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1.
Tanush Gupta Kavisha Patel Dhaval Kolte Sahil Khera Pedro A. Villablanca Wilbert S. Aronow William H. Frishman Howard A. Cooper Anna E. Bortnick Gregg C. Fonarow Julio A. Panza Giora Weisz Mark A. Menegus Mario J. Garcia Deepak L. Bhatt 《The American journal of medicine》2018,131(3):260-268.e1
Background
Prior analyses have largely shown a survival advantage with admission to a teaching hospital for acute myocardial infarction. However, most prior studies report data on patients hospitalized over a decade ago. It is important to re-examine the association of hospital teaching status with outcomes of acute myocardial infarction in the current era.Methods
We queried the 2010 to 2014 National Inpatient Sample databases to identify all patients aged ≥18 years hospitalized with the principal diagnosis of ST-segment elevation myocardial infarction (STEMI). Multivariable logistic regression models were constructed to compare rates of reperfusion and in-hospital outcomes between patients admitted to teaching vs nonteaching hospitals.Results
Of 546,252 patients with STEMI, 273,990 (50.1%) were admitted to teaching hospitals. Compared with patients admitted to nonteaching hospitals, those at teaching hospitals were more likely to receive reperfusion therapy during the hospitalization (86.7% vs 81.5%; adjusted odds ratio [OR] 1.41; 95% confidence interval [CI], 1.39-1.44; P < .001) and had lower risk-adjusted in-hospital mortality (4.9% vs 6.9%; adjusted OR 0.84; 95% CI, 0.82-0.86; P < .001). After further adjustment for differences in use of in-hospital reperfusion therapy, the association of teaching hospital status with lower risk-adjusted in-hospital mortality was significantly attenuated but remained statistically significant (adjusted OR 0.97; 95% CI, 0.94-0.99; P = .02).Conclusions
Patients admitted to teaching hospitals are more likely to receive reperfusion and have lower risk-adjusted in-hospital mortality after STEMI compared with those admitted to nonteaching hospitals. Our results suggest that hospital performance for STEMI continues to be better at teaching hospitals in the contemporary era. 相似文献2.
Ashish Correa Achint Patel Kinsuk Chauhan Harshil Shah Aparna Saha Mihir Dave Priti Poojary Abhishek Mishra Narender Annapureddy Shaman Dalal Ioannis Konstantinidis Renu Nimma Shiv Kumar Agarwal Lili Chan Girish Nadkarni Sean Pinney 《Journal of cardiac failure》2018,24(7):442-450
Background
Dialysis-requiring acute kidney injury (D-AKI) is a serious complication in hospitalized heart failure (HF) patients. However, data on national trends are lacking after 2002.Methods
We used the Nationwide Inpatient Sample (2002–2013) to identify HF hospitalizations with and without D-AKI. We analyzed trends in incidence, in-hospital mortality, length of stay (LoS), and cost. We calculated adjusted odds ratios (aORs) for predictors of D-AKI and for outcomes including in-hospital mortality and adverse discharge (discharge to skilled nursing facilities, nursing homes, etc).Results
We identified 11,205,743 HF hospitalizations. Across 2002–2013, the incidence of D-AKI doubled from 0.51% to 1.09%. We found male sex, younger age, African-American and Hispanic race, and various comorbidities and procedures, such as sepsis and mechanical ventilation, to be independent predictors of D-AKI in HF hospitalizations. D-AKI was associated with higher odds of in-hospital mortality (aOR 2.49, 95% confidence interval [CI] 2.36–2.63; P?<?.01) and adverse discharge (aOR 2.04, 95% CI 1.95–2.13; P?<?.01). In-hospital mortality and attributable risk of mortality due to D-AKI decreased across 2002–2013. LoS and cost also decreased across this period.Conclusions
The incidence of D-AKI in HF hospitalizations doubled across 2002–2013. Despite declining in-hospital mortality, LoS, and cost, D-AKI was associated with worse outcomes. 相似文献3.
Ayman Elbadawi Islam Y. Elgendy Le Dung Ha Amgad Mentias Gbolahan O. Ogunbayo Muhammad Waqas Tahir Nishit Biniwale Odunayo Olorunfemi Kirolos Barssoum Maya Guglin 《Journal of cardiac failure》2018,24(5):337-341
Background
The utility of endomyocardial biopsy (EMB) in the management of myocarditis in the era of advanced cardiac imaging has been challenged.Methods and Results
The Nationwide Inpatient Sample Database (years 1998–2013) was queried to identify hospitalization records with a primary diagnosis of myocarditis, and underwent EMB procedure. We identified 22,299 hospitalization records with a diagnosis of myocarditis during the study period. Of those, 798 (3.6%) underwent EMB procedures. There was an average decrease in the incidence of EMB for myocarditis by 0.15% (P?<?.01) over the study period. Younger patients, women, and those with chronic kidney disease were more likely to undergo EMB. On multivariate analysis, patients with myocarditis who underwent EMB had higher in-hospital mortality (hazard ratio [HR] 1.97, 95% confidence interval [CI] 1.41–2.74) and longer median hospital stay (9 days vs 3 days; P?<?.001). EMB was associated with a higher incidence of cardiac tamponade (odds ratio [OR] 5.21, 95% CI 2.76–9.82), cardiogenic shock (OR 4.66, 95% CI 3.75–5.78), need for intra-aortic balloon pump (OR 3.52, 95% CI 2.49–4.97), and need for extracorporeal membrane oxygenation (OR 4.26, 95% CI 2.78–6.53).Conclusions
The use of EMB in hospitalizations with myocarditis has decreased over time. The use of EMB was associated with a higher likelihood of in-hospital mortality and morbidity. Whether these findings represent a causative association from the procedure or a consequence of more severe disease in this group could not be confirmed in this study. 相似文献4.
Jasvinder A. Singh C. Kent Kwoh Robert M. Boudreau Gwo‐Chin Lee Said A. Ibrahim 《Arthritis \u0026amp; Rheumatology》2011,63(8):2531-2539
Objective
To examine the relationship between hospital procedure volume and surgical outcomes following elective primary total hip arthroplasty/total knee arthroplasty (THA/TKA).Methods
Using the Pennsylvania Health Care Cost Containment Council database, we identified all patients who underwent elective primary THA/TKA in Pennsylvania. Hospitals were categorized according to the annual volume of THA/TKA procedures, as follows: ≤25, 26–100, 101–200, and >200. The 30‐day complication rate and 30‐day and 1‐year mortality rates were assessed by logistic regression models, adjusted for age, sex, race, insurance type, hospital region, 3M All Patient Refined Diagnosis Related Group risk of mortality score, hospital teaching status, and bed count.Results
In the THA and TKA cohorts, the mean age of the patients was 69 years, and 42.8% and 35%, respectively, were men. Compared with patients whose surgeries were performed at very‐high‐volume hospitals (>200 procedures/year), patients who underwent elective primary THA procedures at hospitals with a very low volume (≤25 procedures/year), a low volume (26–100 procedures/year), or a high volume (101–200 procedures/year) had higher multivariable‐adjusted odds ratios (ORs) for venous thromboembolism (OR 2.0, 95% confidence interval [95% CI] 0.2–16.0), OR 3.4 [95% CI 1.4–8.0], and OR 1.1 [95% CI 0.3–3.7], respectively) and 1‐year mortality (OR 2.1 [95% CI 1.2–3.6], OR 2.0 [95% CI 1.4–2.9], and OR 1.0 [95% CI 0.7–1.5], respectively). Among patients ages ≥65 years who underwent elective primary TKA at very‐low‐volume, low‐volume, and high‐volume hospitals, the ORs for 1‐year mortality were significantly higher (OR 0.6 [95% CI 0.2–2.1], OR 1.6 [95% CI 1.0–2.4], and OR 0.9 [95% CI 0.6–1.3], respectively), compared with very‐high‐volume hospitals.Conclusion
Performance of elective primary THA and TKA surgeries in low‐volume hospitals was associated with a higher risk of venous thromboembolism and mortality. Confounding due to unmeasured variables is possible. Modifiable system‐based factors/processes should be targeted to reduce the number of complications associated with THA/TKA procedures.5.
6.
Dhaval Kolte Sahil Khera Chandrasekar Palaniswamy Marjan Mujib Gregg C. Fonarow Ali Ahmed Diwakar Jain William H. Frishman Wilbert S. Aronow 《The American journal of medicine》2013
Background
Previous studies have demonstrated improved outcomes with an early invasive strategy in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI). However, there are limited data for patients ≥80 years of age in these studies.Methods
We used the 2003-2010 Nationwide Inpatient Sample databases to identify all patients ≥80 years of age (octogenarians) with UA/NSTEMI. Multivariable logistic regression was used to compare in-hospital outcomes in octogenarians with UA/NSTEMI undergoing early invasive (coronary angiography within 48 hours of admission, with or without revascularization) versus initial conservative treatment.Results
Among 968,542 octogenarians with UA/NSTEMI, 806,902 (83.3%) were managed using an initial conservative approach and 161,640 (16.7%) using an early invasive strategy. Patients in the early invasive group were more likely to be younger, men, white, and had a higher prevalence of smoking, dyslipidemia, obesity, hypertension, known coronary artery disease, carotid artery disease, and peripheral vascular disease. In-hospital mortality was significantly lower in octogenarians in the early invasive group (adjusted odds ratio [OR] 0.76; 95% confidence interval [CI], 0.74-0.78). Early invasive strategy was associated with lower rates of acute ischemic stroke (adjusted OR 0.63; 95% CI, 0.60-0.66), intracranial hemorrhage (adjusted OR 0.60; 95% CI, 0.510.70), gastrointestinal bleeding (adjusted OR 0.63; 95% CI, 0.60-0.65), and shorter average length of stay (5.3 vs 5.8 days, P <.001), but higher cardiogenic shock (adjusted OR 2.14; 95% CI, 2.06-2.23) and total hospital cost (23,584 vs 13,278 USD).Conclusion
Compared with an initial conservative approach, an early invasive strategy in octogenarians with UA/NSTEMI was associated with lower in-hospital mortality, acute ischemic stroke, intracranial hemorrhage, gastrointestinal bleeding, and shorter length of stay, but higher cardiogenic shock and total hospital cost. 相似文献7.
Keishi Oda Kazuhiro Yatera Yoshihisa Fujino Takashi Kido Tetsuya Hanaka Konomi Sennari Kiyohide Fushimi Shinya Matsuda Hiroshi Mukae 《Respiratory investigation》2018,56(1):64-71
Background
Respiratory comorbidities are frequently associated with idiopathic pulmonary fibrosis (IPF). However, little is known about their prognostic impact in hospitalized patients with IPF. We examined the impact of respiratory comorbidities on the mortality rates of hospitalized patients with IPF using a Japanese nationwide database.Methods
We identified 5665 hospitalized patients diagnosed with IPF between April 2010 and March 2013. The primary outcome was defined as the in-hospital mortality at 30 days after admission. The impact of respiratory comorbidities was assessed using a Cox proportional hazards model that incorporated clinically relevant factors.Results
In hospitalized patients with IPF, the prevalence of bacterial pneumonia, pulmonary hypertension, and lung cancer were 9.5%, 4.6%, and 3.7%, respectively. Among patients with bacterial pneumonia, the four most common pathogens were Streptococcus pneumoniae (31.6%), methicillin-resistant Streptococcus aureus (18.4%), Klebsiella pneumoniae (9.2%), and Pseudomonas aeruginosa (9.2%). Lung cancer was more commonly found in the lower lobes (60.1%) than in other lobes. The survival at 30 days from admission was 78.4% in all patients and significantly lower in IPF patients with bacterial pneumonia (adjusted hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.04–1.63; p < 0.023) and patients with lung cancer (adjusted HR, 1.99; 95% CI, 1.47–2.69; p < 0.001) than in others. Pulmonary hypertension was not associated with mortality. IPF patients with one or more of these three respiratory comorbidities had a poorer survival than others (p < 0.05).Conclusions
Respiratory comorbidities, especially bacterial pneumonia and lung cancer, influence mortality in hospitalized patients with IPF. 相似文献8.
Alexander A. Leung Finlay A. McAlister Samuel R.G. Finlayson David W. Bates 《The American journal of medicine》2013
Background
The prognostic implications of preoperative hypernatremia are unknown. We sought to determine whether preoperative hypernatremia is a predictor of 30-day perioperative morbidity and mortality.Methods
We conducted a cohort study using the American College of Surgeons-National Surgical Quality Improvement Program and identified 908,869 adult patients undergoing major surgery from approximately 300 hospitals from the years 2005 to 2010. We followed the patients for 30-day perioperative outcomes, which included death, major coronary events, wound infections, pneumonia, and venous thromboembolism. Multivariable logistic regression was used to estimate the odds of 30-day perioperative outcomes.Results
The 20,029 patients (2.2%) with preoperative hypernatremia (>144 mmol/L) were compared with the 888,840 patients with a normal baseline sodium (135-144 mmol/L). Hypernatremia was associated with a higher odds for 30-day mortality (5.2% vs 1.3%; adjusted odds ratio [aOR], 1.44; 95% confidence interval [CI], 1.33-1.56), and this finding was consistent in all subgroups. The odds increased according to the severity of hypernatremia (P < .001 for pairwise comparison for mild [145-148 mmol/L] vs severe [>148 mmol/L] categories). Furthermore, hypernatremia was associated with a greater odds for perioperative major coronary events (1.6% vs 0.7%; aOR, 1.16; 95% CI, 1.03-1.32), pneumonia (3.4% vs 1.5%; aOR, 1.23; 95% CI, 1.13-1.34), and venous thromboembolism (1.8% vs 0.9%; OR, 1.28; 95% CI, 1.14-1.42).Conclusion
Preoperative hypernatremia is associated with increased perioperative 30-day morbidity and mortality. 相似文献9.
Jose Calvo Broce Lori Lyn Price Orfeas Liangos Katrin Uhlig Bertrand L. Jaber 《Clinical journal of the American Society of Nephrology》2011,6(7):1556-1565
Summary
Background and objectives
Serum creatinine (sCr) increments currently used to define acute kidney injury (AKI) do not take into consideration the baseline level of kidney function. The objective of this study was to establish whether baseline estimated GFR (eGFR) provides additional risk stratification to sCr-based increments for defining AKI.Design, setting, participants, & measurements
29,645 adults hospitalized at an acute care facility were analyzed. Hospital-acquired AKI was defined by calculating the difference between the nadir and subsequent peak sCr.Results
Different thresholds of nadir-to-peak sCr were found to be independently associated with increased in-hospital mortality according to baseline eGFR strata. A nadir-to-peak sCr minimum threshold of ≥0.2, ≥0.3, and ≥0.5 mg/dl was required to be independently associated with increased in-hospital mortality among patients with baseline eGFR ≥60 ml/min per 1.73 m2 (odds ratio [OR] 1.67; 95% confidence interval [CI] 1.13 to 2.47), 30 to 59 ml/min per 1.73 m2 (OR 2.69; 95% CI, 1.82 to 3.97), and <30 ml/min per 1.73 m2 (OR 2.15; 95% CI 1.02 to 4.51), respectively. There was a significant interaction between the nadir-to-peak sCr and baseline eGFR for in-hospital mortality (P < 0.001). Using these thresholds, survivors of AKI episodes had an increased hospital length of stay and were more likely to be discharged to a facility rather than home. Sensitivity analyses showed a significant interaction between baseline eGFR strata and relative increases in sCr, as well as absolute and relative decreases in eGFR for in-hospital mortality (P < 0.001).Conclusions
This study suggests that future sCr-based definitions of AKI should take into consideration baseline eGFR. 相似文献10.
Justin B. Echouffo-Tcheugui Dhaval Kolte Sahil Khera Herbert D. Aronow J. Dawn Abbott Deepak L. Bhatt Gregg C. Fonarow 《The American journal of medicine》2018,131(7):778-786.e1
Background
Diabetes mellitus (diabetes) increases the risk of acute myocardial infarction, which can result in cardiogenic shock. Data on the relation of diabetes and the occurrence and prognosis of cardiogenic shock postacute myocardial infarction are scant.Methods
Among the National Inpatient Sample patients aged ≥18 years and hospitalized for acute myocardial infarction during the 2012-2014 period, we examined the association between diabetes and the incidence and outcomes of cardiogenic shock complicating acute myocardial infarction, using multivariable logistic and linear regression models.Results
Of 1,332,530 hospitalizations for acute myocardial infarction, 72,765 (5.5%) were complicated by cardiogenic shock. In acute myocardial infarction patients, cardiogenic shock incidence was higher among those with vs without diabetes (5.8% vs 5.2%; adjusted odds ratio [aOR] 1.14; 95% confidence interval [CI], 1.11-1.19; P < .001), with 42.8% (n = 31,135) of patients with acute myocardial infarction and cardiogenic shock having diabetes. Diabetic patients were less likely to undergo revascularization (percutaneous coronary intervention or coronary artery bypass grafting) (67.1% vs 68.7%; aOR 0.88; 95% CI, 0.80-0.96; P = .003). Diabetes was associated with higher in-hospital mortality in patients with acute myocardial infarction and cardiogenic shock (37.9% vs 36.8%; aOR 1.18; 95% CI, 1.09-1.28; P < .001). Among survivors, patients with diabetes had a longer hospital stay (mean ± SEM: 11.6 ± 0.16 vs 10.9 ± 0.16 days; adjusted estimate 1.12; 95% CI, 1.06-1.18; P < .001) and were more likely to be discharged to a skilled nursing home or with home health care (56.0% vs 50.5%; aOR 1.19; 95% CI, 1.07-1.33; P = .001).Conclusions
In a large cohort of acute myocardial infarction patients, preexisting diabetes was associated with an increased risk of cardiogenic shock and worse outcomes in those with cardiogenic shock. 相似文献11.
Yushu Wang Sui Zhu Peijuan Gao Yucheng Chen Qing Zhang 《The American journal of the medical sciences》2018,355(4):331-341
Background
The clinical outcomes of drug-eluting stents versus bare-metal stents in end-stage renal disease patients remains controversial.Methods
A comprehensive literature search of Pubmed, Embase and Cochrane Library from January 2000 until November 2016 was conducted to identify relevant articles. We pooled the odds ratios (OR) from individual studies and conducted heterogeneity, quality assessment and publication bias analyses.Results
A total of 18 studies with 44,194 patients were identified. Compared with bare-metal stent-treated patients, drug-eluting stent-treated patients had significantly lower short-term and long-term all-cause mortality (OR = 0.56; 95% CI: 0.48-0.65; P < 0.00001; OR = 0.78; 95% CI: 0.66-0.92; P = 0.004, respectively), myocardial infarction (OR = 0.69; 95% CI: 0.53-0.88; P = 0.003) and major adverse cardiac events (OR = 0.72; 95% CI: 0.58-0.90; P = 0.004), with no detectable difference regarding stent thrombosis (OR = 0.80; 95% CI: 0.43-1.49; P = 0.47), cardiac mortality (OR = 0.95; 95% CI: 0.89-1.02; P = 0.14) and repeat revascularization (OR = 0.81; 95% CI: 0.62-1.06; P = 0.13).Conclusions
In patients with end-stage renal disease, the use of drug-eluting stents could significantly reduce the rates of mortality, myocardial infarction and major adverse cardiac events without increased risk of stent thrombosis. It poses imperative demands for future prospective randomized studies to define the optimal stent choice in this high-risk population. 相似文献12.
Francis ML Varghese JJ Mathew JM Koneru S Scaife SL Zahnd WE 《The American journal of medicine》2010,123(10):922-928
Background
Patients with rheumatoid arthritis have an increased risk for accelerated atherosclerosis. It is unknown, however, whether rheumatoid arthritis also increases in-hospital mortality after a myocardial infarction or influences the therapy patients receive.Methods
A cross-sectional analysis of 1,112,676 patients with myocardial infarction in the 2003-2005 Nationwide Inpatient Sample was performed.Results
Patients with rheumatoid arthritis were 39% more likely to receive medical therapy (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.30-1.49) than interventional therapy. By using logistic regression, we adjusted for confounding variables to determine the effect of rheumatoid arthritis on the selection of therapy and found that rheumatoid arthritis itself was associated with a 38% increased likelihood of undergoing thrombolysis (OR, 1.38; 95% CI, 1.10-1.71) and a 27% increased likelihood of undergoing percutaneous coronary intervention (OR, 1.27; 95% CI, 1.17-1.39). For the primary outcome measure, we determined that patients with rheumatoid arthritis overall had a 24% better in-hospital mortality compared with other patients with a myocardial infarction (OR, 0.76; 95% CI, 0.68-0.86), which was 34% better after adjusting for confounding variables (OR, 0.66; 95% CI, 0.59-0.74). This better in-hospital mortality was seen in patients with rheumatoid arthritis undergoing medical therapy (adjusted OR, 0.67; 95% CI, 0.59-0.75) and percutaneous coronary intervention (adjusted OR, 0.47; 95% CI, 0.32-0.70), but not in patients undergoing thrombolysis or coronary artery bypass grafting.Conclusions
Among patients with myocardial infarction, rheumatoid arthritis was associated with an increased use of thrombolysis and percutaneous coronary intervention. Moreover, patients with rheumatoid arthritis had an in-hospital survival advantage, particularly those undergoing medical therapy and percutaneous coronary intervention. 相似文献13.
Ghideon Ezaz Susan L. Murphy Jessica Mellinger Elliot B. Tapper 《The American journal of medicine》2018,131(6):645-650.e2
Background
Injuries are more morbid and complicated to manage in patients with cirrhosis. However, data are limited regarding the relative risk of injury and severity of injury from falls in patients with cirrhosis compared with those without cirrhosis.Methods
We examined the nationally representative National Emergency Department Sample, an all-payer database including all patients presenting with falls, 2009-2012. We determined the relative risks for and clinical associations with severe injuries. Outcomes included hospitalization, length of stay, costs, and in-hospital death. Outcomes were compared with those of patients with congestive heart failure.Results
We identified 102,977 visits involving patients with cirrhosis and 26,996,120 involving patients without cirrhosis who presented with a fall. Overall and compared with patients with congestive heart failure, the adjusted risk of severe injury was higher for patients with cirrhosis. These included intracranial hemorrhage (2.33; 95% confidence interval [CI], 2.02-2.68), skull fracture (1.75; 95% CI, 1.53-2.00), and pelvic fracture (1.71; 95% CI, 1.56-1.88). Risk was lower for less-severe injuries, such as concussion (0.95; 95% CI, 0.86-1.06) and lower-leg fracture (0.86; 95% CI, 0.80-0.91). Risk factors significantly positively associated with severe injury on multivariate analysis were hepatic encephalopathy, alcohol abuse, and infection. Cirrhosis was associated with increased risk of in-hospital death, longer length of stay, and higher costs after a fall. All outcomes were worse compared with those for patients with congestive heart failureConclusion
Falls are common in patients with cirrhosis, and they are more likely to incur severe injuries, with increased hospital costs and risk of death. Poor outcomes are most associated with ascites, hepatic encephalopathy, alcohol abuse, and infection, highlighting the subgroups at highest risk and most likely to benefit from preventative interventions. 相似文献14.
Nivas Balasubramaniyam Dhaval Kolte Chandrasekar Palaniswamy Kiran Yalamanchili Wilbert S. Aronow John A. McClung Sahil Khera Sachin Sule Stephen J. Peterson William H. Frishman 《The American journal of medicine》2013
Background
Despite the widespread availability of plasmapheresis as a therapy, thrombotic thrombocytopenic purpura is associated with significant morbidity and mortality. There is a paucity of data on the predictors of poor clinical outcome in this population. Acute myocardial infarction is a recognized complication of thrombotic thrombocytopenic purpura. Little is known about the magnitude of this problem, its risk factors, and its influence on mortality in patients hospitalized with thrombotic thrombocytopenic purpura.Methods
We used the 2001-2010 Nationwide Inpatient Sample database to identify patients aged ≥18 years with the diagnosis of thrombotic thrombocytopenic purpura (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 446.6) who also received therapeutic plasmapheresis (ICD-9-CM code 99.71) during the hospitalization. Patients with acute myocardial infarction were identified using the Healthcare Cost and Utilization Project Clinical Classification Software code 100. Stepwise logistic regression was used to determine independent predictors of in-hospital mortality and acute myocardial infarction in thrombotic thrombocytopenic purpura patients.Results
Among the 4032 patients (mean age 47.5 years, 67.7% women, and 36.9% white) with thrombotic thrombocytopenic purpura who also underwent plasmapheresis, in-hospital mortality was 11.1%. Independent predictors of increased in-hospital mortality were older age (odds ratio [OR] 1.03; 95% confidence interval [CI], 1.02-1.04; P <.001), acute myocardial infarction (OR 1.89; 95% CI, 1.24-2.88; P = .003), acute renal failure (OR 2.75; 95% CI, 2.11-3.58; P <.001), congestive heart failure (OR 1.66; 95% CI, 1.17-2.34; P = .004), acute cerebrovascular disease (OR 2.68; 95% CI, 1.87-3.85; P <.001), cancer (OR 2.49; 95% CI, 1.83-3.40; P <.001), and sepsis (OR 2.59; 95% CI, 1.88-3.59; P <.001). Independent predictors of acute myocardial infarction were older age (OR 1.03; 95% CI, 1.02-1.04; P <.001), smoking (OR 1.60; 95% CI, 1.14-2.24; P = .007), known coronary artery disease (OR 2.59; 95% CI, 1.76-3.81; P <.001), and congestive heart failure (OR 2.40; 95% CI, 1.71-3.37; P <.001).Conclusion
In this large national database, patients with thrombotic thrombocytopenic purpura had an in-hospital mortality rate of 11.1% and an acute myocardial infarction rate of 5.7%. Predictors of in-hospital mortality were older age, acute myocardial infarction, acute renal failure, congestive heart failure, acute cerebrovascular disease, cancer, and sepsis. Predictors of acute myocardial infarction were older age, smoking, known coronary artery disease, and congestive heart failure. 相似文献15.
Karam Ayoub Meera Marji Gbolahan Ogunbayo Ahmad Masri Ahmed Abdel-Latif Khaled Ziada Srikanth Vallurupalli 《JACC: Cardiovascular Interventions》2018,11(18):1862-1868
Objectives
This study sought to evaluate the impact of chronic thrombocytopenia (cTCP) on clinical outcomes after percutaneous coronary intervention (PCI).Background
The impact of cTCP on clinical outcomes after PCI is not well described. Results from single-center observational studies and subgroup analysis of randomized trials have been conflicting and these patients are either excluded or under-represented in randomized controlled trials.Methods
Using the 2012 to 2014 National (Nationwide) Inpatient Sample database, the study identified patients who underwent PCI with or without cTCP as a chronic condition variable indicator. Propensity score matching was performed using logistic regression to control for differences in baseline characteristics. The primary outcome of interest was in-hospital mortality. Secondary outcomes of interest included in-hospital post-PCI bleeding events, post-PCI blood and platelet transfusion, vascular complications, ischemic cerebrovascular accidents (CVAs), hemorrhagic CVAs, and length of stay.Results
Propensity matching yielded a cohort of 65,130 patients (32,565 with and without cTCP). Compared with those without cTCP, PCI in patients with cTCP was associated with higher risk for bleeding complications (odds ratio [OR]: 2.40; 95% confidence interval [CI]: 2.05 to 2.72; p < 0.0001), requiring blood transfusion (OR: 2.10; 95% CI: 1.80 to 2.24; p < 0.0001), requiring platelet transfusion (OR: 11.70; 95% CI: 6.00 to 22.60; p < 0.0001), higher risk for vascular complications (OR: 1.94; 95% CI: 1.43 to 2.63; p < 0.0001), ischemic CVA (OR: 1.60; 95% CI: 1.20 to 2.10; p = 0.01), and higher in-hospital mortality (OR: 2.30; 95% CI: 1.90 to 2.70; p < 0.0001), but without a significant difference in hemorrhagic CVA (OR: 1.50; 95% CI: 0.70 to 3.10; p = 0.27).Conclusions
In this large contemporary cohort, patients with cTCP were at higher risk of a multitude of complications, including higher risk of in-hospital mortality. 相似文献16.
Stephan Reichenbach Michael Leunig Stefan Werlen Eveline Nüesch Christian W. Pfirrmann Harald Bonel Alex Odermatt Willy Hofstetter Reinhold Ganz Peter Jüni 《Arthritis \u0026amp; Rheumatology》2011,63(12):4023-4030
Objective
Femoroacetabular impingement may be a risk factor for hip osteoarthritis in men. An underlying hip deformity of the cam type is common in asymptomatic men with nondysplastic hips. This study was undertaken to examine whether hip deformities of the cam type are associated with signs of hip abnormality, including labral lesions and articular cartilage damage, detectable on magnetic resonance imaging (MRI).Methods
In this cross‐sectional, population‐based study in asymptomatic young men, 1,080 subjects underwent clinical examination and completed a self‐report questionnaire. Of these subjects, 244 asymptomatic men with a mean age of 19.9 years underwent MRI. All MRIs were read for cam‐type deformities, labral lesions, cartilage thickness, and impingement pits. The relationship between cam‐type deformities and signs of joint damage were examined using logistic regression models adjusted for age and body mass index. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were determined.Results
Sixty‐seven definite cam‐type deformities were detected. These deformities were associated with labral lesions (adjusted OR 2.77 [95% CI 1.31, 5.87]), impingement pits (adjusted OR 2.9 [95% CI 1.43, 5.93]), and labral deformities (adjusted OR 2.45 [95% CI 1.06, 5.66]). The adjusted mean difference in combined anterosuperior femoral and acetabular cartilage thickness was −0.19 mm (95% CI −0.41, 0.02) lower in those with cam‐type deformities compared to those without.Conclusion
Our findings indicate that the presence of a cam‐type deformity is associated with MRI‐detected hip damage in asymptomatic young men.17.
C. De la Calle H.G. Ternavasio-de la Vega L. Morata F. Marco C. Cardozo C. García-Vidal A. Del Rio C. Cilloniz A. Torres J.A. Martínez J. Mensa A. Soriano 《The Journal of infection》2018,76(4):342-347
Objective
Combining a macrolide or a fluoroquinolone to beta-lactam regimens in the treatment of patients with moderate to severe community-acquired pneumonia is recommended by the international guidelines. However, the information in patients with bacteraemic pneumococcal pneumonia is limited.Methods
A propensity score technique was used to analyze prospectively collected data from all patients with bacteraemic pneumococcal pneumonia admitted from 2000 to 2015 in our institution, who had received empirical treatment with third-generation cephalosporin in monotherapy or plus macrolide or fluoroquinolone.Results
We included 69 patients in the monotherapy group and 314 in the combination group. After adjustment by PS for receiving monotherapy, 30-day mortality (OR 2.89; 95% CI 1.07–7.84) was significantly higher in monotherapy group. A higher 30-day mortality was observed in monotherapy group in both 1:1 and 1:2 matched samples although it was statistically significant only in 1:2 sample (OR: 3.50 (95% CI 1.03–11.96), P = 0.046).Conclusions
Our study suggests that in bacteraemic pneumococcal pneumonia, empirical therapy with a third-generation cephalosporin plus a macrolide or a fluoroquinolone is associated with a lower mortality rate than beta-lactams in monotherapy. These results support the recommendation of combination therapy in patients requiring admission with moderate to severe disease. 相似文献18.
Yasuyuki Shiraishi Shun Kohsaka Takayuki Abe Kazumasa Harada Tetsuro Miyazaki Takamichi Miyamoto Kiyoshi Iida Shuzou Tanimoto Mayuko Yagawa Makoto Takei Yuji Nagatomo Toru Hosoda Takeshi Yamamoto Ken Nagao Morimasa Takayama 《The American journal of medicine》2018,131(2):156-164.e2
Background
The onset of acute heart failure is known to be associated with increased physical activity and other specific behaviors that can trigger hemodynamic deterioration. This analysis aimed to describe the distribution of triggers in patients hospitalized for acute heart failure, and investigate their effects on in-hospital outcomes.Methods
Consecutive patients hospitalized for acute heart failure between 2010 and 2014 were registered in a multicenter data registration system (72 institutions within Tokyo, Japan). Baseline demographics and in-hospital mortality were extracted from 17,473 patients. Patients with a trigger were grouped based on their triggering event: those with onset during (a) physical activity; (b) sleeping; (c) eating or watching television; (d) bathing or excretion (use of restrooms); and (e) engaging in other activities. These patients were compared with patients without identifiable triggers. Multiple imputation was used for missing data.Results
Patients were predominantly men (57.1%), with a mean age of 76.0 ± 13.0 years; a triggering event was present in 49.1%. No significant difference in baseline characteristics was noted between groups except for younger age, higher blood pressure, and prevalence of signs of congestion in the trigger-positive group. In-hospital mortality rate was 7.9%. Presence of triggers was positively associated with a reduced risk of in-hospital mortality (adjusted odds ratio 0.79; 95% confidence interval, 0.70-0.90; P = .0003). In a delta-adjusted pattern mixture model, the effect of a triggering event on in-hospital mortality remained consistently significant.Conclusion
Triggering events for acute heart failure can provide additional information for risk prediction. Efforts to identify the triggers should be made to classify patients according to risk group. 相似文献19.