Utilization Of Mechanical Ventilation Research Articles

Abstract 4139144: "Comparative Analysis of Inpatient Outcomes: Decompensated Systolic Heart Failure (HFrEF) with and without Iron Deficiency Anemia, Propensity-Matched Nationwide Study (2017-2021)."

Background: Iron deficiency anemia (IDA) affects approximately one-third of patients with systolic heart failure, yet comprehensive population-based analyses of its impact on in-hospital outcomes remain limited. This study seeks to examine how IDA influences in-hospital outcomes among individuals with decompensated systolic congestive heart failure (HFrEF). Methods: Using data from the National Inpatient Sample (NIS) database spanning from 2017 to 2021, this study identified patients hospitalized for decompensated systolic congestive heart failure (HFrEF) with a secondary diagnosis of IDA using ICD-10 codes such as I5020-23 and D500, D501, D508, D509. Propensity score matching (PSM) was then employed to create cohorts without and with IDA at a 1:3 ratio. Multivariate regression analyses were conducted to evaluate various outcomes, including in-hospital mortality, cardiogenic shock (CS), acute myocardial injury (AMI), cardiac arrest, ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges. Furthermore, the utilization rate of mechanical ventilation and circulatory support, including intra-aortic balloon pump and extracorporeal membrane oxygenation, was evaluated in both cohorts. Results: Among 253,034 HFrEF hospitalizations, 16,200 (6.4%) had a secondary diagnosis of IDA. After PSM, multivariate regression analyses revealed no significant differences in the odds of cardiogenic shock (10% vs. 10%, p=0.86), in-hospital mortality (2.6% vs. 2.8%, p=0.71), and LOS (7.19 vs. 7.27 days) between the two groups. Additionally, the likelihood of cardiac arrest, ventricular arrhythmias, AMI, and utilization of mechanical ventilation and circulatory support did not reach statistical significance. However, patients with IDA and HFrEF had higher hospitalization charges ($85,516 vs. $93,000). Conclusion: HFrEF patients, with or without IDA, had similar odds of cardiogenic shock, in-hospital mortality, mechanical circulatory support utilization, as well as LOS. However, IDA with HFrEF correlated with higher hospitalization charges.

Assessment of Inpatient Mortality in the Peri-Transplant Period in Elderly Allogeneic Stem Cell Transplant Recipients with Co-Existing Mental Health Illnesses

Background Allogeneic hematopoietic stem cell transplant (alloHCT) is a potentially curative treatment for patients with hematological malignancies and nonmalignant conditions. AlloHCT involves invasive procedures, conditioning chemotherapy regimens, and prolonged isolation during hospitalization, which is physically and emotionally challenging. Transplant related mortality is higher in older individuals. Careful assessment of mortality risk before transplant is essential for optimal patient selection and informed decision-making, especially in elderly patients. Hematopoietic cell transplantation-specific comorbidity index (HCT-CI), an important prognostic scoring tool used in patients before alloHCT, includes psychiatric comorbidity as one of the scoring criteria. Patients with depression or anxiety disorders receive one point on the scoring scale, with the assumption that the two groups of patients are at an equivalent risk. However, there is literature showing decreased overall survival and worse inpatient outcomes in patients receiving alloHCT with co-morbid depression. Our primary objective was to evaluate the inpatient outcomes of elderly patients undergoing allogeneic stem cell transplant with a concurrent diagnosis of depression and patients with anxiety and adjustment disorders. Methods: Patients of ages ≥ 60 years, admitted with a principal procedure code of allogeneic stem cell transplant, were recruited from the 2016-2020 National Inpatient Sample. Three cohorts were created based on ICD-10 diagnostic codes for Depression and Anxiety and adjustment disorders: patients without depression and anxiety disorders, patients with depression only, and patients with anxiety and adjustment disorders only. Patients with diagnoses of other mental illnesses were excluded. The patient characteristics between the three cohorts were evaluated. Multiple Logistic Regression models were used to determine the impact of depression and anxiety disorders on inpatient mortality. Results: We evaluated 11655 hospital admissions with the primary procedure code for Allogeneic Stem Cell Transplant in patients aged 60 years and above. 8375 patients did not have any mental illness. 800 patients (9.5%) had a diagnosis of Depression, and 1640 patients (19.5%) had a diagnosis of Anxiety and adjustment disorders. Comparing the primary outcomes in patients with and without Depression, the length of stay was 31.3 days vs 28.2 days (p<0.01), the mean hospital charge was 558398.01 USD vs 498971.9 USD (p <0.01), and in-patient mortality was 8.1% vs 5.9% (aOR = 1.359, 95% CI 1.010-1.829, p=0.04). Utilization of mechanical ventilation was more prevalent in patients with depression (8.8 %vs 5.8 %, p <0.01). Out of different infectious complications, pneumonia was more common in patients with depression (14.4 % vs 9.8 %, p <0.01) (Table 1a). Baseline socio-demographic characteristics that were associated with having depression included: Female gender, White race, and Medicare insurance. Patients with depression had an increased prevalence of congestive heart failure, prior stroke, Obesity with BMI >= 35, chronic kidney disease, and COPD compared to patients without depression (p<0.01). For the primary outcomes in patients with and without anxiety and adjustment disorders, the length of stay was 29.15 days vs 28.2 days (p <0.01), the mean hospital charge was 474274.71 USD vs 498971.94 USD (p 0.612), and the in-patient mortality was 4% vs 5.9 % (aOR=0.61, 95% CI 0.45-0.83, p<0.01). Baseline socio-demographic characteristics that were prevalent in patients with anxiety and adjustment disorders were: female gender, white race, and Medicare as the most common insurance (P<0.01) (Table 1b). Conclusion We found that in elderly patients admitted for alloHCT, depression was independently associated with worse inpatient outcomes, while anxiety was not. Patients with depression were noted to have an increased incidence of infectious complications as compared to those without depression, possibly accounting for their increased mortality. Prognostic scoring systems like HCT-CI may need to be modified to assign more weight to depression as a psychiatric co-morbidity. Elderly transplant recipients with depressive disorders are a vulnerable group and multidisciplinary teams such as psychiatry and palliative care should be involved in their care.

Development of a hybrid LSTM with chimp optimization algorithm for the pressure ventilator prediction

The utilization of mechanical ventilation is of utmost importance in the management of individuals afflicted with severe pulmonary conditions. During periods of a pandemic, it becomes imperative to build ventilators that possess the capability to autonomously adapt parameters over the course of treatment. In order to fulfil this requirement, a research investigation was undertaken with the aim of forecasting the magnitude of pressure applied on the patient by the ventilator. The aforementioned forecast was derived from a comprehensive analysis of many variables, including the ventilator's characteristics and the patient's medical state. This analysis was conducted utilizing a sophisticated computational model referred to as Long Short-Term Memory (LSTM). To enhance the predictive accuracy of the LSTM model, the researchers utilized the Chimp Optimization method (ChoA) method. The integration of LSTM and ChoA led to the development of the LSTM-ChoA model, which successfully tackled the issue of hyperparameter selection for the LSTM model. The experimental results revealed that the LSTM-ChoA model exhibited superior performance compared to alternative optimization algorithms, namely whale grey wolf optimizer (GWO), optimization algorithm (WOA), and particle swarm optimization (PSO). Additionally, the LSTM-ChoA model outperformed regression models, including K-nearest neighbor (KNN) Regressor, Random and Forest (RF) Regressor, and Support Vector Machine (SVM) Regressor, in accurately predicting ventilator pressure. The findings indicate that the suggested predictive model, LSTM-ChoA, demonstrates a reduced mean square error (MSE) value. Specifically, when comparing ChoA with GWO, the MSE fell by around 14.8%. Furthermore, when comparing ChoA with PSO and WOA, the MSE decreased by approximately 60%. Additionally, the analysis of variance (ANOVA) findings revealed that the p-value for the LSTM-ChoA model was 0.000, which is less than the predetermined significance level of 0.05. This indicates that the results of the LSTM-ChoA model are statistically significant.

The Burden of Heart Failure and Its Impact on Mortality and Outcomes in Hospitalized Multiple Myeloma Patients: A Nationwide Study.

Background Multiple myeloma is a hematologic malignancy characterized by its association with a range of cardiovascular comorbidities, most notably heart failure. Our study aims to investigate the impact of heart failure on individuals who are hospitalized for multiple myeloma. Methods In this retrospective cohort study, we assembled a cohort of patients diagnosed with multiple myeloma from the National Inpatient Sample (NIS) data from 2019 to 2020. Within this study population, patients were classified according to the presence or absence of heart failure as a secondary diagnosis, with further stratification into distinct groups such as heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). The primary outcome studied was inpatient mortality. Secondary outcomes were length of stay, total hospitalization charges, acute respiratory failure, acute kidney injury, intensive care unit (ICU) admission, and mechanical ventilation. Confounders were adjusted using multivariate regression analysis. Results Among the 38,735 patients admitted with multiple myeloma, 5.6% (2,195 patients) were diagnosed with HFpEF, while 3% (1,170 patients) had HFrEF. The mortality rate was significantly higher in HFpEF patients compared to HFrEF and non-heart failure individuals (aOR: 1.68, [CI: 1.17-2.43]; P = 0.005). Length of hospital stay did not differ between these two groups; however, total hospitalization charges were more significant in the presence of heart failure versus without heart failure (coefficient: 33597; CI: 1730-65463; P = 0.04; and coefficient: 26107; CI: 5414-46800; P = 0.01 for HFrEF and HFpEF, respectively). Similarly, a significant increase in the odds of acute respiratory failure, care at the ICU, and requirement for mechanical ventilation was observed in patients with both types ofheart failure compared to those without heart failure. Conclusion HFpEF was associated with high mortality rates and greater incidence of acute kidney injury in multiple myeloma patients compared to those with HFrEF and non-heart failure counterparts. However, both heart failure subtypes were associated with heightened total hospitalization charges and the increased likelihood of encountering acute respiratory failure, admission to the ICU, and the utilization of mechanical ventilation compared to patients without heart failure.

Bariatric surgery and COVID-19 outcomes: a systematic review and meta-analysis.

Obesity and its associated complications have a negative impact on human health. Metabolic and bariatric surgery (MBS) ameliorates a series of clinical manifestations associated with obesity. However, the overall efficacy of MBS on COVID-19 outcomes remains unclear. The objective of this article is to analyze the relationship between MBS and COVID-19 outcomes. A meta-analysis. The PubMed, Embase, Web of Science, and Cochrane Library databases were searched to retrieve the related articles from inception to December 2022. All original articles reporting MBS-confirmed SARS-CoV-2 infection were included. Outcomes including hospital admission, mortality, intensive care unit (ICU) admission, mechanical ventilation utilization, hemodialysis during admission, and hospital stay were selected. Meta-analysis with fixed or random-effect models was used and reported in terms of odds ratios (ORs) or weighted mean differences (WMDs) along with their 95% confidence intervals (CIs). Heterogeneity was assessed with the I2 test. Study quality was assessed using the Newcastle-Ottawa Scale. A total of 10 clinical trials involving the investigation of 150,848 patients undergoing MBS interventions were included. Patients who underwent MBS had a lower risk of hospital admission (OR: .47, 95% CI: .34-.66, I2 = 0%), mortality (OR: .43, 95% CI: .28-.65, I2 = 63.6%), ICU admission (OR: .41, 95% CI: .21-.77, I2 = 0%), and mechanical ventilation (OR: .51, 95% CI: .35-.75, I2 = 56.2%) than those who did not undergo surgery, but MBS did not affect hemodialysis risk or COVID-19 infection rate. In addition, the length of hospital stay for patients with COVID-19 after MBS was significantly reduced (WMD: -1.81, 95% CI: -3.11-.52, I2 = 82.7%). Our findings indicate that MBS is shown to improve COVID-19 outcomes, including hospital admission, mortality, ICU admission, mechanical ventilation, and hospital stay. Patients with obesity who have undergone MBS infected with COVID-19 will have better clinical outcomes than those without MBS.

Fibrosis-4 (FIB-4) index as a predictor for mechanical ventilation and 30-day mortality across COVID-19 variants.

The Fibrosis-4 (FIB-4) index, a simple index that includes age, liver enzymes, and platelet count has been studied as a tool to identify patients at a risk of requiring mechanical ventilation due to its high negative predictive value. It is unknown if FIB-4 remains useful to predict the severity of respiratory disease requiring mechanical ventilation amongst new Coronavirus disease 2019 (COVID-19) variants and whether a relationship also exists between FIB-4 and 30-day mortality. The main objective was to determine if FIB-4 can predict mechanical ventilation requirements and 30-day mortality from COVID-19 across variants including Alpha, Delta, and Omicron. This was a population-based, retrospective cohort analysis of 232,364 hospitalized patients in the National COVID-19 Cohort Collaborative between the age of 18-90 who tested positive for COVID-19 between April 27, 2020 and June 25, 2022. The primary outcome was association between FIB-4 and need for mechanical ventilation. Secondary measures included the association of FIB-4 with 30-day mortality. A FIB-4 > 2.67 had 1.8 times higher odds of requiring mechanical ventilation across all variants of COVID-19 (OR 1.81; 95% CI: [1.76, 1.86]). The area under the ROC curve showed high diagnostic accuracy with values ranging between 0.79 (Omicron wave) and 0.97 (delta wave). Increased FIB-4 was associated with 30-day mortality across the variates. The FIB-4 was consistently associated with both increased utilization of mechanical ventilation and 30-day mortality among COVID-19 patients across all waves in both adjusted and unadjusted models. This provides a simple tool for risk-stratification for front-line health care professionals.

Risk factors for mortality over 18 years in 317 ICUs in 9 Asian countries: The impact of healthcare-associated infections.

To identify risk factors for mortality in intensive care units (ICUs) in Asia. Prospective cohort study. The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam. Patients aged >18 years admitted to ICUs. In total, 157,667 patients were followed during 957,517 patient days, and 8,157 HAIs occurred. In multiple logistic regression, the following variables were associated with an increased mortality risk: central-line-associated bloodstream infection (CLABSI; aOR, 2.36; P < .0001), ventilator-associated event (VAE; aOR, 1.51; P < .0001), catheter-associated urinary tract infection (CAUTI; aOR, 1.04; P < .0001), and female sex (aOR, 1.06; P < .0001). Older age increased mortality risk by 1% per year (aOR, 1.01; P < .0001). Length of stay (LOS) increased mortality risk by 1% per bed day (aOR, 1.01; P < .0001). Central-line days increased mortality risk by 2% per central-line day (aOR, 1.02; P < .0001). Urinary catheter days increased mortality risk by 4% per urinary catheter day (aOR, 1.04; P < .0001). The highest mortality risks were associated with mechanical ventilation utilization ratio (aOR, 12.48; P < .0001), upper middle-income country (aOR, 1.09; P = .033), surgical hospitalization (aOR, 2.17; P < .0001), pediatric oncology ICU (aOR, 9.90; P < .0001), and adult oncology ICU (aOR, 4.52; P < .0001). Patients at university hospitals had the lowest mortality risk (aOR, 0.61; P < .0001). Some variables associated with an increased mortality risk are unlikely to change, such as age, sex, national economy, hospitalization type, and ICU type. Some other variables can be modified, such as LOS, central-line use, urinary catheter use, and mechanical ventilation as well as and acquisition of CLABSI, VAE, or CAUTI. To reduce mortality risk, we shall focus on strategies to reduce LOS; strategies to reduce central-line, urinary catheter, and mechanical ventilation use; and HAI prevention recommendations.

Predictors of invasive mechanical ventilation in hospitalized COVID-19 patients: a retrospective study from Jordan

ABSTRACT Objectives To identify early indicators for invasive mechanical ventilation utilization among COVID-19 patients. Methods This retrospective study evaluated COVID-19 patients who were admitted to hospital from 20 September 2020, to 8 August 2021. Multivariable logistic regression and machine learning (ML) methods were employed to assess variable significance. Results Among 1,613 confirmed COVID-19 patients, 365 patients (22.6%) received invasive mechanical ventilation (IMV). Factors associated with IMV included older age >65 years (OR,1.46; 95%CI, 1.13–1.89), current smoking status (OR, 1.71; 95%CI, 1.22–2.41), critical disease at admission (OR, 1.97; 95%CI, 1.28–3.03), and chronic kidney disease (OR, 2.07; 95%CI, 1.37–3.13). Laboratory abnormalities that were associated with increased risk for IMV included high leukocyte count (OR, 2.19; 95%CI, 1.68–2.87), low albumin (OR, 1.76; 95%CI, 1.33–2.34) and high AST (OR, 1.71; 95%CI, 1.31–2.22). Conclusion Our study suggests that there are several factors associated with the increased need for IMV among COVID-19 patients. These findings will help in early identification of patients at high risk for IMV and reallocation of hospital resources toward patients who need them the most to improve their outcomes.

Coronavirus disease 2019 and cardiovascular diseases: collateral damage?

Purpose of reviewCardiovascular involvement in coronavirus disease 2019 (COVID-19) is relatively common and portends an increased risk of morbidity and mortality. Manifestations of myocardial injury may exhibit significant overlap and result in diagnostic uncertainty. This review will summarize recent literature around cardiovascular complications of COVID-19.Recent findingsVenous thromboembolism, atrial fibrillation, and type II myocardial infarction are observed commonly in COVID-19, while severe acute respiratory syndrome coronavirus 2 viral myocarditis remains quite rare. Although infrequent, COVID-19 vaccination has been associated with myocarditis and pericarditis in young individuals.SummaryVarious forms of COVID-19-related myocardial injury have been associated with increased utilization of mechanical ventilation, hemodynamic deterioration, and mortality. Manifestations of myocardial injury in COVID-19 are varied, but share common drivers of illness including sequelae of sepsis, immune-mediated factors, and a prothrombotic state. Understanding the forms of myocardial injury in COVID-19 may aid in rapid diagnosis and treatment.

Outcomes for hospitalized patients with idiopathic pulmonary fibrosis treated with antifibrotic medications

BackgroundIdiopathic Pulmonary Fibrosis is a chronic, progressive interstitial lung disease for which there is no cure. However, lung function decline, hospitalizations, and mortality may be reduced with the use of the antifibrotic medications, nintedanib and pirfenidone. Historical outcomes for hospitalized patients with Idiopathic Pulmonary Fibrosis are grim; however there is a paucity of data since the approval of nintedanib and pirfenidone for treatment. In this study, we aimed to determine the effect of nintedanib and pirfenidone on mortality following respiratory-related hospitalizations, intensive care unit (ICU) admission, and mechanical ventilation.MethodsUsing a large U.S. insurance database, we created a one-to-one propensity score matched cohort of patients with idiopathic pulmonary fibrosis treated and untreated with an antifibrotic who underwent respiratory-related hospitalization between January 1, 2015 and December 31, 2018. Mortality was evaluated at 30 days and end of follow-up (up to 2 years). Subgroup analyses were performed for all patients receiving treatment in an ICU and those receiving invasive and non-invasive mechanical ventilation during the index hospitalization.ResultsAntifibrotics were not observed to effect utilization of mechanical ventilation or ICU treatment during the index admission or effect mortality at 30-days. If patients survived hospitalization, mortality was reduced in the treated cohort compared to the untreated cohort when followed up to two years (20.1% vs 47.8%).ConclusionsTreatment with antifibrotic medications does not appear to directly improve 30-day mortality during or after respiratory-related hospitalizations. Post-hospital discharge, however, ongoing antifibrotic treatment was associated with improved long-term survival.

Kidney disease and COVID-19 disease severity-systematic review and meta-analysis.

We aimed to identify prevalence and association of comorbid chronic kidney disease (CKD), acute kidney injury (AKI) and utilization prevalence of continuous renal replacement therapy (CRRT) in COVID-19-hospitalized patients as a function of severity status. With the ongoing struggle across the globe to combat COVID-19 disease, published literature has described the role of kidney disease in COVID-19 patients based on single/multicenter experiences across the globe. We extracted data from observational studies describing comorbid CKD, AKI and CRRT and outcomes and severity of COVID-19-hospitalized patients from December 1, 2019–August 20, 2020 following PRISMA guidelines. Severity of COVID-19 includes intensive care unit admission, oxygen saturation < 90%, invasive mechanical ventilation utilization, in-hospital admission and mortality. Meta-analysis was performed using a random-effects model to calculate pooled estimates, and forest plots were created. In total, 29 studies with 15,017 confirmed COVID-19 patients were included. The overall prevalence of AKI was 11.6% [(430/3693)], comorbid CKD 9.7% [(1342/13,728)] and CRRT 2.58% [(102/3946)] in our meta-analysis. We also found higher odds of comorbid CKD (pooled OR: 1.70; 95%CI: 1.21–2.40; p = 0.002), AKI (8.28; 4.42–15.52; p < 0.00001) and utilization of CRRT (16.90; 9.00–31.74; p < 0.00001) in patients with severe COVID-19 disease. Conclusion Our meta-analysis suggests that comorbid CKD, AKI and utilization of CRRT were significantly associated with COVID-19 disease severity. Clinicians should focus on early triaging of COVID-19 patients with comorbid CKD and at risk for AKI to prevent complication and mortality.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10238-021-00715-x.

COVID-19 Outcomes Amongst Patients With Pre-existing Cardiovascular Disease and Hypertension.

Introduction: Coronavirus disease 2019 (COVID-19) has multiorgan involvement and its severity varies with the presence of pre-existing risk factors like cardiovascular disease (CVD) and hypertension (HTN). Therefore, it is important to evaluate their effect on outcomes of COVID-19 patients. The objective of this meta-analysis and meta-regression is to evaluate outcomes of COVID-19 amongst patients with CVD and HTN.Methods: English full-text observational studies having data on epidemiological characteristics of patients with COVID-19 were identified searching PubMed from December 1, 2019, to July 31, 2020, following Meta-analysis Of Observational Studies in Epidemiology (MOOSE) protocol. Studies having pre-existing CVD and HTN data that described outcomes including mortality and invasive mechanical ventilation (IMV) utilization were selected. Using random-effects models, risk of composite poor outcomes (meta-analysis) and isolated mortality and IMV utilization (meta-regression) were evaluated. Pooled prevalence of CVD and HTN, correlation coefficient (r) and odds ratio (OR) were estimated. The forest plots and correlation plots were created using random-effects models.Results: Out of 29 studies (n=27,950) that met the criteria, 28 and 27 studies had data on CVD and HTN, respectively. Pooled prevalence of CVD was 18.2% and HTN was 32.7%. In meta-analysis, CVD (OR: 3.36; 95% CI: 2.29-4.94) and HTN (OR: 1.94; 95% CI: 1.57-2.40) were associated with composite poor outcome. In age-adjusted meta-regression, pre-existing CVD was having significantly higher correlation of IMV utilization (r: 0.28; OR: 1.3; 95% CI: 1.1-1.6) without having any association with mortality (r: -0.01; OR: 0.9; 95% CI: 0.9-1.1) among COVID-19 hospitalizations. HTN was neither correlated with higher IMV utilization (r: 0.01; OR: 1.0; 95% CI: 0.9-1.1) nor correlated with higher mortality (r: 0.001; OR: 1.0; 95% CI: 0.9-1.1).Conclusion: In age-adjusted analysis, though we identified pre-existing CVD as a risk factor for higher utilization of mechanical ventilation, pre-existing CVD and HTN had no independent role in increasing mortality.

Outcomes of Septuagenarian and Octogenarian Females Hospitalized For Heart Failure with Preserved Ejection Fraction

Introduction Heart Failure with Preserved Ejection Fraction (HFpEF) is generally considered a disease of the elderly. Hospitalizations for HFpEF in the United States are rising, especially among women. It is largely unknown if there are any differences in-hospital outcomes between two elderly age groups of women admitted for acute HFpEF. Aim -To evaluate inpatient differences in outcomes between septuagenarian and octogenarian females admitted for acute HFpEF. Methods The United States Nationwide Inpatient Sample database was queried for hospitalizations of females aged 70 years and above with a primary diagnosis of HFpEF in 2016. Primary outcomes of interest include mortality, length of stay (LOS), and charges. A 1:1 propensity score matching (PSM) was performed to match octogenarians with septuagenarians based on race, region, and selected disease conditions. Outcomes were compared among matched cohorts using multivariable regression models. Results A total of 19,309 HFpEF hospitalizations were identified: 10,895 female patients were octogenarians, and 8,414 were septuagenarians. After PSM, 7,213 patients were matched in each group. Compared to septuagenarians, octogenarians were associated with increased odds of inpatient mortality (OR, 1.25 [1.02-1.54], P=0.0327), and an average of $4,973 less total hospital charges ($3271-$6675, P Conclusion Octogenarian hospitalizations compared to septuagenarian hospitalizations in women for HFpEF was associated with greater risk of in-hospital deaths, lower hospital charges, and decreased utilization of mechanical ventilation.

Age-Adjusted Risk Factors Associated with Mortality and Mechanical Ventilation Utilization Amongst COVID-19 Hospitalizations-a Systematic Review and Meta-Analysis.

The increasing COVID-19 cases in the USA have led to overburdening of healthcare in regard to invasive mechanical ventilation (IMV) utilization as well as mortality. We aim to identify risk factors associated with poor outcomes (IMV and mortality) of COVID-19 hospitalized patients. A meta-analysis of observational studies with epidemiological characteristics of COVID-19 in PubMed, Web of Science, Scopus, and medRxiv from December 1, 2019 to May 31, 2020 following MOOSE guidelines was conducted. Twenty-nine full-text studies detailing epidemiological characteristics, symptoms, comorbidities, complications, and outcomes were included. Meta-regression was performed to evaluate effects of comorbidities, and complications on outcomes using a random-effects model. The pooled correlation coefficient (r), 95% CI, and OR were calculated. Of 29 studies (12,258 confirmed cases), 17 reported IMV and 21 reported deaths. The pooled prevalence of IMV was 23.3% (95% CI: 17.1–30.9%), and mortality was 13% (9.3–18%). The age-adjusted meta-regression models showed significant association of mortality with male (r: 0.14; OR: 1.15; 95% CI: 1.07–1.23; I2: 95.2%), comorbidities including pre-existing cerebrovascular disease (r: 0.35; 1.42 (1.14–1.77); I2: 96.1%), and chronic liver disease (r: 0.08; 1.08 (1.01–1.17); I2: 96.23%), complications like septic shock (r: 0.099; 1.10 (1.02–1.2); I2: 78.12%) and ARDS (r: 0.04; 1.04 (1.02–1.06); I2: 90.3%), ICU admissions (r: 0.03; 1.03 (1.03–1.05); I2: 95.21%), and IMV utilization (r: 0.05; 1.05 (1.03–1.07); I2: 89.80%). Similarly, male (r: 0.08; 1.08 (1.02–1.15); I2: 95%), comorbidities like pre-existing cerebrovascular disease (r: 0.29; 1.34 (1.09–1.63); I2:93.4%), and cardiovascular disease (r: 0.28; 1.32 (1.1–1.58); I2: 89.7%) had higher odds of IMV utilization. COVID-19 patients with comorbidities including cardiovascular disease, cerebrovascular disease, and chronic liver disease had poor outcomes. Diabetes and hypertension had higher prevalence but no association with mortality and IMV. Our study results will be helpful in right allocation of resources towards patients who need them the most.Electronic supplementary materialThe online version of this article (10.1007/s42399-020-00476-w) contains supplementary material, which is available to authorized users.

Pre-existing cerebrovascular disease and poor outcomes of COVID-19 hospitalized patients: a meta-analysis.

BackgroundDue to pro-inflammatory and hypercoagulation states, COVID-19 infection is believed to increase the risk of stroke and worsen the outcomes of the patients having pre-existing cerebrovascular diseases (CeVD). There is limited literature on prevalence of pre-existing CeVD in COVID-19 patients, and outcomes are unknown. The objective of this meta-analysis is to evaluate the outcomes of COVID-19 patients with pre-existing CeVD.MethodsEnglish full-text-observational studies having data on epidemiological characteristics of COVID-19 patients were identified searching PubMed, Web of Science, and Scopus using MeSH-terms COVID-19 OR coronavirus OR SARS-CoV-2 OR 2019-nCoV from December 1, 2019 to April 30, 2020. Studies having CeVD or stroke as one of the pre-existing comorbidities and described outcomes including intensive care unit (ICU) admission, mechanical ventilation utilization, and mortality were selected with consensus of three reviewers. Following MOOSE protocol, 11 studies were included. The pooled prevalence of CeVD and outcomes were calculated. Meta-regression was performed, and correlation coefficient (r) and odds ratio (OR) were estimated to evaluate the effects of pre-existing CeVD on outcomes of COVID-19 patients. Meta-analysis with random-effects model was used to calculate OR along with its 95% CI from the studies containing data on composite poor outcome.ResultsOut of 8/11 studies showing data on mortality and mechanical ventilation, and 7/11 on ICU admission, pooled prevalence of pre-existing CeVD was 4.4% (244/4987). In age-adjusted meta-regression analysis, pre-existing CeVD was associated with ICU admission [r: 0.60; OR: 1.82 (1.25–2.69)], mechanical ventilation [r: 0.29; OR: 1.33 (1.09–1.63)], and mortality [r: 0.35; OR: 1.42 (1.14–1.77)] amongst COVID-19 hospitalizations. 9/11 studies reported data on binary composite outcomes, the pooled prevalence of pre-existing CeVD was 4.3% (155/3603) and 7.46% (83/1113) amongst COVID-19 hospitalizations and COVID-19 hospitalization-related poor outcomes, respectively. In meta-analysis, COVID-19 patient with pre-existing CeVD had 2.67-fold (1.75–4.06) higher odds of poor outcomes.ConclusionCOVID-19 patients with pre-existing cerebrovascular disease have poor outcomes and extra precautions should be taken in managing such patients during the ongoing pandemic.Electronic supplementary materialThe online version of this article (10.1007/s00415-020-10141-w) contains supplementary material, which is available to authorized users.

Overview of management of children with COVID-19.

The widespread and contagious coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has become a burden in the global health domain. The subsequent discovery of the virus features and pathogenesis, and prompt and adequate management are still lacking and remain inconclusive. Children usually present milder symptoms than adults, and management focuses on providing symptomatic and respiratory supports. Several treatment modalities, including the utilization of mechanical ventilation (MV), antivirals, immune-modulating drugs, or other agents, may present promising results in reducing the symptoms of COVID-19, particularly in severe cases. Although no randomized clinical trials have been published to date, it is interesting to explore potential modalities for treating COVID-19 in children, based on review articles, case reports, and recent guidelines.

Original Article Risk Factors for Neonatal Mortality in Neonatal Intensive Care Unit in Benha Children Hospital

Though promising progress has been made towards achieving the Millennium Development Goal [MDG] through substantial reduction in under-five mortality, the decline in neonatal mortality remains stagnant, mainly in the middle and low-income countries. The present study aimed to: assess the incidence of neonatal mortality in neonatal intensive care units in Benha Children Hospital. Assess risk factors for neonatal mortality in neonatal intensive care units in Benha Children Hospital. Methods: This study was a prospective cohort study, which was done on 943 neonates [who were admitted in the neonatal intensive care unit at BenhaChildern Hospital].Data were obtained from: neonatal records and also maternal interview using a predesigned questionnaire. neonatal mortality among the studied cases was 18.3%.There might have been a Factual critical connection the middle of the gestational agdistis toward conception What's more neonatal mortality; there might have been statistically noteworthy expand being used about mv around kicked the bucket over made due situations. There might have been statistically noteworthy expand done crp Furthermore WBC around passed on over made due situations. Neonatal mortality On neonatal seriousness will be essential state funded wellbeing issues in creating nations. Neonatal mortality might have been 18. 3%. Amount from claiming danger figures seemed on make fundamentally connected with neonatal mortality like, easier gestational age, low conception weight, easier maternal age, neonatal sepsis Furthermore utilization of mechanical ventilation.

Clinical value of IL-13 and ECP in the serum and sputum of eosinophilic AECOPD patients.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an inevitable trend in the development of the disease and eosinophils (EOS) participate in inflammation process. It is important to explore some relatively simple biomarkers in AECOPD which are useful to recognize the disease. In the present study, 108 hospitalized patients with AECOPD were collected and the levels of IL-13 and ECP in the serum and sputum were measured. The levels of IL-13 and ECP in sputum in the eosinophilic group were higher than those in the noneosinophilic group. Moreover, the noneosinophilic group had a higher rate of rehospitalization due to acute exacerbation during the one-year follow-up. The results show that eosinophils in peripheral blood are a simple, convenient, and inexpensive index for assessing the condition and prognosis of AECOPD patients. IL-13 and ECP are involved in the pathogenesis of eosinophilic AECOPD and may be the new targeted anti-inflammatory therapies.

Utilization of Extracorporeal Membrane Oxygenation for Pulmonary Toxicity Caused by Inhaled Synthetic Cannabinoid. A Harbinger of Future Complications Associated with Inhaled Cannabinoid Products

There has been a dramatic increase in medical complications related to synthetic cannabinoid (SC) use either by water pipe or vaping. The legalization of marijuana in an increasing number of states has also resulted in an increase in a number of complications related not just to marijuana, but in particular, to SC. As a result, there have been recent increased reports of acute pulmonary injury related to inhaled SC products. We describe that rarely endotracheal intubation with mechanical ventilation has been required to treat the acute respiratory distress syndrome (ARDS) and the diffuse alveolar hemorrhage (DAH) associated with the acute toxicity of SC inhalation. We describe the second reported case of successful utilization of mechanical ventilation and extracorporeal membrane oxygenation (ECMO) in order to treat acute pulmonary toxicity caused by SC inhalation by a water pipe. While the exact pathophysiology of these interesting and recent pulmonary complications is unknown, the recent increase in exposure to SC via water pipe systems and vaping suggests that there will be many more cases of patients that will require ECMO as a form of life-saving therapy.

THE CONTROVERSY OF THE EPIPEN: A COST-BENEFIT ANALYSIS AND WHAT IT MEANS FOR CARE PROVIDERS

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: In 2007, Mylan purchased the EpiPen. Since then the cost of the EpiPen has soared. The wholesale acquisition cost (WAC) has risen from $93.88 – $349.19 between the years 2007 – 2014. This abstract is an analysis of the overall trends seen with the rising WAC of the EpiPen and its effect on multiple variables. Analysis of trends were also done in association with passing of the Affordable Health Care Act (ACA) METHODS: Patients with a principal diagnosis of anaphylaxis (ICD9 code 995.0) within Nationwide Emergency Department Sample database and National Inpatient Sample database between 2006 – 2014 were identified. Data relating to demographics, type of insurance, emergency room (ED) disposition, in-hospital length of stay (LOS), in-patient mortality were extracted. Intubation and mechanical ventilation utilization data was extracted. The WAC of the EpiPen, (defined as the manufacturer’s list price for the drug to wholesalers or direct purchases in the United States) was sourced from the Elsevier Clinical Solutions' Gold Standard Drug Database. Correlations of rising WAC to ED visits, need for mechanical ventilation, mortality, rising hospital cost were made using trend analysis. Spearman correlation was used to define trends prior to and after the passing of the ACA. RESULTS: A total of 47,008 patients with the diagnosis of anaphylaxis were identified and included in this study. Average age of patients were 42 years, with insurance coverage consisting of Medicare 19.31%, Medicaid 16.35%, private insurance 48%, self pay 10.95%. Overall the rising cost of the EpiPen was associated with increased ED visits (spearman rank order correlation rho = 0.9987; p=0.0001) and increased LOS (spearman rho= 0.0663; p=0.01). Trend analysis before and after the ACA legislation passed in 2010 was also performed. Rising cost of ED visits and inpatient management was unchanged by passing of the ACA; however decline in LOS; p=0.0051 and requirement of mechanical ventilation; p=0.035 was seen. Total number of ED visits increased despite implementation of universal insurance; p=0.001. There was no change in mortality. Trend analysis looking at patients with Medicaid coverage revealed rising mean LOS, mortality, ventilation requirement associated with increase in WAC of EpiPen prior to implementation of ACA and a steady decline post passing of the legislation. CONCLUSIONS: Rising EpiPen WAC was associated with increased ED visits and increase LOS between 2007 and 2014. Trend analysis revealed rising cost of the EpiPen was associated with increase mean LOS, mortality and ventilation requirement prior to ACA implementation. With ACA implementation, despite increased WAC, there was a steady decline in mean LOS, mortality and ventilation requirement. ED visits cost and inpatient hospital cost continued to increase from 2007–2014. CLINICAL IMPLICATIONS: Rising cost of life-saving interventions has detrimental down stream effects. DISCLOSURES: No relevant relationships by kimberley cousins, source=Web Response No relevant relationships by Alem Mehari, source=Web Response No relevant relationships by Funmilola Ogundipe, source=Web Response No relevant relationships by Richard Ogunti, source=Web Response