Lower Risk Of In-hospital Mortality Research Articles

Protein and Energy Intake Assessment and Their Association With In-Hospital Mortality in Critically Ill COVID-19 Patients: A Prospective Cohort Study.

Background and Aim: It is partially known that nutritional intake could alleviate proteolysis and course of disease severity in patients with COVID-19; however, not enough data are available in this regard. The present study aimed to assess protein and energy intake and their association with in-hospital mortality in critically ill COVID-19 patients.Methods: A total of 126 patients with COVID-19, who were critically ill, ≥5 days and a subset of 111 patients in ICU ≥10 days completed the present prospective observational cohort study.Results: Protein and energy intakes on Day 5 of ICU admission in survivors were 46 and 58% of target values, respectively. These values in non-survivors were 42 and 50% of target values, respectively (p < 0.05). In the sample ≥10 days, protein and energy intakes in survivors reached 64 and 87% of target values, respectively, without statistically significant differences with non-survivors. In the sample ≥5 days, Cox proportional hazard regression was adjusted for GLIM, APACHE II, comorbidity, and age; the results indicated that the patients with protein and energy intake lower than 0.59 g/kg/day and 14 kcal/kg/day, had ~2-fold mortality hazard (protein: HR, 2.38; 95% CI, 1.40–4.03; P = 0.001 and energy: HR, 2.23; 95% CI, 1.27–3.92; P = 0.005).Conclusion: Actual protein and energy intakes in critically ill patients with COVID-19 are in suboptimal levels compared with goal recommendations in these patients. Moreover, higher amounts of protein and energy intakes in the early acute phase were significantly associated with better survival and lower risk of in-hospital mortality.

Feasibility and Outcomes of a Standardized Management Protocol for Acute Exacerbation of Interstitial Lung Disease.

Despite the high mortality of acute exacerbations of interstitial lung disease (AE-ILD), there is minimal evidence to guide management decisions. We aimed to assess the feasibility and outcomes of a standardized management protocol for AE-ILD. We performed a retrospective cohort study of patients with AE-ILD admitted to hospital between January 2015 and August 2019. Patients were managed with a standardized protocol including chest computed tomography (CT) at diagnosis, pulse corticosteroid treatment, and a follow-up CT 7 days after corticosteroid pulse. The association between idiopathic pulmonary fibrosis (IPF) versus non-IPF diagnosis and transplant-free survival within 1-year of AE-ILD was assessed using adjusted Cox proportional hazards regression survival analysis. Associations with CT chest improvement 7 days after corticosteroid pulse were secondarily assessed. 89 patients with AE-ILD were identified. 1-year transplant-free and overall survival were 20.2 and 51.7%, respectively. Protocol adherence to pulse corticosteroids was high (95.5%). A diagnosis of IPF was associated with higher risk of death or transplant at 1-year versus a non-IPF diagnosis [hazard ratio (HR) 2.23, 95% CI 1.19-4.17, p = 0.012]. There were no significant associations with 7-day CT improvement; however, CT improvement was associated with higher transplant-free survival (p = 0.02) and a lower risk of in-hospital mortality (χ2 = 7.06, p = 0.01) on unadjusted analysis. IPF is associated with a higher risk of death or transplant at 1-year as compared to a non-IPF diagnosis in patients with AE-ILD managed using a standardized protocol. Improvement on CT chest 7 days after corticosteroid pulse is associated with better survival.

Inflammatory and Hypercoagulable Biomarkers and Clinical Outcomes in COVID-19 Patients.

Systemic inflammation and hypercoagulopathy are known pathophysiological processes of coronavirus disease 2019 (COVID-19), particularly in patients with known cardiovascular disease or its risk factors (CVD). However, whether a cumulative assessment of these biomarkers at admission could contribute to the prediction of in-hospital outcomes remains unknown. The CLAVIS-COVID registry was a Japanese nationwide retrospective multicenter observational study, supported by the Japanese Circulation Society. Consecutive hospitalized patients with pre-existing CVD and COVID-19 were enrolled. Patients were stratified by the tertiles of CRP and D-dimer values at the time of admission. Multivariable Cox proportional hazard models were constructed. In 461 patients (65.5% male; median age, 70.0), the median baseline CRP and D-dimer was 58.3 (interquartile range, 18.2–116.0) mg/L and 1.5 (interquartile range, 0.8–3.0) mg/L, respectively. Overall, the in-hospital mortality rate was 16.5%, and the rates steadily increased in concordance with both CRP (5.0%, 15.0%, and 28.2%, respectively p < 0.001) and D-dimer values (6.8%, 19.6%, and 22.5%, respectively p = 0.001). Patients with the lowest tertiles of both biomarkers (CRP, 29.0 mg/L; D-dimer, 1.00 mg/L) were at extremely low risk of in-hospital mortality (0% until day 50, and 1.4% overall). Conversely, the elevation of both CRP and D-dimer levels was a significant predictor of in-hospital mortality (Hazard ratio, 2.97; 95% confidence interval, 1.57–5.60). A similar trend was observed when the biomarker threshold was set at a clinically relevant threshold. In conclusion, the combination of these abnormalities may provide a framework for rapid risk estimation for in-hospital COVID-19 patients with CVD.

Impact of Sex Differences on Mortality in Patients With Sepsis After Trauma: A Nationwide Cohort Study.

ObjectiveSepsis is the leading cause of death in intensive care units, and sepsis after trauma is associated with increased mortality rates. However, the characteristics of sepsis after trauma remain unknown, and the influence of sex on mortality remains controversial. This study aimed to assess the role of sex in in-hospital mortality in patients with sepsis after trauma.MethodsWe performed a retrospective cohort study involving several emergency hospitals (n=288) in Japan. The data of patients with trauma who developed sepsis after admission from 2004 to 2019 were obtained from the Japan Trauma Data Bank. We divided the patients into two groups according to sex and compared their in-hospital mortality. We also performed subgroup analysis limited to the elderly population (age ≥ 65 years) and evaluated in-hospital mortality between men and women.ResultsA total of 1935 patients met the inclusion criteria during the study period. Of these, 1204 (62.2%) were allocated to the male group and 731 (37.8%) to the female group. Multivariable Cox proportional-hazards analysis showed a significantly lower risk of in-hospital mortality in the female group than in the male group (hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.62–0.89; p=0.001). In the subgroup analysis, multivariable Cox proportional hazards still showed significantly lower risks of in-hospital mortality in the female group than in the male group (HR: 0.72, 95% CI: 0.58–0.88; p=0.002).ConclusionThe present study shows a significantly increased survival in the female group when compared to that in the male group of patients with sepsis after trauma. The underlying mechanism remains unclear, and further investigations are required.

Endovascular Versus Open Surgical Repair for Ruptured Descending Aortic Pathologies: A Systematic Review and Meta-Analysis of Observational Studies.

Ruptured descending thoracic aorta (rDTA) is an harmful condition requiring emergent treatment. Thoracic endovascular aortic repair (TEVAR) is replacing the traditional open repair in the majority of descending thoracic aortic disease. An unanimous agreement regarding the optimal approach to treat rDTA has not been reached yet due to the lack of evidences supporting the improvement of long-term survival. The present meta-analysis of observational cohort studies aims to estimate the outcome of endovascular (TEVAR) versus surgical (OR) approach in the treatment of rDTA. Prisma Statement for performing and reporting meta-analysis has been used. MEDLINE, Scopus and the Cochrane Library databases were searched. A meta-analysis of observational cohort studies that examined the outcomes after OR and TEVAR for the management of rDTA was performed. A total of 10,466 patients with rDTA were screened. Endovascular therapy was associated with a lower risk of in-hospital mortality compared with open repair (Risk Ratio[RR] 0.63; 95% CI0.57-0.70). The risk of stroke rate was not statistically different between endovascular versus open approach (RR0.86; 95% CI0.62-1.19). Endovascular treatment had benefits on paraplegia (RR0.70; 95% CI0.55-0.91) and other neurological complications (RR0.24; 95% CI0.10-0.56). TEVAR was associated with lower renal failure, cardiac complications and vascular injuries. Late mortality (Hazard Ratio[HR] 0.84; 95% CI0.63-1.13) and re-intervention rate (RR1.48; 95% CI0.80-2.74) were not significantly different between TEVAR and OR. TEVAR seems to offer advantages in terms of early mortality and complications rate. Moreover, data on late mortality and re-intervention are encouraging to consider endovascular treatment comparable to open repair for acute thoracic aorta emergency on long-term follow-up.

Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study

BackgroundGlucocorticoid therapy has emerged as an effective therapeutic option in hospitalized patients with coronavirus disease 2019 (COVID-19). This study aimed to focus on the impact of relevant clinical and laboratory factors on the protective effect of glucocorticoids on mortality. MethodsA sub-analysis was performed of the multicenter Cardio-COVID-Italy registry, enrolling consecutive patients with COVID-19 admitted to 13 Italian cardiology units between 01 March 2020 and 09 April 2020. The primary endpoint was in-hospital mortality. ResultsA total of 706 COVID-19 patients were included (349 treated with glucocorticoids, 357 not treated with glucocorticoids). After adjustment for relevant covariates, use of glucocorticoids was associated with a lower risk of in-hospital mortality (adjusted HR 0.44; 95% CI 0.26–0.72; p = 0.001). A significant interaction was observed between the protective effect of glucocorticoids on mortality and PaO2/FiO2 ratio on admission (p = 0.042), oxygen saturation on admission (p = 0.017), and peak CRP (0.023). Such protective effects of glucocorticoids were mainly observed in patients with lower PaO2/FiO2 ratio (<300), lower oxygen saturation (<90%), and higher CRP (>100 mg/L). ConclusionsThe protective effects of glucocorticoids on mortality in COVID-19 were more evident among patients with worse respiratory parameters and higher systemic inflammation.

Impact of rate control in hospitalized patients with atrial fibrillation and sepsis: a systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial Fibrillation (AF) is a common complication in patients with sepsis, and imposes a worse prognosis and challenging clinical management. Administration of antiarrhythmics is often needed, to achieve rate or rhythm control, especially in the occurrence of AF with rapid ventricular response; however, it is unclear whether different classes of antiarrhythmics are associated with better outcomes in patients with sepsis and AF. Methods We performed a systematic review and meta-analysis according to PRISMA Guidelines. Pubmed and EMBASE databases were systematically searched for studies reporting outcomes in patients with sepsis and AF, according to the use of Beta-blockers (BBs), calcium-channel blockers (CCBs), digoxin and amiodarone. Random-effect models were used to provide pooled estimates; fixed-effect models were also performed as a sensitivity analysis. Results Among 4,166 studies, 2 articles were included from the literature search, and an additional 1 from the author’s knowledge, yielding a total of 40,593 patients with sepsis and AF included. According to the data available from the included studies, the meta-analysis was performed only for in-hospital mortality. BBs were associated with a reduced risk of in-hospital mortality compared to amiodarone (OR 0.52, 95% CI: 0.46-0.58; I2 = 0%, Figure 1, Panel C), while no significant differences were observed for BBs. vs. CCBs (Figure 1, Panel A) and for BBs vs. digoxin (Figure 1, Panel B). In the pre-specified sensitivity analysis using a fixed-effect model, BBs resulted associated with a lower risk of in-hospital mortality compared with both CCBs and digoxin). Conclusion In patients with AF during sepsis, BBs were associated with reduced risk of in-hospital mortality, compared to amiodarone; inconclusive results emerged for the comparisons between BBs and CCBs or digoxin, although with a benefit of BBs observed in the fixed-effect models. Further studies are needed to provide definitive data and to guide physicians in the choice of the best rate control strategy in this clinical setting. Abstract Figure.

Association Between Timing of Extracorporeal Membrane Oxygenation and Clinical Outcomes in Refractory Cardiogenic Shock.

The aim of this study was to investigate whether earlier extracorporeal membrane oxygenation (ECMO) support is associated with improved clinical outcomes in patients with refractory cardiogenic shock (CS). The prognosis of patients with refractory CS receiving ECMO remains poor. However, little is known about the association between the timing of ECMO implantation and clinical outcomes in these patients. From a multicenter registry, 362 patients with refractory CS who underwent ECMO between January 2014 and December 2018 were identified. Participants were classified into 3 groups according to tertiles of shock-to-ECMO time (early, intermediate, and late ECMO). Inverse probability of treatment weighting was conducted to adjust for baseline differences among the groups, followed by a weighted Cox proportional hazards regression analysis to calculate hazard ratios and 95% confidence intervals for 30-day mortality associated with each ECMO time group. The overall 30-day mortality rate was 40.9%. The risk for 30-day mortality was lower in the early group than in the late group (hazard ratio: 0.53; 95% confidence interval: 0.28 to 0.99). Early ECMO support was also associated with lower risk for in-hospital mortality, ECMO weaning failure, composite of all-cause mortality or rehospitalization for heart failure at 1 year, all-cause mortality at 1 year, and poor neurological outcome at discharge. However, the incidence of adverse events, including stroke, limb ischemia, ECMO-site bleeding, and gastrointestinal bleeding, did not differ significantly among the groups. Earlier ECMO support was associated with improved clinical outcomes in patients with refractory CS.

In-Hospital Outcomes and Trends of Endovascular Intervention vs Surgical Revascularization in Octogenarians With Peripheral Artery Disease

A retrospective review of the National Inpatient Sample (NIS) database from 2002 to 2014. Of 394,504 octogenarian patients, 184,926 (47%) underwent surgical revascularization and 209,578 (53%) underwent endovascular intervention (EVI). Multivariate analysis revealed that the EVI group had significantly lower in-hospital mortality, myocardial infarction, stroke, acute kidney injury, and limb amputation compared with the surgical group. The EVI group had a significantly greater risk of bleeding and vascular complications compared with the surgical group. The use of EVI in octogenarians is associated with a lower risk of in-hospital mortality and adverse cardiovascular and limb outcomes compared with surgical revascularization.

Infection management processes in intensive care and their association with mortality.

ICU-specific tables of antimicrobial susceptibility for key microbial species ('antibiograms'), antimicrobial stewardship (AMS) programmes and routine rounds by infectious diseases (ID) physicians are processes aimed at improving patient care. Their impact on patient-centred outcomes in Australian and New Zealand ICUs is uncertain. To measure the association of these processes in ICU with in-hospital mortality. The Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database and Critical Care Resources registry were used to extract patient-level factors, ICU-level factors and the year in which each process took place. Descriptive statistics and hierarchical logistic regression were used to determine the relationship between each process and in-hospital mortality. The study included 799 901 adults admitted to 173 ICUs from July 2009 to June 2016. The proportion of patients exposed to each process of care was 38.7% (antibiograms), 77.5% (AMS programmes) and 74.0% (ID rounds). After adjusting for confounders, patients admitted to ICUs that used ICU-specific antibiograms had a lower risk of in-hospital mortality [OR 0.95 (99% CI 0.92-0.99), P = 0.001]. There was no association between the use of AMS programmes [OR 0.98 (99% CI 0.94-1.02), P = 0.16] or routine rounds with ID physicians [OR 0.96 (99% CI 0.09-1.02), P = 0.09] and in-hospital mortality. Use of ICU-specific antibiograms was associated with lower in-hospital mortality for patients admitted to ICU. For hospitals that do not perform ICU-specific antibiograms, their implementation presents a low-risk infection management process that might improve patient outcomes.

Association of Nutritional Support With Clinical Outcomes in Malnourished Cancer Patients: A Population-Based Matched Cohort Study.

Malnutrition is prevalent in hospitalized cancer patients and has been associated with poor therapy response and unfavorable clinical outcome. While recent studies have shown a survival benefit through nutritional support in a hospitalized malnourished medical population including cancer patients, we aimed to investigate the association of nutritional support with in-hospital mortality and other clinical outcomes in a nationwide inpatient cancer population. In this population-based cohort study, using a large Swiss administrative claims database from April 2013 to December 2018, we created two cohorts of malnourished cancer patients on medical wards. We generated two pairwise cohorts of malnourished patients who received nutritional support by 1:1 propensity-score matching to patients not receiving nutritional support. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were 30-days all-cause hospital readmission and discharge to a post-acute care facility. To account for disease activity, we stratified patients either admitted for cancer as main diagnosis or admitted with cancer as comorbidity. Among 1,851,498 hospitalizations on medical ward, we identified a total of 32,038 malnourished cancer patients. After matching, 11,906 (37%) cases were included in the “cancer main diagnosis cohort” and 5,954 (18.6%) in the “cancer comorbidity cohort.” Patients prescribed a nutritional support showed a lower in-hospital mortality in both cohorts as compared to their respective matched controls not receiving nutritional support [cancer main diagnosis cohort: 15.4 vs. 19.4 %, OR 0.76 (95% CI 0.69–0.83); cancer comorbidity cohort: 7.4 vs. 10.2%, OR 0.71 (95% CI 0.59–0.85)]. While we found no difference in 30-days readmission rates, discharge to a post-acute care facility was less frequent in the nutritional support group of both cohorts. In this large cohort study, nutritional support in hospitalized patients with either cancer as main diagnosis or comorbidity was associated with a lower risk of in-hospital mortality and discharge to a post-acute care facility.

Clinical outcomes and prognostic factors for prolonged mechanical ventilation in patients with acute stroke and brain trauma

Neurological dysfunction is a common condition necessitating prolonged mechanical ventilation (PMV). We investigated the clinical features and outcomes of patients with acute neurological diseases requiring PMV.This retrospective observational study was conducted at the Respiratory Care Center (RCC) of Chang Gung Memorial Hospital, Taiwan, between January 2011 and January 2014. The main outcome was weaning success, defined as successful withdrawal from mechanical ventilator support for more than 5 days.The study included 103 patients with acute stroke and brain trauma receiving PMV. Weaning success was reported in 63 (61%) patients and weaning failure was reported in 40 (39%) patients. Patients in the weaning failure group were older and had a lower RCC Glasgow Coma Scale (GCS) score (6.0 vs 7.9, p = 0.005), lower albumin level (2.8 vs 3.1, p = 0.015), longer RCC stay (28.7 vs 21.3 days, p = 0.017), and higher in-hospital mortality rate (47% vs 9%, p < 0.01). Multivariate analysis revealed that reduced RCC GCS score is an independent prognostic factor for weaning failure (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.05-1.46, p = 0.016) and that per unit increase of RCC GCS score is associated with a lower risk of in-hospital mortality (OR = 0.83, 95% CI = 0.70-0.96, p = 0.019).Reduced RCC GCS score is an independent prognostic factor for weaning failure, and is associated with increased in-hospital mortality rates in patients with acute stroke and brain trauma requiring PMV.

Association between use of Qingfei Paidu Tang and mortality in hospitalized patients with COVID-19: A national retrospective registry study

BackgroundQingfei Paidu Tang (QPT), a formula of traditional Chinese medicine, which was suggested to be able to ease symptoms in patients with Coronavirus Disease 2019 (COVID-19), has been recommended by clinical guidelines and widely used to treat COVID-19 in China. However, whether it decreases mortality remains unknown. PurposeWe aimed to explore the association between QPT use and in-hospital mortality among patients hospitalized for COVID-19. Study designA retrospective study based on a real-world database was conducted. MethodsWe identified patients consecutively hospitalized with COVID-19 in 15 hospitals from a national retrospective registry in China, from January through May 2020. Data on patients’ characteristics, treatments, and outcomes were extracted from the electronic medical records. The association of QPT use with COVID-19 related mortality was evaluated using Cox proportional hazards models based on propensity score analysis. ResultsOf the 8939 patients included, 28.7% received QPT. The COVID-19 related mortality was 1.2% (95% confidence interval [CI] 0.8% to 1.7%) among the patients receiving QPT and 4.8% (95% CI 4.3% to 5.3%) among those not receiving QPT. After adjustment for patient characteristics and concomitant treatments, QPT use was associated with a relative reduction of 50% in-hospital COVID-19 related mortality (hazard ratio, 0.50; 95% CI, 0.37 to 0.66 p < 0.001). This association was consistent across subgroups by sex and age. Meanwhile, the incidences of acute liver injury (8.9% [95% CI, 7.8% to 10.1%] vs. 9.9% [95% CI, 9.2% to 10.7%]; odds ratio, 0.96 [95% CI, 0.81% to 1.14%], p = 0.658) and acute kidney injury (1.6% [95% CI, 1.2% to 2.2%] vs. 3.0% [95% CI, 2.6% to 3.5%]; odds ratio, 0.85 [95% CI, 0.62 to 1.17], p = 0.318) were comparable between patients receiving QPT and those not receiving QPT. The major study limitations included that the study was an observational study based on real-world data rather than a randomized control trial, and the quality of data could be affected by the accuracy and completeness of medical records. ConclusionsQPT was associated with a substantially lower risk of in-hospital mortality, without extra risk of acute liver injury or acute kidney injury among patients hospitalized with COVID-19.

Patient Characteristics and Clinical Outcomes of Type 1 Versus Type 2 Myocardial Infarction

BackgroundType 2 myocardial infarction (MI) patients may have different characteristics and outcomes when compared with type 1 MI. ObjectivesThe purpose of this study was to compare patients with type 1 MI to those with type 2 MI in the United States. MethodsUsing the Nationwide Readmissions Database, MI patients were categorized over the 3 months following the introduction of an International Classification of Diseases-10th Revision code specific for type 2 MI. Baseline characteristics and inpatient and post-discharge outcomes among both cohorts were compared. ResultsThere were 216,657 patients with type 1 MI, 37,765 patients with type 2 MI, and 1,525 patients with both type 1 and 2 MI. Patients with type 2 MI were older (71 years vs. 69 years; p < 0.001), were more likely to be women (47.3% vs. 40%; p < 0.001), and had higher prevalence of heart failure (27.9% vs. 10.9%; p < 0.001), kidney disease (35.7% vs. 25.7%; p < 0.001), and atrial fibrillation (31% vs. 21%; p < 0.001). Rates of coronary angiography (10.9% vs. 57.3%; p < 0.001), percutaneous coronary intervention (1.7% vs. 38.5%; p < 0.001), and coronary artery bypass grafting (0.4% vs. 7.8%; p < 0.001) were lower among type 2 MI patients. Patients with type 2 MI had lower risk of in-hospital mortality (adjusted odds ratio: 0.57 [95% confidence interval: 0.54 to 0.60]) and 30-day MI readmission (adjusted odds ratio: 0.46 [95% confidence interval: 0.35 to 0.59]). There was no difference in risk of 30-day all-cause or heart failure readmission. ConclusionsPatients with type 2 MI have a unique cardiovascular phenotype when compared with type 1 MI, and are managed in a heterogenous manner. Validated management strategies for type 2 MI are needed.

In-Hospital Outcomes and Trends of Endovascular Intervention vs Surgical Revascularization in Octogenarians With Peripheral Artery Disease

It is unknown whether endovascular intervention (EVI) is associated with superior outcomes when compared with surgical revascularization in octogenarian. National Inpatient Sample (NIS) database was used to compare the outcomes of limb revascularization in octogenarians who had surgical revascularization versus EVI. The NIS database's information on PAD patients ≥80-year-old who underwent limb revascularization between 2002 and 2014 included 394,504 octogenarian patients, of which 184,926 underwent surgical revascularization (46.9%) and 209,578 underwent EVI (53.1%). Multivariate analysis was performed to examine in-hospital outcomes. Trend over time in limb revascularization utilization was examined using Cochrane-Armitage test. EVI group had lower odds of in-hospital mortality (adjusted odds ratio [aOR]: 0.61 [95% CI: 0.58 to 0.63], myocardial infarction (aOR: 0.84 [95% CI: 0.81 to 0.87]), stroke (aOR: 0.93 [95% CI: 0.89 to 0.96]), acute kidney injury (aOR: 0.79 [95% CI: 0.77 to 0.81]), and limb amputation (aOR: 0.77 [95% CI: 0.74 to 0.79]) compared with surgical group (p < 0.001 for all). EVI group had higher risk of bleeding (aOR: 1.20 [95% CI: 1.18 to 1.23]) and vascular complications (3.2% vs 2.7%, aOR: 1.25 [95% CI: 1.19 to 1.30]) compared with surgical group (p < 0.001 for all). Within study period, EVI utilization increased in octogenarian patients from 2.6% to 8.9% (ptrend < 0.001); whereas use of surgical revascularization decreased from 11.6% to 5.2% (ptrend < 0.001). In conclusion, the utilization of EVI in octogenarians is increasing, and associated with lower risk of in-hospital mortality and adverse cardiovascular and limb outcomes as compared with surgical revascularization.

Short-Term Outcomes of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Kidney Transplant Recipients (from the US Nationwide Representative Study)

Kidney transplant recipients (KTRs) are considered high-risk patients for surgical interventions. Transcatheter aortic valve implantation (TAVI) has been introduced as an alternative to surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) at high operative risk. However, the outcomes of TAVI compared with SAVR KTRs have not been well-studied in nationally representative data. Patients with prior history of functioning kidney transplant who were hospitalized for TAVI and SAVR between January 2012 and December 2017 were identified retrospectively in the Nationwide Readmissions Database. Our study included 762 TAVI and 1,278 SAVR KTRs. Compared with SAVR, TAVI patients generally had higher rates of co-morbidities with lower risk of in-hospital mortality (3.1% vs 6.3, p = 0.002), blood transfusion (11.5% vs 38.6%, p <0.001), acute myocardial infarction (3.9% vs 6.5%, p = 0.16), acute kidney injury (24.5% vs 42.1%, p <0.001), sepsis (3.9% vs 9.5%, p <0.001) and discharge with disability (42.6% vs 68.4%, p <0.001). However, the rate of permanent pacemaker implantation was significantly higher in TAVI group (11.4% vs 3.9%, p <0.001). Of note, in-hospital stroke and 30-day readmission were comparable between both groups. These findings were confirmed after adjusting for other co-morbidities. TAVI is growing as a valid and safe alternative for KTRs with severe AS.

Blood Eosinophils and Clinical Outcome of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Background: Numerous studies have shown the association between eosinophilia and clinical outcomes of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). But the evidences are lack of consensus. Objective: The aim of this meta-analysis was to conduct a pooled analysis of outcome comparing eosinophilic (EOS) AECOPD and non-EOS AECOPD patients. Methods: We included PubMed, EMBASE, Web of Science, and Cochrane databases up to 2020 to retrieve articles. Randomized controlled trials and quasi-experimental studies about patients with and without EOS AECOPD in terms of in-hospital mortality, length of hospital stay, comorbidities, forced expiratory volume in 1 s (FEV1), gender, and BMI were included preclinical studies, review articles, editorials, commentaries, conference abstracts, and book chapters were excluded. The methodologic assessment of studies was performed with the Newcastle-Ottawa Scale and Cochran scale. Comprehensive Rev Man 5 was used for the statistical analysis. Results: Twenty-one studies with 18,041 patients fulfilled the inclusion criteria and were used in this meta-analysis. Comparing to the non-EOS group, those with EOS AECOPD patients had a lower risk for in-hospital mortality (odds ratio (OR) = 0.59, 95% confidence interval [CI] 0.36–0.95, p = 0.03), shorter length of hospital stay (OR = −0.72, 95% CI −1.44 to −0.00, p = 0.05), better FEV1 (mean difference = 0.14, 95% CI 0.08–0.20, p < 0.00001), and a lower risk of arrhythmias (OR = 1.50, 95% CI 1.01–2.21, p = 0.04). In addition, the non-EOS group had a higher percentage of male (OR = 1.34, 95% CI 1.15–1.56, p = 0.0002) than EOS group. The rate of steroid use (OR = 0.82, 95% CI 0.47–1.42, p = 0.48) and BMI (mean difference = 0.43, 95% CI −0.18 to 1.05, p = 0.17] had no difference between 2 groups. Conclusion: The results of our meta-analysis suggest that EOS AECOPD patients have a better clinical outcome than non-EOS AECOPD patients in terms of length of hospital stay, in-hospital mortality, FEV1, and risk of arrhythmias. In addition, the non-EOS AECOPD patients have higher percentage of male than EOS AECOPD patients.

Clinical Outcomes With the Use of Prophylactic Versus Therapeutic Anticoagulation in Coronavirus Disease 2019.

Objectives:To determine the impact of anticoagulation on inhospital mortality among coronavirus disease 2019-positive patients with the a priori hypothesis that there would be a lower risk of inhospital mortality with use of preemptive therapeutic over prophylactic dose enoxaparin or heparin.Design Setting:Retrospective cohort study from April 1, 2020, to April 25, 2020. The date of final follow-up was June 12, 2020 Two large, acute-care hospitals in Western Connecticut.Patients:Five hundred and one inpatients were identified after discharge as 18 years or older and positive for severe acute respiratory syndrome coronavirus 2. The final sample size included 374 patients after applying exclusion criteria. Demographic variables were collected via hospital billing inquiries, whereas the clinical variables were abstracted from patients’ medical records.Exposure:Preemptive enoxaparin or heparin at a therapeutic or prophylactic dose.Main Results:When comparing treatments through multivariable analysis, risk of inhospital mortality was 2.3 times greater in patients receiving preemptive therapeutic anticoagulation (95% CI = 1.0–4.9; p = 0.04). Additionally, the average treatment effects were higher (β = 0.11, p = 0.01) in the therapeutic group.Conclusions:An increase in inhospital mortality was observed among patients on preemptive therapeutic anticoagulation. Thus, in the management of coronavirus disease 2019 and its complications, we recommend further research and cautious use of preemptive therapeutic over prophylactic anticoagulation.

What Does a Diagnosis of Depression Mean for Patients Undergoing Colorectal Surgery?

BackgroundDepression has been linked to increased morbidity and mortality in patients after surgery. The purpose of this study is to investigate the impact of documented depression diagnosis on in-hospital postoperative outcomes of patients undergoing colorectal surgery. Materials and methodsPatients from the National Inpatient Sample (2002-2017) who underwent proctectomies and colectomies were included. The outcomes measured included total hospital charge, length of stay, delirium, wound infection, urinary tract infection (UTI), pneumonia, deep vein thrombosis, pulmonary embolism, mortality, paralytic ileus, leak, and discharge trends. Multivariable logistic and Poisson regression analyses were performed. ResultsOf the 4,212,125 patients, depression diagnosis was present in 6.72% of patients who underwent colectomy and 6.54% of patients who underwent proctectomy. Regardless of procedure type, patients with depression had higher total hospital charges and greater rates of delirium, wound infection, UTI, leak, and nonroutine discharge, with no difference in length of stay. On adjusted analysis, patients with a depression diagnosis who underwent colectomies had increased risk of delirium (odds ratio (OR) 2.11, 95% confidence interval (CI) 1.93-2.32), wound infection (OR 1.08, 95% CI 1.03-1.12), UTI (OR 1.15, 95% CI 1.10-1.20), paralytic ileus (OR 1.06, 95% CI 1.03-1.09), and leak (OR 1.37, 95% CI 1.30-1.43). Patients who underwent proctectomy showed similar results, with the addition of significantly increased total hospital charges among the depression group. Depression diagnosis was independently associated with lower risk of in-hospital mortality (colectomy OR 0.58, 95% CI 0.53-0.62; proctectomy OR 0.72, 95% CI 0.55-0.94). ConclusionsPatients with a diagnosis of depression suffer worse in-hospital outcomes but experience lower risk of in-hospital mortality after undergoing colorectal surgery. Further studies are needed to validate and fully understand the driving factors behind this.

Non-O blood group is associated with lower risk of in-hospital mortality in non-surgically managed patients with type A aortic dissection

BackgroundThe association between different ABO blood groups and mortality of aortic dissection (AD) remains controversial. This study aimed to examine whether different ABO blood groups affect the prognosis of AD.MethodsDemographic and clinical data were collected from 877 patients diagnosed with AD from 2015 to 2019 in the First Affiliated Hospital of Shantou University Medical College. The association between in-hospital mortality of AD patients and ABO blood group was analyzed using Cox proportional hazards regression models.ResultsThis retrograde cohort study demonstrated that for 877 patients, male gender, non-O blood group, Stanford type B AD (TBAD), higher presenting systolic and diastolic blood pressure, and being a recipient of aortic arch replacement surgery (surgery) or endovascular stent-graft implantation (stent-graft) were associated with decreased in-hospital mortality of AD. In Cox proportional hazards models, non-O blood group was associated with lower risk of early mortality regardless of adjustment (HR = 0.668, 95% confidence interval [CI] 0.473–0.944 before adjustment, HR = 0.662, 95% CI 0.468–0.935 after adjustment for age and sex, and HR = 0.641, 95% CI 0.453–0.906 after adjustment for AD types, SBP and surgery). Further analyses revealed that for patients diagnosed with type A AD (TAAD), non-O blood group renders a significant 34.3% decrease in the risk of in-hospital mortality compared with blood group O. Specifically, this difference in mortality risk was found among TAAD patients who did not undergo surgery (HR = 0.579, 95% CI 0.377–0.889), rather than those who did. There was no significant difference in early mortality for patients with TBAD, whether or not stent-grafts were implanted.ConclusionsNon-O blood type decreases the risk of in-hospital mortality, especially for TAAD, in AD patients without surgical intervention. More attention must be paid to blood type O TAAD patients without surgical interventions, and early surgical intervention may be an effective means to decrease in-hospital mortality of TAAD.