ERCP within 24 h of admission. We aimed to estimate the impact of ERCP on hospitalization outcomes in this patient population. Methods: We collected data from the Healthcare Cost and Utilization Project- (HCUP) Nationwide Readmission Database- 2018. Patients admitted with acute biliary pancreatitis with concurrent cholangitis were identified and discharge weights were applied. Median and IQR were used to describe Continuous variables, and proportions were used with categorical variables. Comparison between groups was performed by Mann Whitney test for continuous variables and the Chi-Square test for Categorical variables. Results: We identified 3,981 index hospitalizations with acute biliary pancreatitis with cholangitis, 71.4% of whom received ERCP. Patient received ERCP had significantly lower mortality (3.3% vs. 7.1%, P< 0.001) compared to those who didn’t but performing ERCP was associated with increased length of stays (6; IQR: 4-9 vs. 5; IQR: 3-8 P< 0.001) and higher total costs of hospitalization ($68,904; IQR: $44,876 -$109,459 vs. $50,667; IQR: $28,694- $101,917, P< 0.001). Only 65.2% of ERCPs were performed within 24 hours of admission. Those who received ERCP within 24 hours had decreased LOS (5; IQR: 3-8 vs. 7; IQR: 5-11, P < 0.001), lower hospitalization costs ($63,263; IQR: $41,180-$102,942 vs. $76,958; IQR: $48,808-$128,660, P< 0.001) and lower 90-day readmission rates (15.1% vs. 19.9%, P= 0.006) compared to those who received ERCP after 24 hours of admission. (Table) Conclusion: Performing ERCP was associated with lower inpatient mortality in patients admitted with acute biliary pancreatitis with cholangitis and performing the ERCP within 24 hours of admission was associated with decreased length of stays, hospitalization costs, and 90-day readmission rates. Our study supports ACG guidelines and urges clinicians to adhere to the recommendations to improve outcomes. Table 1. - Demographic and clinical characteristics of patients with biliary pancreatitis with cholangitis ERCP performed NoN= 1,137 YesN= 2,844 P-value Median Age (IQR) 71 (59- 81) 72 (61-81) 0.452 Sex (%) Male 544 (47.8) 1,453 (51.1) 0.064 Female 593 (52.2) 1391 (48.9) Hypertension (%) 471 (41.4) 1,357 (47.7) < 0.001 Diabetes mellitus (%) 356 (31.3) 927 (32.6) 0.433 Dyslipidemia (%) 466 (41) 1,311 (46.1) 0.004 Obesity (%) 270 (23.7) 640 (22.5) 0.399 COPD (%) 134 (11.8) 288 (10.1) 0.124 Acute kidney failure (%) 342 (30.1) 865 (30.4) 0.835 CKD (%) 188 (16.5) 546 (19.2) 0.051 Heart failure (%) 225 (19.8) 424 (14.9) < 0.001 Cirrhosis (%) 33 (2.9) 115 (4) 0.086 ICU admission (%) 20 (1.8) 36 (1.3) 0.232 Bed size of the hospital (%) Small 195 (17.2) 319 (11.2) < 0.001 Medium 357 (31.4) 764 (26.9) Large 585 (51.5) 1,761 (61.9) Insurance (%) Medicare 711 (62.5) 1901 (66.8) 0.002 Medicaid 91 (8) 243 (8.5) Private insurance 267 (23.5) 558 (19.6) Self-pay 30 (2.6) 85 (3) Other 8 (0.7) 4 (0.1) No charge 30 (2.6) 54 (1.9) 90-day readmission (%) 155 (18.7) 359 (16.9) 0.261

Association between statin use and the prognosis of patients with acute myocardial infarction complicated with diabetes.

BackgroundType 2 diabetes leads to an increase in the prevalence of lipid abnormalities, which increases the risk of cardiovascular disease. Therefore, current guidelines generally recommend the use of moderate or high-intensity statins in patients with type 2 diabetes. There are still few studies on the overall risk benefit balance of statins for acute myocardial infarction (AMI) patients with diabetes. Compared with other types of lipid-lowering drugs, the advantage of statins for the prognosis of patients with AMI has not yet been determined. We investigated the effects of statins and non-statins on intensive care unit (ICU) and inpatient mortality in patients with AMI and diabetes.MethodsThis study retrospectively collected all patients with AMI and diabetes in the Medical Information Mart Intensive Care-IV database. We assessed ICU and in-hospital mortality rates during hospitalization in both groups. The clinical end point was in-hospital mortality and ICU mortality. Kaplan-Meier and Cox proportional-hazards regression models were applied to analyze the correlation between the two groups and the outcomes.ResultsData on 1,315 patients with AMI and diabetes were collected, among which 1,211 used statins during hospitalization. The overall in-hospital mortality of patients with AMI and diabetes was 17.2%, and the total ICU mortality was 12.6%. The in-hospital mortality was lower for the statin group than for the non-statin group (13.9% and 55.8%, respectively). Kaplan-Meier survival curves demonstrated that survival probability was higher in the statin group than in the non-statin group. In the cohort without hyperlipidemia, the statin group had lower risks of ICU death (HR = 0.12, 95% CI = 0.04–0.40) and in-hospital death (HR = 0.36, 95% CI = 0.16–0.84) compared with the non-statin group.ConclusionsStatins can significantly reduce ICU and in-hospital mortality rates in patients with AMI and diabetes. Even in the population without hyperlipidemia, statins can still reduce the mortality in patients with AMI and diabetes.