Predictors Of In-hospital Complications Research Articles

E/e' Ratio as a Predictor of In-Hospital Complications and Clinical Outcomes of Acute Myocardial Infarction.

Introduction Acute myocardial infarction (AMI) is the leading cause of death worldwide. E/e' ratio can predict complications and mortality in the long term, but information on its effectiveness in in-hospital settings is limited. Identifying high-risk patients effectively is crucial for early management, which may improve overall clinical outcomes. This study evaluated the predictive value of the E/e' ratio of in-hospital complications and clinical outcomes of AMI. Methods Patients presenting with AMI to Batumi Referral Hospital, Georgia, between December 2023 and May 2024, were examined in this study. During the first 24 hours of hospitalization, all patients underwent two-dimensional echocardiograms. Early diastolic filling velocity (E) was measured by pulsed wave Doppler, and early mitral annulus velocity (e') was measured by tissue Doppler. Based on the ratio of the two measures, patients were divided into three groups: E/e'<8, E/e' 8-14, and E/e'>14. Results A total of 113 patients (92 males and 21 females) were included in the study. The average age of the patients was 62 years (SD = 11.71). Overall, 27 (23.8%) patients were diagnosed with ST-elevation myocardial infarction (STEMI) and 86 (76.2%) patients with non-ST-elevation myocardial infarction (NSTEMI). The E/e' ratio was normal (less than 8) in 39 (34.5%) patients (group A), increased to 8-14 in 46 (40.7%) (group B), and greater than 14 in 28 (24.8%) (group C). The percentage of deaths in group B was higher than that in group A (2.2% vs 0%), and in group C, it was significantly higher than that in group B (17.9% vs 2.2%) (p<0.05). The percentage of heart failure developed during hospitalization was higher in group B compared to group A (54.3% vs 2.6%), and it was significantly higher in group C compared to group B (67.9% vs 54.3%) (p<0.05). The percentage of arrhythmias developed during hospitalization was higher in group B compared to group A (13.0% VS 2.6%), and in group C, was significantly higher compared to group B (35.7% VS 13.0%) (p<0.05). The percentage of cardiogenic shock in group B was higher than that in group A (4.3% VS 0%), and in group C, it was significantly higher than group B (25.0% VS 4.3%) (p<0.05). No significant association was found between E/e' ratio and recurrent angina, nor was there a significant association between all-cause deterioration during hospitalization (p>0.05). Conclusions Both slightly and significantly elevated E/e' ratios are predictors of in-hospital complications and may be used to identify individuals at high risk of negative health outcomes.

Incidence and predictors of in-hospital complications after myocardial infraction in contemporary clinical practice: Findings from the FRENCHIE myocardial infarction cohort

Incidence and predictors of in-hospital complications after myocardial infraction in contemporary clinical practice: Findings from the FRENCHIE myocardial infarction cohort

Association between insulin resistance indices and perioperative functional status and immediate prognosis in patients with carbohydrate metabolism disorders undergoing coronary artery bypass grafting

Highlights. Patients with coronary artery disease undergoing coronary artery bypass grafting have a high prevalence of type 2 diabetes mellitus and prediabetes. The frequency of postoperative stroke and hospital stay is significantly higher in patients with impaired carbohydrate metabolism.Insulin resistance markers are associated with a variety of perioperative characteristics, but according to multivariate analysis, only free fatty acids and HOMA-IR were independent predictors of hospitalacquired complications and long-term hospital stayAim. To analyze insulin resistance markers and their association with the preoperative outcome and in-hospital complications of coronary bypass grafting (CABG) in patients with type 2 diabetes mellitus (DM 2), prediabetes and normoglycemia.Methods. The study included 383 consecutive patients undergoing CABG at the same center. Glycemic status, free fatty acids (FFA), fasting insulin, glucose, lipid profile of all patients were determined before surgery and the following insulin resistance indices (IR) were calculated: HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), QUICKI (Quantitative Insulin Sensitivity Check Index), Revised QUICKI, McAuley. Patients were divided into 2 groups: the group that included patients with carbohydrate metabolism disorders (CMD), type 2 diabetes mellitus and prediabetes (n = 192), and the group of patients without CMD (n = 191). Perioperative characteristics of patients, postoperative complications and their association with insulin resistance markers were analyzed.Results. FFA and calculated indices of insulin resistance such as HOMA-IR, QUICKI, RevisedQUICKI, and McAuley correlated with the following perioperative characteristics: the duration of surgical intervention and cardiopulmonary bypass, lipid levels, coagulation index, left ventricular dimension and myocardial diastolic function, etc. The analysis of in-hospital complications revealed that the frequency of postoperative stroke (p = 0.044) and hospital stay after CABG &gt;30 days (p = 0.014) was significantly higher in patients with CMD. According to the results of multivariate analysis, the predictors of the composite endpoint (hospital stay after CABG&gt;10 days and/or significant perioperative complication) were as follows: female sex (odds ratio (OR) 2.862, 95% confidence interval (CI) 1.062-7.712, p = 0.036); age (OR 1.085, 95%CI 1.027–1.147, p = 0.003); duration of cardiopulmonary bypass (OR 1.146, 95%CI 1.008–1.301, p = 0.035); body mass index (OR 1.125, 95% CI 1.035–1.222, p = 0.005), left atrial dimension (OR 5.916 95% CI 2.188–15.996, p&lt;0.001); any CMD (OR 1.436, 95%CI 1.029–2.003, p = 0.032), type 2 DM (OR 2.184, 95%CI 1.087–4.389, p = 0.027), FFA levels (OR 5.707, 95%CI 1.183–27.537, p = 0.029) and HOMA–IR index (OR 1.164, 95%CI 1.025–1.322, p = 0.019).Conclusion. FFA, HOMA-IR, QUICKI, Revised-QUICKI, and McAuley correlate with a variety of perioperative characteristics of patients undergoing CABG, but multivariate analysis revealed that only FFA levels and the HOMA-IR can be used as predictors of in-hospital complications and prolonged hospital stay.

Neutrophil-to-lymphocyte ratio as a predictor of in-hospital complications and overall mortality in Takotsubo syndrome preceded by physical triggers

BackgroundTakotsubo syndrome (TTS) with physical triggers has worse short- and long-term clinical courses than those with emotional triggers. However, predictive factors associated with poor outcomes of TTS with physical triggers are unknown.MethodsWe included 231 patients identified as TTS preceded by physical triggers at two tertiary referral hospitals from 2010 to 2019. In-hospital complications (IHC)—a composite of malignant arrhythmia, need for mechanical circulatory support or mechanical ventilation, and in-hospital death—and overall mortality were retrospectively reviewed. The associations with clinical features were evaluated by multivariable logistic and Cox regression analyses.ResultsThe mean age was 69.3 ± 11.6 years, and 85 (36.8%) were male. The in-hospital complications rate was 46.8%. During a median follow-up of 883 days, 96 (41.6%) had died, and overall mortality was 13.6% per patient-year. Higher neutrophil-to-lymphocyte ratio (NLR) was associated with a higher risk of IHC (area under the receiver operating characteristic curve = 0.73; positive and negative predictive value = 60.9% and 67.2% for NLR ≤ 12); odds ratio (OR) with 95% confidence interval (CI) was 1.03 (1.01–1.05), p = 0.010. Subsequently, higher NLR was also related to a greater risk of overall mortality; patients with high NLR (NLR > 12) exhibited poor long-term survival than those with low NLR (NLR ≤ 5): hazard ratio (95% CI), 3.70 (1.72–7.94) with p < 0.001.ConclusionsA high NLR at initial presentation is associated with an increased risk of IHC and overall mortality in TTS preceded by physical triggers. Given that the treatment of TTS is mainly supportive, intensive monitoring with careful follow-up would be warranted in patients with high NLR.

Predictors of in-hospital complications after transcatheter aortic valve implantation in patients with degenerative aortic valve disease

Predictors of in-hospital complications after transcatheter aortic valve implantation in patients with degenerative aortic valve disease

Mortality and 30-Day Readmission Rates After Inpatient Leadless Pacemaker Implantation: Insights From a Nationwide Readmissions Database.

This study aimed to provide real-world data on the rates, trends, and predictors of in-hospital complications and 30-day readmission following leadless pacemaker (LP) implantation. We analysed leadless and conventional pacemaker implantations with the use of the all-payer, nationally representative Nationwide Readmissions Database from 2017 to 2019. The national trends of in-hospital mortality, in-hospital complications, and 30-day readmission rates after pacemaker implantation were analysed. Mixed-effects multivariable logistic regression analysis was performed to identify factors associated with in-hospital death and 30-day readmission in LP patients. A total of 137,732 admissions (age 78 years, IQR 70-85 years, 5986 LP implantations) were analysed. The in-hospital mortality, overall in-hospital complication, and 30-day readmission rates after LP implantations were 5.0%, 16%, and 16%, respectively. In LP recipients, the national estimate of in-hospital mortality declined from 10.9% in the second quarter of 2017 to 4.3% in the fourth quarter of 2019 (P < 0.001). Furthermore, the national estimate of overall complications declined from 20.6% in the second quarter of 2017 to 13.0% in the fourth quarter of 2019 (P < 0.001). In LP recipients, female sex, history of chronic kidney disease, heart failure, and malnutrition were factors associated with in-hospital death. Analysis of the nationally representative claims database from the United States showed in-hospital mortality and complication rates (for LP implantation performed during hospitalisation) of 5.0% and 16%, respectively. Although these rates showed a decreasing trend over time, ongoing surveillance is needed for the safety of LP implantation.

Prognostic value of anemia in patients with ST-elevation myocardial infarction

Abstract Introduction Haemoglobin (Hb) levels are an important outcome predictor in several diseases. Purpose We aimed to evaluate Hb at hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) as a predictor of in-hospital complications, mortality and heart failure (HF) during follow-up. Methods We retrospectively studied consecutive STEMI patients treated with primary percutaneous coronary intervention between January 2010 and December 2016. Clinical data was retrieved by review of patients' clinical records. Severity of anaemia was defined according World Health Organization cut-offs. Results Of 864 patients with mean age of 63±13 years, 646 (75%) were male. Mean Hb at hospital admission was 14±2g/dL, 682 (81%) with normal Hb, 118 (14%) with mild anaemia, 45 (5%) with moderate anaemia and 2 (0.2%) with severe anaemia. Female gender, smoking, diabetes, hypertension, previous myocardial infarction and peripheral artery disease were associated to higher incidence of anaemia at hospital admission. Anaemia was also associated to Killip-Kimball (KK) class ≥II at hospital admission. They also had higher incidence of in-hospital stroke, advanced atrioventricular block, gastrointestinal bleeding and blood transfusion. In-hospital mortality was 9%, higher patients with anaemia (13% vs 7%, p=0.022). Median follow-up was 43 (26–66) months. All-cause mortality was 14%, higher in patients with anaemia (27% vs 11%, p&amp;lt;0.001, Log rank test p&amp;lt;0.001). In multivariate analysis, age (HR 1.1, 95% CI 1.0–1.1), diabetes (HR 1.9, 95% CI 1.1–3.4), left ventricular ejection fraction (LVEF) at discharge (if &amp;lt;50%, HR 3.4, 95% CI 1.6–7.2), and anaemia at admission (HR 1.8, 95% CI 1.0–3.2) were independent predictors of all-cause death during follow-up. Incidence of de novo HF, clinical worsening or hospitalization was 18%, higher in patients with anaemia (27% vs 17%, p=0.007, Log rank test p=0.007). In multivariate analysis, age (HR 1.1, 95% CI 1.0–1.1), KK class (if II, HR 2.1, 95% CI 1.3–3.5; if III, HR 4.0, 95% CI 1.8–8.9; if IV, HR 2.1, 95% CI 1.2–3.9), body mass index (if obese, HR 2.5, 95 CI 1.4–4.4) and LVEF at discharge (if &amp;lt;50%, HR 4.2, 95% CI 2.2–7.7), but not anaemia at admission (p=0.633) were independent predictors HF. Conclusion In our contemporary cohort of STEMI patients, the presence of anaemia at hospital admission was not only associated to in-hospital complications, but also all-cause mortality during follow-up. Funding Acknowledgement Type of funding sources: None.

Left ventricular end-diastolic pressure predicts in-hospital outcomes in Takotsubo syndrome

Abstract Background Takotsubo syndrome (TTS) is an acute and reversible form of myocardial injury often preceded by an emotional or physical stressful event. Of importance, TTS may be associated to serious adverse in-hospital complications. Coronary angiography and left ventricle angiography remain a cornerstone for TTS diagnosis. However, the prognostic role of invasively assessed left ventricular end-diastolic pressure (LVEDP) at the time of cardiac catheterization has never been investigated. Purpose We evaluated the role of invasively assessed LVEDP for predicting in-hospital complications in TTS patients compared to the most widely used echocardiographic parameters of ventricular function. Methods We prospectively enrolled 130 patients (mean age 71.2±11.3 years, 114 [87.7%] female) with TTS. Invasive measurement of LVEDP was performed at the time of cardiac catheterization. The rate of in-hospital complications (composite of acute heart failure, cardiogenic shock, life-threatening arrhythmias and all-cause death) was examined. Results In-hospital complications occurred in 37 (28.5%) patients. Patients who experienced in-hospital complications had a higher prevalence of neurological trigger and lower prevalence of emotional trigger, higher LVEDP and mean E/e' ratio and lower LV ejection fraction (LVEF) values compared to those who did not experience in-hospital complications. At multivariable Cox regression, higher LVEDP (hazard ratio [HR] 1.12, 95% confidence interval [CI] [1.05–1.20], p&amp;lt;0.001) and lower LVEF (HR 0.95, 95% CI [0.91–0.99], p=0.011) remained independently predictors of in-hospital complications, while emotional trigger was associated to a lower risk (HR 0.24, 95% CI [0.06–0.96], p=0.044). The area under the curve (AUC) for LEVDP in the prediction of in-hospital events was 0.776 (95% CI [0.69–0.86], p&amp;lt;0.001, with a sensitivity and specificity of 95% and 58% using a LVEDP cut-off value of 22.5 mmHg). The AUC was significantly higher for LVEDP than for E/e' ratio (p=0.045). Conclusions LVEDP measured at the time of cardiac catheterization may help in identifying TTS patients at higher risk of cardiovascular events during the hospitalization with relevant therapeutic implications. Of note, in the prediction of in-hospital events the LEVDP performed better than non-invasive indexes commonly used for the assessment of diastolic function. Funding Acknowledgement Type of funding sources: None.

The Role of Tumor Necrosis Factor-alpha as a Marker of Inflammation and a Predictor of in-hospital Complications in Patients with Acute Coronary Syndrome

The Role of Tumor Necrosis Factor-alpha as a Marker of Inflammation and a Predictor of in-hospital Complications in Patients with Acute Coronary Syndrome

Study of Interleukin 6 as marker of inflammation and a predictor of in-hospital complications in patients with acute coronary syndrome

Background Although abnormal fatty deposits of infected arterial plaque play a major role in the formation of atherosclerotic plaque, activation of inflammatory cells plays a major role in the instability of the plaque and the cause of acute coronary syndrome. The aim of this study was to measure the level of interleukin-6 and to study its association with complications that occur in hospital in patients with acute coronary syndrome. Method: One hundred and twenty-five patients with acute coronary syndrome and 120 healthy individuals as a control group were included in this study. According to ECG and serum troponin changes, the patient group was classified into three ST-elevated myocardial infarction, ST non-elevated myocardial infarction and unstable angina. Sandwich ELISA was used by commercial groups (LEGAND MAX TM) for the IL-6 assay. Result: This study shows significantly significant differences in the level of IL-6 in patients with acute coronary syndrome (73.37 pg / dL) compared to the control group (9.47 pg / dL) (P value 0.001) There were no significant differences at the level of IL-6 in patients with acute coronary syndrome and conventional risk factors (P. value <0.05). There were significant differences in the level of IL-6 in all forms of ACS. (P. value 0.001). And those patients who had complications in hospital had a higher IL-6 level (92.89 Pg / dl) than those without complications (68.83 Pg / dl) P. value (0.012). Conclusion: This study indicated that IL-6 was significantly elevated in ACS patients

Preoperative status and in-hospital complications of coronary artery surgery in patients with pre-diabetes and type 2 diabetes mellitus

Abstract Aim To assess the preoperative status and the rate of in-hospital complications of coronary artery surgery (CABG) in patients with pre-diabetes compared to patients with type 2 diabetes mellitus (type 2 DM) and normoglycemia. Materials and methods 708 consecutive patients who underwent CABG between 2011 to 2012 were included in the study. All patients without positive history of diabetes underwent an oral glucose tolerance test (OGTT). The lab findings were interpreted in accordance with the recommended diagnostic criteria for diabetes and other glycemic disorders. Results DM screening before coronary artery bypass grafting allowed to diagnose type 2 diabetes in 8.9% (n=63) and prediabetes in 10.4% (n=74) of the study population. The preoperative screening increased the number of patients with DM from 15.2% (n=108) to 24.1% (n=171), and with prediabetes from 3.0% (n=21) to 13.4% (n=95). The total number of patients with carbohydrate metabolism disorders increased from 18.2% (n=129) to 37.5% (n=266). All patients were enrolled into 3 groups based on their glycemic status: Group 1 - without carbohydrate metabolism disorders (n=442), Group 2 - pre-diabetes (n=95), Group 3 - type 2 DM (n=171). The analysis of in-hospital complications reported that patients with pre-diabetes more often underwent urgent peripheral artery bypass compared to the other two groups (p1–2=0.002 vs. p1–3=0.023). The highest rate of wound complications was found in patients with pre-diabetes (p1–2=0.012). In addition, a clear trend towards the rate of other in-hospital complications of CABG in the groups with pre-diabetes and diabetes was found. The regression analysis shows that type 2 DM was associated with the total number of significant complications (odds ratio (OR) 1.731, 95% confidence interval (CI) 1.131–2.626, p=0.012), prolonged in-hospital stay (OR 2.2229, 95% CI 1.412- 3.519, p&amp;lt;0.001), the risk of urgent peripheral artery bypass (OR 1.638, 95% CI 1.009–15.213, p=0.020), multiple organ dysfunction syndrome (OR 2.911, 95% CI 1.072–7.901, p=0.039) and the need for hemostasis correction using the extracorporeal methods (OR 3.472, 95% CI 1.042–11.556, p=0.044). All the associations described above remained significant when pre-diabetes was introduced into the regression model and any carbohydrate metabolism disorder was considered as a potential predictor of in-hospital complications. Additionally, an association between pre-diabetes and diabetes and the risk of acute renal damage (OR 1.700, 95% CI 1.067–2.612, p=0.024) and wound complications (OR 1.547, 95% CI 1.073–2.231, p=0.019) was observed. Conclusion Pre-diabetes affects the in-hospital outcomes after CABG as well as diabetes mellitus. Our findings emphasizes the relevance of active preoperative detection of carbohydrate metabolism disorders. Funding Acknowledgement Type of funding source: None

PRE-SURGERY STATUS AND IN-HOSPITAL COMPLICATIONS OF CORONARY BYPASS GRAFTING IN PREDIABETES AND TYPE 2 DIABETES PATIENTS

Aim. Investigation of pre-operational status and the rate of in-hospital complications of coronary bypass surgery in patients with prediabetes comparing to diabetes type 2 (DM2) and normoglycemia. Material and methods. Totally, 708 consecutive patients included, post coronary bypass grafting (CBG) in 2011-2012 in the SRI CICVS. If there was no established DM2 diagnosis, but borderline hyperglycemia had existed, patients underwent oral glucose tolerance test (GTT). Its results were interpreted in accordance with the recommended diagnostic criteria for DM2 and other glycemia disorders. Results. Screening before the CBG made it to additionally reveal DM2 in 8,9% (n=63) of the investigated patients, prediabetes — in 10,4% (n=74). This increased the number of patients with established DM2 from 15,2% (n=108) to 24,1% (n=171), with prediabetes — from 3,0% (n=21) to 13,4% (n=95), overall number of persons with glucose metabolism disorder from 18,2% (n=129) to 37,5% (n=266). All participants were then selected to 3 groups by glycemia status: group 1 — no disorders (n=442), group 2 — prediabetes patients (n=95), group 3 — diabetes type 2 (n=171). In analysis of in-hospital complications, the following attracts an attention: in the prediabetes group, specifically, an urgent operation on lower limbs arteries was done more frequently comparing to two other groups (р 1 2 =0,002 and р 1 3 =0,023). Also, the highest rate of wound complications was in the prediabetes group (р 1 =0,012). There was clear trend of comparability of prediabetes and DM2 by the rate of in-hospital complications (odds ratio PR) 1,731, 95% confidence interval (CI) 1,131-2,626, р=0,012), longer hospitalization ^R 2,229, 95% CI 1,4123,519, р&lt;0,001), risk of urgent operation on the lower extremities arteries (OR 1,638, 95% CI 1,009-15,213, р=0,020), multiorgan failure PR 2,911, 95% CI 1,072-7,901, р=0,039), and the need for extra-corporal hemostasis correction ^R 3,472, 95% CI 1,042-11,556, р=0,044). With addition of prediabetes to the regression model and regard of any glucose tolerance disorder as possible predictor of in-hospital complications, all the listed above remained significant, and there was additional relation of prediabetes and diabetes with the risk of acute kidney injury ^R 1,700, 95% CI 1,067-2,612, р=0,024) and wound complications PR 1,547 95% CI 1,0732,231, р=0,019). Conclusion. Prediabetes is the same adverse as diabetes in its influence on inhospital prognosis of CBG, that underscores the importance of active preoperational screening of glucose intolerance.

In-Hospital Outcomes and Complications of Coronary Artery Bypass Grafting in the United States Between 2008 and 2012

To investigate the frequency and predictors of in-hospital complications among patients undergoing coronary artery bypass grafting (CABG) in the United States. Retrospective national database analysis SETTINGS: United States hospitals. A weighted sample of 1,910,236 patients undergoing CABG surgery identified from the National (Nationwide) Inpatient Sample from 2008 to 2012. CABG surgery MEASUREMENTS AND MAIN RESULTS: The number of CABG surgeries decreased from 436,275 in 2008 to 339,749 in 2012. The Deyo comorbidity index showed a steady increase from 2008 to 2012. The rate of in-hospital mortality decreased from 2.7% in 2008 to 2.2% in 2012 (p<0.001). The most common in-hospital complication was postoperative hemorrhage (30.4%), followed by cardiac (11.34%) and respiratory complications (2.3%). During the 5-year period, the rates of in-hospital cardiac, respiratory and infectious complications decreased (p<0.001), while the rate of postoperative hemorrhage showed a 35.8% relative increase in 2012 compared to 2008. The annual number of CABG surgeries is declining in the United States. While the burden of comorbidities is increasing, the rates of mortality and most in-hospital complications are improving. The increasing rate of postoperative bleeding necessitates the need to develop strategies to improve the risk of bleeding in this patient population.

Abstract TP161: Gastrointestinal Bowel Obstruction in Acute Ischemic Stroke: Incidence, Risk Factors, and Outcomes

Introduction: The prognosis of patients suffering acute ischemic stroke (AIS) is worsened by medical complications that occur during subsequent hospitalization. The incidence, risk factors, and outcomes of gastrointestinal bowel obstruction (GIBO) in AIS have not been previously reported. Methods: We employed the Nationwide Inpatient Sample from 2002 to 2011 to identify all patients admitted with a primary diagnosis of AIS and subsets with and without a secondary diagnosis of GIBO without hernia. Multivariate logistic regression was utilized to analyze predictors of GIBO in AIS patients and the association between GIBO, in-hospital complications, and outcomes. Results: We identified 16,987 patients with GIBO (425 per 100,000) among 3,988,667 AIS hospitalizations and 4.2% of patients of these patients underwent repair surgery for intestinal obstruction. Multivariate predictors of GIBO included: age 55-64 (OR: 1.52, 95% CI: 1.40-1.64), age 65-74 (OR: 1.69, 95% CI: 1.56-1.84), age 75+ (OR: 1.97, 95% CI: 1.81-2.13), black race (OR: 1.42, 95% CI: 1.36-1.49), coagulopathy (OR: 1.39, 95% CI: 1.29-1.50), cancer (OR: 1.59, 95% CI: 1.44-1.75), blood loss anemia (OR: 2.51, 95% CI: 2.22-2.84), fluid/electrolyte disorder (OR: 2.91, 95% CI: 2.81-3.02), weight loss (OR: 3.08, 95% CI: 2.93-3.25), and thrombolytic therapy (OR: 1.30, 95% CI: 1.20-1.42) (all p&lt;0.0001). Patients with GIBO had a greater likelihood of suffering intubation (OR: 1.79, 95% CI: 1.70-1.90), deep vein thrombosis (OR: 1.35, 95% CI: 1.25-1.46), pulmonary embolism (OR: 1.84, 95% CI: 1.53-2.21), sepsis (OR: 2.39, 95% CI: 2.22-2.56), acute kidney injury (OR: 1.85, 95% CI: 1.76-1.95), gastrointestinal hemorrhage (OR: 2.82, 95% CI: 2.63-3.03), and blood transfusions (OR: 2.02, 95% CI: 1.90-2.15) (all p&lt;0.0001). In adjusted analyses, AIS patients with GIBO were 284% and 39% more likely to face moderate to severe disability and in-hospital death, respectively (p&lt;0.0001). GIBO occurrence increased length of stay and total costs by an average of 9.7 days and $22,342 (p&lt;0.0001). Conclusion: Advanced age, black race, and several pre-existing comorbidities increase the likelihood of post-AIS GIBO, which is an independent predictor of in-hospital complications, disability, and mortality.

Select Articles Published on the Topic of Arrhythmia and Electrophysiogy in 2013

Select Articles Published on the Topic of Arrhythmia and Electrophysiogy in 2013

Abstract WP378: Characteristics and Outcomes of Stroke Patients Transferred to Hospitals Participating in the Michigan Coverdell Acute Stroke Registry 2009-2011

Characteristics and Outcomes of Stroke Patients Transferred to Hospitals Participating in the Michigan Coverdell Acute Stroke Registry, 2009-2011 Background: As stroke systems of care are evolving the number of stroke patients transferred between hospitals is increasing. Our objectives were to describe the characteristics of acute stroke patients who were transferred to hospitals participating in the Michigan Coverdell Acute Stroke Registry, and to determine the independent association between transfer status (TS) and in-hospital mortality (IHM) and in-hospital complications (IHC). Methods: From 2009-2011, 30934 acute ischemic (IS) and hemorrhagic stroke (HS) patients were admitted to 35 registry hospitals. Patients with an in-hospital stroke, TIA, or unknown arrival mode were excluded (N= 14,732). Independent factors associated with TS and predictors of IHC (defined as deep vein thrombosis, pneumonia, and/or UTI) were identified using multivariable logistic regression models. Results: The mean age of the 16202 admissions was 69.2 years, 51% were female, 68% were white, 83% had an IS, 7.4% died in-hospital, and 13.8% had an IHC. Overall, 19% (N= 3091) were transferred to a registry hospital. The transfer rate increased from 2009-2011 (16.9% -21.1%), and was higher in HS vs. IS patients (37.6% vs. 15.3%). Significant predictors of TS were year, age, gender, race, stroke type, pre-stroke ambulatory status, nursing home residence, and medical history of diabetes or prior stroke. Length of stay (LOS) was longer for transferred patients vs. non-transferred (7.9 vs. 5.3 days, p&lt;0.0001). Transferred patients were more likely to die in-hospital vs. non-transferred (12.0% vs. 6.4%, P &lt;0.001), and develop IHC (18.4% vs. 12.8%, P &lt; 0.001). After adjusting for confounding variables, TS remained a significant predictor of IHM (adjusted odds ratios [aOR] = 1.46, 95%CI =1.14- 1.88), and IHC (aOR= 1.58, 95%CI =1.34- 1.87). Conclusions: The frequency of hospital transfers increased markedly in this registry. Transferred patients experience higher rates of IHM, IHC and longer LOS. Further studies are needed to understand the relationship between TS and outcomes and the implication for improved clinical care and reducing poor outcomes in this higher risk group.

Abstract TMP78: Do Hospital Complications Justify Excluding Elderly Patients from Stroke Clinical Trials?

Background and Objectives: There is a paucity of data from recent trials analyzing outcomes and hospital complications in octogenarians after acute ischemic stroke (AIS). Stroke trials often set an arbitrary upper age limit (usually age 80) as an inclusion criterion. We hypothesized that based on hospital complication rates and outcome, age ≥80 does not justify exclusion from clinical trials testing new AIS therapies. Methods: From our prospectively compiled stroke registry, we identified AIS patients older than 50 from January 1, 2007 to March 30, 2012. Patients were excluded if they 1) had a baseline mRS &gt;2, 2) received intra-arterial therapy, or 3) were enrolled in a trial. Demographic and clinical data were analyzed in patients ≥80 and 50-79 to determine if age ≥80 raises the odds for hospital complications and worse outcomes. Results: We identified 526 patients ≥80 and 1572 aged 50-79. Compared with their younger counterparts, patients ≥80 had a higher incidence of vascular risk factors, higher NIHSS scores, higher IV tPA rates, and a 1.3 times higher odds (95% confidence interval 1.01 - 1.7) of developing in-hospital complications, after controlling for all co-variates (including NIHSS, t-PA, vascular risk factors). However, higher complication rates appeared to be driven by UTIs. A stratified analysis of age cutoffs at 5 year intervals for all complications other than UTI did not show that ages 85 and above have significantly higher odds of complications as compared to those aged 50-74. Older patients had higher odds (OR 2.11 95% CI 1.34 - 3.31) of a poor outcome at 90 days (mRS &gt;2) compared with younger patients, after adjusting for co-variates. Conclusion: Age ≥80 is a predictor of in-hospital complications but only the rates of UTI were significantly higher. These findings support re-considering age &gt;80 as an exclusion from participating in clinical trials testing new AIS therapies. The higher odds for poor outcome also raise the need to design therapies for patients ≥80.

Usefulness of Sum of ST-Segment Elevation on Electrocardiograms (Limb Leads) for Predicting In-Hospital Complications in Patients With Stress (Takotsubo) Cardiomyopathy

Although the prognosis of patients with stress (takotsubo) cardiomyopathy is relatively favorable, serious complications occur in some patients. It is generally accepted that electrocardiography is an essential tool for the diagnosis of stress cardiomyopathy, with findings highly suggestive of the characteristics of myocardial damage. We tested the hypothesis that the quantitative analysis of electrocardiograhic changes can predict complications in stress cardiomyopathy. The study subjects were 85 patients with stress cardiomyopathy. A total of 34 patients developed ≥1 in-hospital complications (heart failure, intraventricular pressure gradient [>30 mm Hg], cardiogenic shock, ventricular tachycardia/fibrillation, and embolism). Patients with complications were likely to have a higher heart rate (96 ± 25 vs 76 ± 17 beats/min, p <0.001), larger sum of ST-segment elevation in 12 leads (median 10.5 mm; interquartile range 5.0 to 17.5 vs 3.0 mm, interquartile range 0 to 7.0; p <0.001) and extension of ST-segment elevation to limb leads (50% vs 12%, p <0.001) than those without complications. Multivariate logistic regression analysis identified heart rate (odds ratio 1.05, 95% confidence interval 1.02 to 1.07, p = 0.001) and sum of ST-segment elevation in 12 leads (odds ratio 1.24, 95% confidence interval 1.11 to 1.39, p <0.001) as significant and independent predictors of complications. Receiver operating characteristic analysis selected 5.5 mm as the best cutoff value of sum of ST-segment elevation in 12 leads for the prediction of complications, with a sensitivity and specificity of 74% and 73%, respectively, and area under the curve of 0.81 (95% confidence interval 0.72 to 0.90, p <0.001). The results suggest that the extent and magnitude of ST-segment elevation on the electrocardiogram are potentially useful predictors of in-hospital complications in patients with stress cardiomyopathy.

Faecal impaction: in‐hospital complications and their predictors in a retrospective study on 130 patients

Faecal impaction may be a medical emergency. The frequency of complications of this condition and their predictors are not known. We determined the clinical presentation, the in-hospital complications and their predictors in 130 patients diagnosed with faecal impaction. This was a retrospective study of the medical records of 130 patients who presented with faecal impaction to a tertiary care center in Beirut, Lebanon, between 1992 and 2009. The clinical outcome and complications were reviewed. The association between in-hospital complications and other variables was determined. The mean age of the patients was 67.1 years. Ninety-eight (75.3%) patients had at least one of the following: heart disease (36.3%), neurological disease (28.8%) or diabetes (22.6%), and 26.7% were bedridden. The site of impaction was the rectum in 66.4%. The patients were treated by manual disimpaction (34.5%), enema (89.1%) or oral laxatives (84.0%). A delay in treatment of more than 6 h occurred in 70 (53.8%) patients. In-hospital complications occurred in 34 (24.6%) patients, the most common of which were infectious (16 cases), systemic inflammatory response syndrome (16 cases), cardiopulmonary (14 cases) and death (one patient). Time to the start of treatment was longer in patients who developed complications compared with those who did not (10.1 h vs 7.1 h; P = 0.02). Patients > 80 years of age, or patients with heart or neurological disease were at a higher risk of developing complications (P = 0.03, P = 0.03 and P = 0.02, respectively). Treatment delay, increasing age and the presence of heart or neurological disease seem to be predictors of in-hospital complications in patients with faecal impaction.

Impact of Prehospital Delay in Treatment Seeking on In-Hospital Complications After Acute Myocardial Infarction

Rapid arrival to the hospital for treatment of acute myocardial infarction (AMI) improves long-term outcomes. Whether prehospital delay time is associated with short-term, in-hospital complications remains unknown. The purpose of this study was to evaluate the fit of a theoretical model where prehospital delay time was indirectly associated with hospital length of stay through in-hospital complications after AMI considering simultaneously for demographic, clinical, and psychosocial factors using structural equation modeling. Acute myocardial infarction patients (N = 536; 66% men; mean age, 62 [SD, 14] years) were enrolled in this prospective study. Demographic and clinical data were obtained by patient interview and medical record review. After patient discharge, complications were abstracted from the medical record. Prehospital delay, admission Killip class, and in-hospital anxiety were the best predictors of in-hospital complications, including recurrent ischemia, reinfarction, sustained ventricular tachycardia or fibrillation, and cardiac death, after AMI (P = .019). The occurrence of in-hospital complications was related to length of stay in the hospital (P < .001). Prehospital delay in promptly seeking hospital treatment for AMI symptoms, together with state anxiety and worse heart failure, was associated with the occurrence of more frequent serious complications during the hospital stay. It is essential that research and clinical efforts focus on the complex and dynamic issue of improving prehospital delay in AMI patients.