Odds Of All-cause Mortality Research Articles

Current US prevalence of myocardial injury patterns and clinical outcomes among hospitalised patients with familial hypercholesterolaemia: insight from the National Inpatient Sample—a retrospective cohort study

BackgroundFamilial hypercholesterolaemia (FH) increases propensity for premature atherosclerotic disease. Knowledge of inpatient outcomes among patients with FH admitted with acute myocardial injury (AMI) is limited.ObjectivesOur study aimed to identify myocardial...

Implementation of Opioid Safety Efforts: Influence of Academic Detailing on Adverse Outcomes Among Patients in the Veterans Health Administration.

The Veterans Health Administration (VA) implemented academic detailing (AD) to support safer opioid prescribing and overdose prevention initiatives. Patient-level data were extracted monthly from VA's electronic health record to evaluate whether AD implementation was associated with changes in all-cause mortality, opioid poisoning inpatient admissions, and opioid poisoning emergency department (ED) visits in an observational cohort of patients with long-term opioid prescriptions (≥45-day supply of opioids 6 months prior to a given month with ≤15 days between prescriptions). A single-group interrupted time series analysis using segmented logistic regression for mortality and Poisson regression for counts of inpatient admissions and ED visits was used to identify whether the level and slope of these outcomes changed in response to AD implementation. Among 955 376 unique patients (19 431 241 person-months), there were 53 369 deaths (29 025 pre-AD; 24 344 post-AD), 1927 opioid poisoning inpatient admissions (610 pre-AD; 1317 post-AD), and 408 opioid poisoning ED visits (207 pre-AD; 201 post-AD). Immediately after AD implementation, there was a 5.8% reduction in the odds of all-cause mortality (95% confidence interval [CI]: 0.897, 0.990). However, patients had a significantly increased incidence rate of inpatient admissions for opioid poisoning immediately after AD implementation (incidence rate ratio = 1.523; 95% CI: 1.118, 2.077). No significant differences in ED visits for opioid poisoning were observed. AD was associated with decreased all-cause mortality but increased inpatient hospitalization for opioid poisoning among patients prescribed long-term opioids. Mechanisms via which AD's efforts influenced opioid-related outcomes should be explored.

Review of the Association Between Long-Term and Current Systemic Steroid Use With Electromechanical Complications and Inpatient Mortality After ST-Elevation Myocardial Infarction.

Background The impact of long-term systemic steroid use on electrical and mechanical complications following ST-segment elevation myocardial infarction (STEMI) has not been extensively studied. Methods In a retrospective cohort study of the National Inpatient Sample (NIS) from 2018 to 2020, adults admitted with STEMI were dichotomized based on the presence of long-term (current) systemic steroid (LTCSS) use. The primary outcome was all-cause mortality. Secondary outcomes included a composite of mechanical complications, electrical, hemodynamic, and thrombotic complications, as well as revascularization complexity, length of stay (LOS), and total charge. Multivariate linear and logistic regressions were used to adjust for confounders. Results Out of 608,210 admissions for STEMI, 5,310 (0.9%) had LTCSS use. There was no significant difference in the odds of all-cause mortality (aOR: 0.89, 95%CI: 0.74-1.08, p-value: 0.245) and the composite of mechanical complications (aOR: 0.74, 95%CI: 0.25-2.30, p-value: 0.599). LTCSS use was associated with lower odds of ventricular tachycardia, atrioventricular blocks, new permanent-pacemaker insertion, cardiogenic shock, the need for mechanical circulatory support, mechanical ventilation, cardioversion, a reduced LOS by 1 day, and a reduced total charge by 34,512 USD (all p-values: <0.05). There were no significant differences in the revascularization strategy (coronary artery bypass graft (CABG) vs. percutaneous coronary interventions (PCI)) or in the incidence of composite thrombotic events. Conclusion LTCSS use among patients admitted with STEMI was associated with lower odds of electrical dysfunction and hemodynamic instability but no difference in the odds of mechanical complications, CABG rate, all-cause mortality, cardiac arrest, or thrombotic complications. Further prospective studies are needed to evaluate these findings further.

The association of comorbid depression with mortality and amputation risk in patients with chronic limb-threatening ischemia

ObjectiveThere is increasing evidence that depression is a risk factor for worse outcomes in patients with peripheral artery disease. The association of depression in patients with chronic limb-threatening ischemia (CLTI) is not well described, nor is the impact of medical treatment for depression in this patient population. The objective of this study was to investigate the prevalence of depression in patients with CLTI, its association on major amputation and all-cause mortality, and whether medical antidepressant treatment is associated with improvement in these outcomes in patients with depression. MethodsA retrospective review of all adult patients (≥18 years old) diagnosed with CLTI from January 1, 2007, to December 31, 2018, at a single academic medical center was performed. Collected data included patient demographics, comorbidities, and diagnosis of depression within 6 months of initial CLTI diagnosis. We also collected data on use of antidepressant medications. Outcomes evaluated were need for major lower extremity amputation and all-cause mortality. Multivariable logistic regression models estimated the adjusted effects of comorbid depression and antidepressant medication use on major amputation and all-cause mortality. Kaplan-Meier survival curves illustrated the probabilities of survival and limb salvage over time, stratified by diagnosis of comorbid depression. Multivariable Cox proportional hazards models estimated the adjusted effects of comorbid depression on time to major amputation and all-cause mortality, and the adjusted effect of antidepressant treatment on time to all-cause mortality. ResultsA total of 2987 patients with CLTI were identified. Mean age was 68.6 years (standard deviation, 12.9 years); 56.5% were male, and 43.5% were female. Comorbid depression within 6 months of CLTI diagnosis was present in 7.1% of the cohort (212 patients). In multivariable analysis, comorbid depression was associated with a 68% increase in the odds of major amputation (adjusted odds ratio [aOR], 1.68; 95% confidence interval [CI], 1.19-2.37; P < .01), a 164% increase in the odds of all-cause mortality among patients not taking antidepressants (aOR, 2.64; 95% CI, 1.31-5.32; P = .03), and only a 6% increase in the odds of all-cause mortality among patients taking antidepressants (aOR, 1.06; 95% CI, 0.72-1.55; P = .99). The effect of comorbid depression on mortality varied significantly by whether or not the patient was taking an antidepressant medication (P = .02). ConclusionsComorbid depression in the patient population with CLTI is associated with a worse prognosis for major lower extremity amputation overall, and a worse prognosis for all-cause mortality among patients not taking an antidepressant. Furthermore, antidepressant treatment in the presence of comorbid depression in this patient population is associated with an improvement in the odds of all-cause mortality, illustrating the potential importance of medical management of depression.

Amplatzer amulet versus watchman device for percutaneous left atrial appendage closure: A systematic review and meta-analysis.

The Amplatzer Amulet (AA) and Watchman devices (WD) are the 2 most frequently used devices for percutaneous LAA closure globally. To evaluate the safety and clinical outcomes associated with these 2 devices in patients undergoing percutaneous LAA closure. We systematically searched all electronic databases from inception until February 21, 2023. The primary endpoint was procedure related complications. Secondary endpoints were device related thrombus, stroke, cardiovascular mortality, peri device leak, systemic embolism, and all-cause mortality. A total of 3 randomized clinical trials with 2150 patients were included in this meta-analysis. The mean age was 75 and 76 years in the Amplatzer group and in the Watchman group, respectively. The odds of procedure-related complications (OR, 1.80 [95% CI: 1.21-2.67], P < .001) were significantly higher among patients with AA compared to the WD. However, the odds of all-cause mortality (OR, 0.75 (95% CI: 0.49-1.16), P = .20), stroke (OR, 0.79 [95% CI: 0.47-1.34], P = .39), systemic/pulmonary embolism (OR, 1.34 [95% CI: 0.30-6.04], P = .70), and major bleeding (OR, 1.10 [95% CI: 0.83-1.48], P = .50) were comparable between the two devices. The odds of device related thrombus (OR, 0.72 [95% CI: 0.46-1.14], P = .17) was comparable between both the group of patients, however the incidence of peri device leak was significantly lower in AA group (OR, 0.41 [95% CI: 0.26-0.66], P < .001) compared with WD group of patients. The AA was not superior to the Watchman device in terms of safety and efficacy. However, the Amulet occluder was associated with a higher incidence of procedure-related complications, and lower peri device leak.

In-hospital outcomes of patients with pancreatic cancer and venous thromboembolism.

e16317 Background: Pancreatic cancer accounts for about 3.2% of all new cancers in the US. It has dismal 5-year relative survival of 11.5% and accounts for 8.2% of all cancer deaths. Studies have shown a strong association of pancreatic cancer with venous thromboembolism (VTE). However, data surrounding outcomes associated with VTE in this population is limited. We aim to estimate the effect of VTE on mortality and healthcare utilization in this population. Methods: We queried the National Inpatient Sample (NIS) 2017-2019 for all adult patients with a diagnosis of pancreatic cancer. The cohort was further classified by the presence of VTE (either acute deep vein thrombosis (DVT) or acute pulmonary embolism (PE)). The primary outcome of interest was in-hospital mortality, and secondary outcomes included hospitalization cost and length of stay, reflecting resource utilization. Multivariable regression analysis was performed to examine the association. Results: Over a period of 3 years, 392,744 admissions were identified with a diagnosis of pancreatic cancer. The mean age was 67 years, and 48% were females. The prevalence of acute DVT and acute PE was 5.0% and 5.8% respectively. In-hospital mortality was roughly 12% in the study cohort who had either DVT or PE. The odds of all-cause mortality were higher in pancreatic cancer admissions complicated by DVT (OR 1.59, 95% CI: 1.34-1.70, p&lt;0.001) or PE (OR 1.39, 95 %CI: 1.23-1.58, p&lt;0.001). The presence of VTE was also associated with higher hospital costs ($17,351 (14,256-20,446, p&lt;0.001) for DVT, and $5,710 (2,679-8,740, p&lt;0.001) for PE and longer hospital stay (7.2 vs 5.7, p&lt;0.001) for DVT and (6.6 vs 5.7, p&lt;0.001) for PE. Conclusions: Our study suggests that the presence of VTE portends poor outcomes in patients with pancreatic cancer. They also increase healthcare expenditure and lead to a longer hospital stay. Current guidelines (2020) recommend against offering thromboprophylaxis to patients with any cancer. Given the worse outcomes, this study reflects the need to formulate risk assessment models for the role of primary thromboprophylaxis in pancreatic cancer.

Combined associations of vitamin D and cognitive function with all-cause mortality among older adults in Chinese longevity areas: A prospective cohort study.

While both vitamin D deficiency and cognitive impairment have individually been linked to a greater risk of all-cause mortality, the combined effects of these two different conditions have not previously been explored in this context. We aimed to investigate the combined impact of vitamin D concentration and cognitive impairment on all-cause mortality in older adults. The analyzed data were collected from community-dwelling adults ≥65 years of age that were enrolled in the Chinese Longitudinal Healthy Longevity Survey (n = 1,673). The Mini-Mental Status Examination (MMSE) was used to assess cognitive function, while the plasma 25-hydroxyvitamin D [25(OH)D] test was used to assess vitamin D status. The associations between vitamin D concentration, cognitive function, and all-cause mortality were assessed with Cox proportional hazards models. We used restricted cubic splines to examine the dose-response relationship between vitamin D and the risk of all-cause mortality and used joint effect testing to explore interactions between vitamin D concentration and cognitive function. During a mean (SD) follow-up of 3.8 (1.9) years, 899 (53.7%) deaths occurred. A negative dose-response relationship was observed between 25(OH)D concentration and cognition impairment at baseline, as well as the odds of all-cause mortality during follow-up. Similarly, cognitive impairment was significantly related to all-cause mortality risk (HR 1.81, 95% CI: 1.54 to 2.12). The combined analyses showed positive associations, with the highest mortality risk observed in older adults with both low vitamin D and cognitive impairment (HR 3.04, 95% CI: 2.40 to 3.86). Moreover, the interaction between 25(OH)D concentration and cognitive function was found to be significant in relation to the risk of mortality (p for interaction <0.001). Lower plasma 25(OH)D and cognitive impairment were, respectively, associated with increased all-cause mortality risks. The 25(OH)D concentration and cognitive impairment exhibited a combined additive effect on all-cause mortality among older Chinese adults.

Impact on childhood mortality of interventions to improve drinking water, sanitation, and hygiene (WASH) to households: Systematic review and meta-analysis.

In low- and middle-income countries (L&MICs), the biggest contributing factors to the global burden of disease in childhood are deaths due to respiratory illness and diarrhoea, both of which are closely related to use of water, sanitation, and hygiene (WASH) services by households. However, current estimates of the health impacts of WASH interventions use self-reported morbidity, which may fail to capture longer-term or more severe impacts. Reported mortality is thought to be less prone to bias than other reported measures. This study aimed to answer the question: What are the impacts of WASH interventions on reported childhood mortality in L&MICs? We conducted a systematic review and meta-analysis, using a published protocol. Systematic searches of 11 academic databases and trial registries, plus organisational repositories, were undertaken to locate studies of WASH interventions, which were published in peer review journals or other sources (e.g., organisational reports and working papers). Intervention studies of WASH improvements implemented under endemic disease circumstances in L&MICs were eligible, which reported findings at any time until March 2020. We used the participant flow data supplied in response to journal editors' calls for greater transparency. Data were collected by two authors working independently. We included evidence from 24 randomized and 11 nonrandomized studies of WASH interventions from all global regions, incorporating 2,600 deaths. Effects of 48 WASH treatment arms were included in analysis. We critically appraised and synthesised evidence using meta-analysis to improve statistical power. We found WASH interventions are associated with a significant reduction of 17% in the odds of all-cause mortality in childhood (OR = 0.83, 95% CI = 0.74, 0.92, evidence from 38 interventions), and a significant reduction in diarrhoea mortality of 45% (OR = 0.55, 95% CI = 0.35, 0.84; 10 interventions). Further analysis by WASH technology indicated interventions providing improved water in quantity to households were most consistently associated with reductions in all-cause mortality. Community-wide sanitation was most consistently associated with reductions in diarrhoea mortality. Around one-half of the included studies were assessed as being at "moderate risk of bias" in attributing mortality in childhood to the WASH intervention, and no studies were found to be at "low risk of bias." The review should be updated to incorporate additional published and unpublished participant flow data. The findings are congruent with theories of infectious disease transmission. Washing with water presents a barrier to respiratory illness and diarrhoea, which are the two biggest contributors to all-cause mortality in childhood in L&MICs. Community-wide sanitation halts the spread of diarrhoea. We observed that evidence synthesis can provide new findings, going beyond the underlying data from trials to generate crucial insights for policy. Transparent reporting in trials creates opportunities for research synthesis to answer questions about mortality, which individual studies of interventions cannot be reliably designed to address.

Amplatzer amulet versus watchman device for percutaneous left atrial appendage closure: a systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background The Amplatzer Amulet and Watchman devices are the two most frequently used devices for percutaneous LAA closure globally. Aim To evaluate the safety and clinical outcomes associated with these two devices in patients undergoing percutaneous LAA closure. Method A systematic literature search was performed in PubMed, Scopus, Embase, and Cochrane databases for studies comparing the safety and outcomes of patients undergoing LAA closure using either Amulet or Watchman devices. The primary outcome was all-cause mortality. Secondary outcomes were incidence of ischemic stroke, systemic/pulmonary embolism, major bleeding, and procedure-related complications. Results A total of 3 randomized clinical trials with 2150 patients were included in this meta-analysis. The mean age was 75 years and 76 years in the Amplatzer group and in the Watchman group, respectively. The mean CHA2DS2-VASc score (4.2 vs. 4.34) and mean HAS-BLED score (3.46 vs. 3.56) were comparable between both groups. The odds of all-cause mortality (OR, 0.74 (95% CI: 0.48-1.13), p = 0.16), ischemic stroke (OR, 0.81 (95% CI: 0.27-2.49), p = 0.72), systemic/pulmonary embolism (OR, 1.33 (95% CI: 0.29-6.00), p = 0.71), and major bleeding (OR, 1.10 (95%CI: 0.82-1.48), p = 0.51) were comparable between the two devices. In contrast, procedure-related complications (OR, 2.11 (95%CI: 1.31-3.40), p = 0.002) were significantly higher among patients with Amplatzer Amulet compared to the Watchman device. Conclusion The Amplatzer Amulet was non-inferior to the Watchman device in terms of safety and efficacy. However, the Amulet occluder was associated with a higher incidence of procedure-related complications.

SGLT2 Inhibitors in Acute Heart Failure: A Meta-Analysis of Randomized Controlled Trials.

Acute heart failure (AHF) is a major public health concern, affecting 26 million worldwide. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a class of glucose-lowering drugs, comprising canagliflozin, dapagliflozin, and empagliflozin that are being explored for AHF. We aim to meta-analyze the effectiveness of SGLT2 inhibitors compared to placebo for primary outcomes including all-cause and cardiovascular mortality, heart failure events, symptomatic improvement, and readmissions. Our secondary outcome is the risk of serious adverse events. This meta-analysis has been designed in accordance with the PRISMA Statement 2020. A systematic search across PubMed, Scopus, and Cochrane Library was conducted through August 13, 2022. The following keywords were utilized: sglt2, sodium-glucose transporter 2 inhibitors, sglt2 inhibitors, decompensated heart failure, de-novo heart failure, and/or acute heart failure. Only randomized controlled trials (RCTs) with adult patients (&gt;18 years), hospitalized with de-novo AHF, acutely decompensated chronic heart failure with reduced, borderline, or preserved ejection, and receiving SGLT2 inhibitors were included. A quantitative analytical methodology was applied where the standardized mean difference (SMD) applying 95% confidence intervals (CI) for continuous outcomes and risk ratio (RR) with 95% CI was yielded. All tests were carried out on Review Manager 5.4 (Cochrane). In total, three RCTs were included pooling in a total of 1831 patients where 49.9% received SGLT2 inhibitors. The mean age was 72.9 years in the interventional group compared to 70.6 years in the placebo. Only 33.7% of the sample was female. The follow-up spanned 2-9 months. Heart failure events were reduced by 62% in the interventional group (RR = 0.66, p &lt; 0.0001). readmissions had a reduced risk of 24% with SGLT2 inhibitors (RR = 0.76, p = 0.03). We assessed the efficacy and safety of SGLT2 inhibitors in preventing complications post-AHF. The odds of all-cause mortality, cardiovascular mortality, heart failure events, and re-admissions rates were substantially reduced within the first 1-9 months of hospitalization.

Prevalence and in-Hospital Outcomes of Cardiac Events in Iron Deficiency Anemia: A National Inpatient Database Analysis

Introduction: Anemia is a serious global public health problem. It causes a reduction in oxygen carrying and delivering capacity thereby counteracting the very function of the heart. There is some literature regarding iron deficiency and heart failure, however, less is known about the implications of iron deficiency anemia (IDA) in other cardiac conditions. We seek to find this association between IDA and cardiac conditions namely acute coronary syndrome (ACS), atrial fibrillation(AF), coronary artery disease (CAD), and heart failure (HF). Methods: The National Inpatient Sample 2017 was queried for the adult population (age>18 years) with a primary or secondary diagnosis of IDA. Prevalence of cardiovascular risk factors including diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLD), tobacco use, and obesity were compared between patients with and without IDA. The association of cardiac diagnoses including ACS, AF, CAD, and HF with IDA was also analyzed. Multivariate regression analysis was performed adjusting for chronic comorbidities taking all-cause mortality as a primary outcome and total cost of hospital stay as a secondary outcome. The association of the above cardiac conditions with these outcomes was studied. Results: A total of 1252409 (4.11%) adult patients were identified with a primary or secondary diagnosis of IDA in 2017. The mean age of this study population was 62.5 years and 62.34% of these were females. In a cohort of adults with IDA being compared to adults without IDA ,DM (32.24 % vs 24.57%; p<0.001), HLD (36.79 % vs 31.93%; p<0.001), tobacco use (24.26% vs 21.53%; p<0.001) and obesity (18.23% vs 15.23%; p<0.001) were more prevalent. However, hypertension (30.38% vs 33.13%; p<0.001) was less prevalent in adults with IDA. IDA was associated with greater prevalence of HF (5.23% vs 3.79%; p=0.004), CAD (23.9% vs. 18.77%; p<0.001) and AF (20.12% vs. 14.45%; p<0.001) but no such significant association was seen with ACS (3.49 vs 3.42; p=0.61) Multivariate regression analysis after adjusting for demographics and risk factors showed increased mortality associated with AF (OR: 1.43; C.I :1.345- 1.534, p<0.001), ACS (OR: 2.40; C.I: 2.175- 2.658; p<0.001) and HF (OR: 1.163; C.I: 1.049-1.290; p=0.004) in the sub-population of adult patients with IDA. Similarly, patients with IDA incurred significantly higher total costs when they had AF ( mean increase: $8910; CI: 7634- 10185, p<0.01) or ACS (mean increase: $38779; CI :35678- 41880; p=<0.01). However, the total cost was not statistically significant in patients with IDA and HF ($141; CI: -1707-2002; p=0.882). Conclusion: In our study, patients with IDA had a higher prevalence of CAD, AF, and HF. The odds of all-cause mortality in the subpopulation of IDA were higher if they had coexisting ACS, AF, or HF. The total cost of hospital stay was also higher in patients with IDA when they had ACS or AF, but no significant difference was noted if heart failure was coexisting with IDA. Although easily reversible, IDA given its high prevalence and potential to cause worse outcomes should be further studied in various cardiac conditions like ACS, CAD, and AF to better identify its role and develop therapeutic approaches which can limit mortality and morbidity. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Vitamin D Deficiency Increases Mortality Risk in the UK Biobank : A Nonlinear Mendelian Randomization Study.

Low vitamin D status is associated with increased mortality, but randomized trials on severely deficient participants are lacking. To assess genetic evidence for the causal role of low vitamin D status in mortality. Nonlinear Mendelian randomization analyses. UK Biobank, a large-scale, prospective cohort from England, Scotland, and Wales with participants recruited between March 2006 and July 2010. 307 601 unrelated UK Biobank participants of White European ancestry (aged 37 to 73 years at recruitment) with available measurements of 25-hydroxyvitamin D (25-(OH)D) and genetic data. Genetically predicted 25-(OH)D was estimated using 35 confirmed variants of 25-(OH)D. All-cause and cause-specific mortality (cardiovascular disease [CVD], cancer, and respiratory) were recorded up to June 2020. There were 18 700 deaths during the 14 years of follow-up. The association of genetically predicted 25-(OH)D with all-cause mortality was L-shaped (P for nonlinearity < 0.001), and risk for death decreased steeply with increasing concentrations until 50 nmol/L. Evidence for an association was also seen in analyses of mortality from cancer, CVD, and respiratory diseases (P ≤ 0.033 for all outcomes). Odds of all-cause mortality in the genetic analysis were estimated to increase by 25% (odds ratio, 1.25 [95% CI, 1.16 to 1.35]) for participants with a measured 25-(OH)D concentration of 25 nmol/L compared with 50 nmol/L. Analyses were restricted to a White European population. A genetic approach is best suited to providing proof of principle on causality, whereas the strength of the association is approximate. Our study supports a causal relationship between vitamin D deficiency and mortality. Additional research needs to identify strategies that meet the National Academy of Medicine's guideline of greater than 50 nmol/L and that reduce the premature risk for death associated with low vitamin D levels. National Health and Medical Research Council.

Clinical Outcomes Associated with Co-infection of Carbapenem-Resistant Enterobacterales and other Multidrug-Resistant Organisms

Infections with carbapenem-resistant Enterobacterales (CRE) are associated with increased risk of death. Polymicrobial infections with antimicrobial-resistance may add to the burden of clinical care and patients' clinical prognosis. To examine the impact of CRE co-infection with other multi-drug resistant organisms (MDRO) on patient clinical outcomes. A retrospective observational study was conducted to compare the clinical outcomes of CRE patients who were co-infected with carbapenem-resistant Pseudomonas aeruginosa (CRPA), multidrug-resistant Acinetobacter baumannii (MDRA) and Methicillin-resistant Staphylococcus aureus (MRSA). A total of 224 CRPA and 209 MDRA co-infections with CRE were identified from 4,236 cases from 2015-2020. The overall 90-day all-cause mortality was 21.6% but increased to 35.0% and 33.5% among patients who were co-infected with CRPA and MDRA, respectively. The odds of all-cause mortality among CRE patients who were co-infected with CRPA was twice that of patients identified with CRE alone [adjusted odds ratio (AOR)= 2.02, 95% confidence interval (CI): 1.18-3.46]. Further, the odds of all-cause mortality among CRE patients who were concomitantly identified with MRSA was more than twice that of patients who were not identified with MRSA [AOR= 2.16, 95%CI:1.31-3.56]. The clinical outcome of patients with CRE did not differ significantly depending on the presence of carbapenemase genes. The results show that CRPA and CRE co-infections have synergistic effects on clinical outcomes. Further investigation is necessary to understand the mechanism. Screening high risk patients for concomitant antimicrobial-resistant infections may have a significant clinical impact, including effective therapies, antibiotic stewardship, and infection control policies.

Impact of venous thromboembolism in hospitalized patients with pancreatic cancer: A nationwide inpatient sample (NIS) study.

535 Background: Pancreatic cancer (PC) has a strong association with venous thromboembolism (VTE) but the impact of it on mortality and morbidity is unknown. Inpatient costs contribute significantly to the overall cancer care costs even though there is a modest improvement in survival of pancreatic cancer patients. This study aims to determine the mortality trends and associated health care utilization in PC patients with and without VTE and to analyze its impact on hospitalized patients. Methods: We used National Inpatient Sample (NIS) to extract data for all patients above 18years of age hospitalized with a primary diagnosis of Pancreatic cancer from 2002-2018 using ICD-9 and ICD-10 codes. Unadjusted odds ratio for dichotomous outcomes were calculated, and independent t test analysis was done for continuous outcomes. Results: The odds of all-cause mortality (OR 1.35, 95% CI 1.33-1.37, p&lt;0.001) and stroke (OR 1.82, 95% CI, 1.76-1.87, p&lt;0.001) were significantly higher in pancreatic cancer patients with VTE compared to without VTE. PC patients with VTE were found to have significantly higher average cost of hospitalization (US $56101 vs US $46325, p&lt;0.001) and longer length of stay(LOS) (8.20 vs 6.83, p&lt;0.001) when compared to patients without VTE. Conclusions: Hospitalized PC patients with VTE have higher odds of mortality and stroke when compared to PC patients without VTE. Similarly, VTE in PC patients is shown to increase the hospitalization costs and overall length of stay.[Table: see text]

Abstract 10416: Rising Trends in the Burden of Cardiovascular Comorbidities and Major Adverse Cardiovascular Events in Young Female Smokers Across Two Nationwide Cohorts Studied a Decade Apart (2017 vs. 2007)

Background: Ample evidence has suggested that female smokers are at a higher risk of smoking-related health problems compared to men. With the increasing number of young smokers in the US, there is limited data on the impact of smoking in young female smokers in the last decade. Methods: The National Inpatient Sample datasets (2007 and 2017) were utilized to identify hospitalizations among young (18-44 years) female tobacco smokers. We compared differences in frequency of admissions, comorbidity burden, and in-hospital outcomes (all-cause mortality and MACE) and resource utilization across two young cohorts 10-years apart. Results: A total of 1,224,479 (median age 32) admissions among young female smokers were identified in 2017 vs. 665,901 (median age 35) in 2007. Both cohorts showed the majority of admissions among white female smokers, followed by African Americans (Table 1) . Compared to the 2007 cohort, the rate of alcohol abuse, hyperlipidemia, uncomplicated diabetes and chronic pulmonary disease decreased inn 2017, whereas a rising trend was observed for deficiency and chronic blood loss anemias, diabetes with complications, drug abuse, hypertension, congestive heart failure, depression, liver disease, and obesity (p&lt;0.001). On adjusted multivariable analysis, the 2017 cohort showed significantly higher odds of all-cause mortality [aOR 1.25 (95%CI: 1.16-1.35)] with a higher risk of MACE [aOR 1.17 (95%CI:1.14-1.20)] (p&lt;0.001). There were fewer routine discharges and higher requirements of home health care in the 2017 cohort vs. 2007. Conclusion: The study reveals escalating trends in the burden of comorbidities, MACE and healthcare resource utilization in admissions (irrespective of primary cause) among young female smokers in this decade apart analysis. It is essential to raise awareness among young female smokers about the adverse impact of tobacco and associated polysubstance abuse on cardiovascular outcomes.

Abstract 13645: Contemporary Propensity-Matched Analysis Reveals Alarmingly High Risk Of Mortality, Arrhythmia And Cardiac Arrest In Nationwide Hospitalizations Of Patients With Heart Failure With Preserved Ejection Fraction And Cannabis Use Disorder

Background: Preliminary reports have suggested a link between cannabis use and heart failure (HF); however, with inconclusive literature on the subject, there exists an unmet need for contemporary data on outcomes of HF patients with cannabis use. The rising prevalence of Heart Failure with Preserved Ejection Fraction (HFpEF) incited us to assess the impact of cannabis use disorder (CUD) on in-hospital outcomes of HFpEF using nationwide multicenter data. Methods: Adult admissions related to HFpEF with vs. without CUD were identified using the National Inpatient Sample (Oct 2015-Dec 2017). Demographically matched cohorts, HFpEF-CUD+ vs. HFpEF-CUD-, were obtained and compared for comorbidities and in-hospital outcomes. Multivariable regression analyses were performed after controlling for confounders (demographic/hospital characteristics, comorbidities and substance abuse) to assess the risk of adverse outcomes including all-cause mortality, arrhythmia (atrial fibrillation/flutter, ventricular arrhythmia &amp; cardiac arrest) and stroke. Results: Of 3,835,473 HFpEF-related admissions, 10980 (0.3%) patients were cannabis users. Matched cohorts, CUD+ and CUD- were comparable for demographics (median age 55 vs. 54 years, &gt;60% male, &gt;80% white/black). The CUD+ cohort had a lower rate of comorbidities including hypertension (87.5% vs 88.5%), diabetes (33.7% vs 43.7%), hyperlipidemia (38.4% vs 42.1%), obesity (26.7% vs 36.2%), and renal failure (32.8% vs 39.8%) (Table 1). Despite a lower comorbidity burden, the CUD+ cohort was often admitted non-electively (95.2% vs. 92.8%) and had considerably higher odds of all-cause mortality (aOR 2.24, 95%CI:1.81-2.78), arrhythmia (aOR 1.15, 95%CI:1.05-1.25) and cardiac arrest (aOR 3.87, 95%CI: 2.88-5.21) (p&lt;0.05) (Fig. 1). Conclusions: This nationwide multicenter analysis revealed HFpEF admissions in patients with CUD had a significantly higher risk of adverse in-hospital outcomes despite a lower CVD risk.

Abstract 10045: Higher Morbidity, Mortality and Healthcare Resource Utilization in Admissions for Congestive Heart Failure with Concomitant Aspiration Pneumonia: National Inpatient Sample Analysis

Introduction: Data on the burden of congestive heart failure (CHF) in aspiration pneumonia (AP) patients is sparse. Our aim is to study the burden, morbidity and outcomes of CHF on AP patients. Methods: We queried the National Inpatient Sample (2015 October-2017) to identify admissions for AP in patients with CHF vs without CHF using relevant ICD-codes. Primary outcomes reported were all-cause mortality and pulmonary morbidity. Secondary outcomes included patient disposition, LOS and utilization of hospital resources. Results: We included 14,38,034 aspiration pneumonia (AP) hospitalizations amongst which 3,33,975 had associated CHF (23.2%). AP-CHF cohort often included older (79 [68-87]), white (74.8% vs 72.6%), male (54.7% vs 45.3%) patients admitted non-electively with Medicare insurance at Urban teaching facilities compared to AP only cohort (p&lt;0.001) (Table 1) . AP-CHF cohort was more often associated with valvular disease, pulmonary circulation disease, peripheral vascular disease, chronic pulmonary disease, hypertension (secondary/complicated), diabetes mellitus, hyperlipidemia and obesity compared to AP-only cohort. AP-CHF cohort had lower rates of alcohol abuse, drug abuse and smoking. AP- CHF cohort had higher adjusted odds of all-cause mortality (aOR 1.14 95% CI 1.13-1.15, p&lt;0.001), ARDS (aOR 2.27), respiratory failure (aOR 1.77), severe sepsis with septic shock (aOR 1.34) and requirement of respiratory support (aOR 1.40) compared to AP only cohort. AP-CHF cohort was more often discharged to short-term or intermediate facility and had longer stay with higher hospital charges compared to AP only cohort. Conclusion: Based on our analysis it can be concluded that nearly one-fourth of AP hospitalizations have concomitant CHF and that is associated with higher morbidity, mortality and complications ultimately leading to higher hospital resource utilization.

Clinical outcomes of hypertensive patients with COVID-19 receiving calcium channel blockers: a systematic review and meta-analysis.

We aimed to perform a systematic review and meta-analysis to determine the overall effect of the preadmission/prediagnosis use of calcium channel blockers (CCBs) on the clinical outcomes in hypertensive patients with COVID-19. A systematic literature search with no language restriction was conducted in electronic databases in July 2021 to identify eligible studies. A random-effects model was used to estimate the pooled summary measure for outcomes of interest with the preadmission/prediagnosis use of CCBs relative to the nonuse of CCBs at 95% confidence intervals (CIs). The meta-analysis revealed a significant reduction in the odds of all-cause mortality with the preadmission/prediagnosis use of CCBs relative to the nonuse of CCBs (pooled OR = 0.65; 95% CI 0.49–0.86) and a significant reduction in the odds of severe illness with preadmission/prediagnosis use of CCBs relative to the nonuse of CCBs (pooled OR = 0.61; 95% CI 0.44–0.84), and is associated with adequate evidence to reject the model hypothesis of ‘no significant difference’ at the current sample size. The potential protective effects offered by CCBs in hypertensive patients with COVID-19 merit large-scale prospective investigations.

S674 Incidence of Gastrointestinal Hemorrhage in Hospitalized COVID-19 Patients and Subsequent Clinical Outcomes

Introduction: SARS-CoV-2 infection (COVID-19) is known for its pathologic effects on micro-vasculature and is proposed to afflict the gastrointestinal tract via the ACE2 receptors. We hypothesize that there is a higher incidence and an increased risk of mortality among Covid-19 patients with gastrointestinal bleeding (GIB). Methods: This retrospective study included 2,711 patients ages 18 years or older who tested positive for Covid-19 between March 2020 through March 2021 at a public hospital in New York City. GIB was documented based on clinical criteria and a decrease in hemoglobin level. Patients were divided into two groups, GIB and non-GIB. We examined baseline characteristics of sex and age, as well as comorbidities including diabetes mellitus type 2, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), hypertension (HTN), heart failure (HF), and proton pump inhibitor (PPI) use. We used T-test for statistical analysis of age and Pearson's chi-squared test for the primary outcome of all-cause mortality and the secondary outcomes of acute kidney injury, vasopressor use, and mechanical ventilation. Results: Of 2,711 patients, 205 (incidence of 8.18%) developed GIB. Overall sample characteristics included mean age of 71.15 (SD = 16.36) and 63.36 (SD = 19.26) for GIB and non-GIB groups, respectively. Males comprised 54.6% of the GIB group and 54.1% of the non-GIB group. Baseline clinical characteristics except for sex significantly differed between groups (p< 0.05). The odds of all-cause mortality (OR: 2.604, 95% CI: 1.947, 3.482, p < 0.001) were significantly higher in the GIB group. For secondary outcomes, patients with GIB had increased unadjusted odds for acute kidney injury (OR: 3.238, 95% CI: 2.387, 4.392, p < 0.001), vasopressor use (OR: 3.004, 95% CI: 2.242, 4.023, p< 0.001), and mechanical ventilation (OR: 2.806, 95% CI: 2.079, 3.787, p< 0.001). Conclusion: GIB is associated with increased odds for all-cause mortality, mechanical ventilation, vasopressor use, and acute kidney injury compared to patients without GIB. Despite having largely differing baseline characteristics, these findings support studies that suggest a correlation between GI symptoms and Covid-19 disease severity. Future research with a larger sample size is needed. Subsequently, supportive care is key to decreasing morbidity and mortality amongst these patients.

SEPSIS PREDICTS HIGHER MORTALITY AND CARDIOPULMONARY COMPLICATIONS IN PERIPARTUM CARDIOMYOPATHY-RELATED HOSPITALIZATIONS: A NATIONWIDE ANALYSIS

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Sepsis-induced cardiomyopathy has been increasingly recognized; however, the prevalence and impact of sepsis in peripartum cardiomyopathy (PPCM) patients need further exploration. We aimed to assess the burden and outcomes of PPCM-related hospitalization with vs. without sepsis in this population-based study in the United States. METHODS: We queried the National Inpatient Sample (2015October-2017) to access PPCM with vs. without sepsis using relevant ICD-10 codes. We compared baseline demographics and comorbidities between the groups (sepsis+ vs. sepsis-). The primary outcomes included all-cause mortality, cardiac arrest including ventricular tachyarrhythmias, cardiogenic shock, respiratory failure, mechanical ventilation/respiratory intubation, and secondary outcomes included patient disposition, length of stay, and hospital charges. A two-tailed p-value<0.05 was considered for statistical significance. RESULTS: Of the 10,275 PPCM admissions, 460 were related to sepsis (0.04%). The PPCM-sepsis+ cohort often consisted of younger (30 [24-36]), white (47.1% vs 39%, p<0.001) patients admitted non-electively (90.2% vs 87.7%, p=0.109) compared to the PPCM-sepsis- cohort. The PPCM-sepsis+ cohort more frequently comprised of Medicaid enrollees (52.2% vs 51.9%, p<0.001), patients in middle income quartile (27.2% vs 26.0%, p=0.007), admissions to large bedsized hospitals (64.1% vs 62%, p=0.588) compared to PPCM-sepsis - cohort. The PPCM-sepsis+ cohort was often associated with congestive heart failure (55.4% vs 48.2%, p=0.003), coagulopathy (10.9% vs 6.4%, p<0.001), chronic kidney disease (15.2% vs 5.9%, p<0.001), anemias (27.2% vs 20.8%, p<0.001), pulmonary circulation disorder (3.3% vs 1.7%, p=0.012), and psychoses (4.3% vs 1.9%, p<0.001) compared to PPCM-sepsis- cohort. PPCM-sepsis+ cohort showed lower frequency of hypertension (40.2% vs 59.9%, p<0.001), obesity (16.3% vs 26.3%, p<0.001), chronic pulmonary disease (8.7% vs 14.9%, p<0.001) and valvular heart disease (7.6% vs 13.0%, p<0.001) compared to sepsis- cohort. The PPCM-sepsis+ cohort had significantly higher frequency and odds of all-cause mortality (7.6% vs 1.2%, aOR 7.59, 95% CI 4.35-13.23; p<0.001) along with higher rates of cardiac arrest (5.4% vs 3.0%, p0.003), cardiogenic shock (8.7% vs 5.2%, p<0.001), respiratory failure (56.5% vs 19.8%, p<0.001), mechanical ventilation/respiratory intubation (28.3% vs 10.9%, p<0.001) compared to the PPCM-sepsis- cohort. The PPCM-sepsis+ cohort were less often discharged routinely (63.0% vs. 81.5%, p<0.001), experienced prolonged hospital stay (5 vs 3 days) and higher hospital charges (60,752$ vs 30,554$) as compared to PPCM-sepsis- cohort (p<0.001). CONCLUSIONS: The frequency of sepsis in PPCM-related admissions remains low. However, concomitant sepsis predicted nearly seven times higher all-cause mortality and alarmingly higher rates of cardiopulmonary complications in PPCM. Preventive screening measures and timely management of sepsis in PPCM could prevent worse outcomes. CLINICAL IMPLICATIONS: Sepsis in PPCM patients leads to significantly higher mortality and morbidity which needs to be further assessed with larger prospective studies. Enforcement of screening protocols in PPCM could help curtail worse outcomes and healthcare expenditure. DISCLOSURES: No relevant relationships by Charu Agarwal, source=Web Response No relevant relationships by Rupak Desai, source=Web Response No relevant relationships by Zainab Gandhi, source=Web Response No relevant relationships by Geethu Jnaneswaran, source=Web Response No relevant relationships by Gaurav Mudgal, source=Web Response No relevant relationships by Athul Raj Raju, source=Web Response No relevant relationships by Bisharah Rizvi, source=Web Response No relevant relationships by Rutul Shah, source=Web Response No relevant relationships by Vivek Joseph Varughese, source=Web Response