Risk Factors, Management, and Outcomes of Pyogenic Liver Abscess in a US Safety Net Hospital

Background: Several studies have examined the risk of cardiovascular disease (CVD) among larger racial and ethnic groups such as Hispanics and African-Americans in the United States, but limited information is available on smaller subgroups such as Armenians. According to the World Health Organization, Armenia ranks eighth in CVD rates among all countries however it is unclear if Armenian immigrants living in the US have the same high rates of disease. This study examined whether being of Armenian descent increased the risk of having a positive exercise treadmill test (ETT) among patients treated at a safety net hospital in Los Angeles County. Methods: Data on patients who received an ETT from 2008-2011 were used to conduct a retrospective analysis of the relationship between Armenian ethnicity and ETT result as a surrogate measure for CVD. A multivariate logistic regression analysis was used to estimate the odds ratios (OR) for having a positive ETT among Armenians relative to non-Armenians, adjusting for the following pre-specified covariates: gender, age, diabetes, hypertension, hyperlipidemia, smoking, family history of coronary artery disease (CAD), and patient history of CAD. Results: A total of 5,297 patients, ages 18 to 89, were included. Of these, 13% were Armenian and 46% were male, with an average age of 53 years. Armenians had higher odds of having a positive ETT than non-Armenians (Crude OR=1.30, p=0.037, CI:1.02,1.66). After adjusting for CV risk factors, Armenians were still significantly more likely to have a positive ETT than non-Armenians (OR=1.33, p=0.029, CI:1.03,1.71). CAD (OR 2.02, p<0.001, CI:1.38,2.96), and hyperlipidemia (OR=1.31, p=0.008, CI:1.07,1.60) were also significantly associated with a positive ETT. Conclusion: Armenians have a higher likelihood of having a positive ETT than non-Armenians. This relationship appears to be independent of traditional CV risk factors and suggests a role for cultural and/or genetic influences.

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Abstract WP375: Fall Risk in Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.wp375 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Robynn S Cox ◽

Cheryl Bradas ◽

Victoria Bowden ◽

Beth Buckholz ◽

Kathleen Kerber ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Fall Risk ◽

Safety Net ◽

Public Healthcare ◽

Inpatient Setting ◽

Stroke Patients ◽

Safety Net Hospital ◽

Risk Factors For Falls

Fall Risk Factors among Hospitalized Acute Post-Ischemic Stroke Patients in an Urban Public Healthcare System Background: Falls remain an important benchmarking indicator for hospitals. The incidence of falls is a nursing-sensitive indicator, amenable to preventable measures. Research indicates factors associated with falls, but few studies specifically identify factors among hospitalized patients with acute ischemic stroke (AIS). Purpose: Identify prevalence and risk factors for falls among acute, hospitalized AIS patients within an urban safety net hospital. Methods: Retrospective cohort study. Data abstracted from stroke and fall registries, and medical records from 2013-2015 among all adult patients admitted for AIS. Variables included traditional risk factors for falls, as well as stroke-specific factors (NIHSS score, functional status, stroke location and vessel, administration of tPA). Results: N=683 AIS stroke patients, with 1.6% fall rate. Falls among AIS patients accounted for 6% of all hospital falls. AIS patients who experienced an inpatient fall had a mean age of 67 (range 46-86), were mostly male (82%), and ambulating independently prior to arrival (91%). Mean NIHSS scores upon admission were higher among those who experienced a fall, when compared to AIS patients who did not fall (mean=8.73, 7.01, respectively). Most patients who experienced a fall demonstrated weakness and/or paresis upon initial exam (90%), with 64% experiencing small vessel ischemic changes, and 36% MCA strokes. Administration of tPA was not associated with increased falls. LOS was significantly increased among AIS patients who experienced a fall (7.7 vs. 4.8, respectively, p <0.01). Conclusions: Fall rates among hospitalized AIS patients may be lower than earlier reports, reflecting increased vigilance among providers and widespread integration of fall prevention strategies. Elevated NIHSS scores and weakness/paresis upon initial exam may be important predictors of falls among newly diagnosed AIS patients who had previously been able to ambulate independently. Consistent with fall literature among other populations, the occurrence of a fall in the inpatient setting can substantially increase length of stay.

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Absceso hepático piógeno en pediatría: serie de casos

Revista Pediátrica de Panamá ◽

10.37980/im.journal.rspp.20191566 ◽

2019 ◽

pp. 13-19

Author(s):

José F Sotillo-Lindo ◽

Bustamante Bustamante ◽

Magda Rojas ◽

Kathia Luciani

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Liver Abscess ◽

Parasitic Infection ◽

Case Series ◽

Pyogenic Liver Abscess ◽

Left Lobe ◽

Long Time ◽

Mean Size ◽

Right Lobe

El absceso hepático es un reto diagnóstico y terapéutico. Es una patología poco frecuente en la niñez que predomina en países en desarrollo y se asocia a malnutrición y parasitosis. El absceso hepático piógeno es el más frecuente, es una causa de hospitalización prolongada por el requerimiento de antimicrobianos endovenosos; usualmente con baja mortalidad.A continuación, presentamos una serie de cuatro casos clínicos de pacientes con abscesos hepáticos piógenos que fueron manejados entre el 2016 y 2018 en el Hospital de Especialidades Pediátricas.Tres pacientes fueron del sexo femenino y uno masculino. En dos de los pacientes se identi có factor predisponente: diabetes mellitus e infección avanzada por VIH. Los síntomas más frecuentes fueron ebre (100%), dolor abdominal (100%) y hepatomegalia (50%). En ninguno de los casos se sospechó absceso hepático a su ingreso. Los casos fueron diagnosticados por sonograma hepático y corroborados con tomografía abdominal. El tamaño promedio de las lesiones fue de 6.88 x 6.18 x 6.12 cm. Tres fueron de localización derecha y uno de localización izquierda. Todos los pacientes recibieron antibioticoterapia de amplio espectro y drenaje percutáneo. Se identi có agente etiológico en uno de los pacientes: Staphylococcus aureus.Los pacientes recibieron una media de 33 + 3.5 días de tratamiento. Con evolución favorable en todos los casos y mejoría en seguimiento con ultrasonidos. Ningún paciente requirió intervención quirúrgica. Abstract The liver abscess involves an authentic diagnostic and therapeutic challenge. It is not frecuent in childhood. Occurs mainly in developing countries and is associated to malnutrition and parasitic infection, that are described as risk factors. Pyogenic liver abscess represents, in most of the cases, a cause of long-time hospitalizations because of the requirement of endovenous treatment, but usually with low mortality.We describe a four-case series of patients with pyogenic liver abscess between 2016 and 2018 in Hospital de Especialidades Pediatricas in Panamá City.Three patients were female and one was a male. In two of the cases, there were risk factors such as diabetes mellitus and advanced HIV infection.The most frequent symptoms were: fever (100%), abdominal pain (100%) and hepatomegaly (50%).In neither one of the cases, liver abscess was suspected as diagnosis. All cases were diagnosed by hepatic sonogram and con rmed by abdominal CT- scan. The mean size of lesions was 6.88 x 6.18 x 6.12 cm. Three of the cases were located in right lobe and one in the left lobe of the liver. They were managed with broad-spectrum antibiotics and percutaneous drainage.Staphylococcus aureus was isolated in one case.The patients received a mean of 33 + 3.5 days of treatment. All cases evolved well with improvement of lesion in ultrasonography. None of the patients required surgical intervention.

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Evaluation of clinical risk factors for developing pleural empyema secondary to liver abscess

BMC Gastroenterology ◽

10.1186/s12876-019-1128-4 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Eunjue Yi ◽

Tae Hyung Kim ◽

Jun Hee Lee ◽

Jae Ho Chung ◽

Sungho Lee

Keyword(s):

Risk Factors ◽

Pleural Effusion ◽

Liver Abscess ◽

Biliary Tract ◽

Clinical Manifestation ◽

Pyogenic Liver Abscess ◽

Pleural Empyema ◽

Patient Characteristics ◽

Group 2 ◽

The Right

Abstract Background The aim of this study was to investigate the clinical manifestation and predictive risk factors of pleural empyema developing during treatment of the pyogenic liver abscess. Methods Medical records of patients with the liver abscess in our institution were reviewed retrospectively. Enrolled patients were classified into four groups; Group 1: patients without pleural effusion, Group 2: patients with pleural effusion and who were treated noninvasively, Group 3: patient with pleural effusion and who were treated with thoracentesis, and Group 4: patients with pleural effusion that developed into empyema. Patient characteristics, clinical manifestation, and possible risk factors in development of empyema were analyzed. Results A total of 234 patients was enrolled in this study. The incidence rate of empyema was 4.27% (10 patients). The mean interval for developing pleural effusion was 5.6 ± 6.35 days. In multivariate analysis, risk factors for developing pleural effusion included the location of the liver abscess near the right diaphragm (segment 7 and 8, OR = 2.30, p = 0.048), and larger diameter of the liver abscess (OR = 1.02, p = 0.042). Among patients who developed pleural effusions, presences of mixed microorganisms from culture of liver aspirates (OR = 10.62, p = 0.044), bilateral pleural effusion (OR = 46.72, p = 0.012) and combined biliary tract inflammation (OR = 21.05, p = 0.040) were significantly associated with the need for invasive intervention including surgery on effusion. Conclusion The location of the liver abscess as well as pleural effusion, elevated inflammatory markers, and combined biliary tract inflammation may be important markers of developing pleural complication in patients with pyogenic liver abscess.

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Risk Factors for Failure to Return After a Poor Preparation Colonoscopy: Experience in a Safety-Net Hospital

The American Journal of Gastroenterology ◽

10.14309/00000434-201610001-00255 ◽

2016 ◽

Vol 111 ◽

pp. S120

Author(s):

Butros Toro ◽

Gabrielle Dawkins ◽

Frank K. Friedenberg ◽

Adam C. Ehrlich

Keyword(s):

Risk Factors ◽

Safety Net ◽

Safety Net Hospital

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Mortality Risk Factors in Patients with Pyogenic Liver Abscess

10.47829/cos.2021.5903 ◽

2021 ◽

Vol 05 (09) ◽

Author(s):

dos Santos-Rosa OM ◽

dos Santos RLC ◽

Favaro ML ◽

Fonseca AZ ◽

Junior MAFR

Keyword(s):

Risk Factors ◽

Liver Abscess ◽

Mortality Risk ◽

Pyogenic Liver Abscess

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Risk Factors for Development of Hypocalcemia in Patients With Cancer Treated With Bone-Modifying Agents

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2019.7370 ◽

2020 ◽

Vol 18 (4) ◽

pp. 420-427

Author(s):

Paul S. White ◽

Michael Dennis ◽

Eric A. Jones ◽

Janice M. Weinberg ◽

Shayna Sarosiek

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Bone Metastases ◽

Tertiary Care ◽

Safety Net ◽

High Rate ◽

Close Monitoring ◽

Patients With Cancer ◽

Vitamin D Levels ◽

Safety Net Hospital

Background: This retrospective analysis describes the prevalence of and risk factors associated with the development of hypocalcemia in patients with cancer receiving bone-modifying agents (BMAs) as supportive care. Patients and Methods: Patients with cancer treated with an intravenous or subcutaneous BMA, including pamidronate, zoledronic acid, or denosumab, at a tertiary care/safety net hospital in 2005 through 2015 were included in this retrospective review. We reviewed the medical records for predictive clinical and laboratory parameters and for patient outcomes. Results: A total of 835 patients with cancer received at least one dose of a BMA during the specified time frame; 205 patients (25%) developed hypocalcemia of CTCAE grade ≥1 within 8 weeks of BMA initiation, 18 of whom (8.8%) had grade ≥3, and 3 patients died as a result. Multivariate analysis showed that patients with hematologic malignancy (odds ratio [OR], 1.956; P=.025), bone metastases (OR, 2.443; P=.017), inpatient status (OR, 2.592; P<.001), and deficient baseline vitamin D levels (OR, 2.546; P<.023) were more likely to develop hypocalcemia. Hypercalcemia before BMA administration (OR, 0.474; P=.032) was protective. Conclusions: Certain patient populations, including those with hematologic malignancies and/or bone metastases, warrant closer monitoring of calcium levels while receiving BMAs because of the high rate of hypocalcemia. Low pretreatment vitamin D levels are associated with the development of hypocalcemia. These data support close monitoring of calcium levels in patients with cancer receiving BMAs, in addition to adequate repletion of vitamin D before initiation of BMAs when possible.

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