scholarly journals Patient-Driven Goals for High-Risk Hospitalized Patients (QI637)

2020 ◽  
Vol 59 (2) ◽  
pp. 519-520
Author(s):  
Kelly Pennington ◽  
Timothy Dempsey ◽  
Ann Vu ◽  
Courtney Stellpflug ◽  
Daniel Partain ◽  
...  
Keyword(s):  
High Risk ◽  
Hospitalized Patients

scholarly journals Prevalence and Prognosis of High-Risk Plaque on Coronary CT Angiography in Hospitalized Patients

2020 ◽  
Vol 13 (2) ◽  
pp. 522-523
Author(s):  
Yong Yang ◽  
Jageshwar Prasad Shah ◽  
Hanjiang Zeng ◽  
Jianqun Yu ◽  
Abdullah Hagar ◽  
...  
Keyword(s):  
High Risk ◽  
Ct Angiography ◽  
Coronary Ct Angiography ◽  
Hospitalized Patients ◽  
Coronary Ct

scholarly journals Clinical features associated with COVID-19 outcome in multiple myeloma: first results from the International Myeloma Society data set

Blood ◽  
2020 ◽  
Vol 136 (26) ◽  
pp. 3033-3040 ◽  
Author(s):  
Ajai Chari ◽  
Mehmet Kemal Samur ◽  
Joaquin Martinez-Lopez ◽  
Gordon Cook ◽  
Noa Biran ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
High Risk ◽  
Renal Disease ◽  
Univariate Analysis ◽  
Staging System ◽  
Outcome Data ◽  
Careful Consideration ◽  
Hospitalized Patients ◽  
Related Factors ◽  
Data Set

Abstract The primary cause of morbidity and mortality in patients with multiple myeloma (MM) is an infection. Therefore, there is great concern about susceptibility to the outcome of COVID-19–infected patients with MM. This retrospective study describes the baseline characteristics and outcome data of COVID-19 infection in 650 patients with plasma cell disorders, collected by the International Myeloma Society to understand the initial challenges faced by myeloma patients during the COVID-19 pandemic. Analyses were performed for hospitalized MM patients. Among hospitalized patients, the median age was 69 years, and nearly all patients (96%) had MM. Approximately 36% were recently diagnosed (2019-2020), and 54% of patients were receiving first-line therapy. Thirty-three percent of patients have died, with significant geographic variability, ranging from 27% to 57% of hospitalized patients. Univariate analysis identified age, International Staging System stage 3 (ISS3), high-risk disease, renal disease, suboptimal myeloma control (active or progressive disease), and 1 or more comorbidities as risk factors for higher rates of death. Neither history of transplant, including within a year of COVID-19 diagnosis, nor other anti-MM treatments were associated with outcomes. Multivariate analysis found that only age, high-risk MM, renal disease, and suboptimal MM control remained independent predictors of adverse outcome with COVID-19 infection. The management of MM in the era of COVID-19 requires careful consideration of patient- and disease-related factors to decrease the risk of acquiring COVID-19 infection, while not compromising disease control through appropriate MM treatment. This study provides initial data to develop recommendations for the management of MM patients with COVID-19 infection.

scholarly journals Transient azotaemia is associated with a high risk of death in hospitalized patients

2010 ◽  
Vol 25 (6) ◽  
pp. 1833-1839 ◽  
Author(s):  
S. Uchino ◽  
R. Bellomo ◽  
S. M. Bagshaw ◽  
D. Goldsmith
Keyword(s):  
High Risk ◽  
Hospitalized Patients ◽  
Risk Of Death

scholarly journals Risk of thrombotic complications in influenza versus COVID-19 hospitalized patients

2020 ◽  
Author(s):  
◽  
MV Huisman ◽  
Milou AM Stals ◽  
Marco JJH Grootenboers ◽  
Coen van Guldener ◽  
...  
Keyword(s):  
High Risk ◽  
Cumulative Incidence ◽  
Respiratory Tract Infections ◽  
Hospitalized Patients ◽  
Thrombotic Complication ◽  
List Type ◽  
Virus Infections ◽  
Risk Of Death ◽  
Thrombotic Complications ◽  
Tract Infections

AbstractBackgroundWhereas accumulating studies on COVID-19 patients report high incidences of thrombotic complications, large studies on clinically relevant thrombosis in patients with other respiratory tract infections are lacking. How this high risk in COVID-19 patients compares to those observed in hospitalized patients with other viral pneumonias such as influenza is unknown.ObjectivesTo assess the incidence of venous and arterial thrombotic complications in hospitalized influenza patients as opposed to that observed in hospitalized COVID-19 patients.MethodsRetrospective cohort study; we used data from Statistics Netherlands (study period: 2018) on thrombotic complications in hospitalized influenza patients. In parallel, we assessed the cumulative incidence of thrombotic complications – adjusted for competing risk of death - in patients with COVID-19 in three Dutch hospitals (February 24th - April 26th 2020).ResultsOf the 13.217 hospitalized influenza patients, 437 (3.3%) were diagnosed with thrombotic complications, versus 66 (11%) of the 579 hospitalized COVID-19 patients. The 30-day cumulative incidence of any thrombotic complication in influenza was 11% (95%CI 9.4-12) versus 25% (95%CI 18-32) in COVID-19. For venous thrombotic complications (VTE) and arterial thrombotic complications alone, these numbers were respectively 3.6% (95%CI 2.7-4.6) and 7.5% (95%CI 6.3-8.8) in influenza versus 23% (95%CI 16-29) and 4.4% (95%CI 1.9-8.8) in COVID-19.ConclusionsThe incidence of thrombotic complications in hospitalized influenza patients was lower than in hospitalized COVID-19 patients. This difference was mainly driven by a high risk of VTE complications in the COVID-19 patients admitted to ICU. Remarkably, influenza patients were more often diagnosed with arterial thrombotic complications.EssentialsIt is unknown how COVID-19 compares to patients with other virus infections regarding thrombosis.Hospitalized patients with influenza and COVID-19 were evaluated and compared to each other.30-day cumulative incidence of thrombosis was lower in influenza (11%) than in COVID-19 (25%).Difference was mainly driven by a high risk of VTE in COVID-19 patients admitted to the ICU.

Impact of age and frailty markers on overall survival among hospitalized patients with lung cancer treated with immunotherapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21151-e21151
Author(s):  
Eric Olson ◽  
Gregory Russell ◽  
Jeffrey Lantz ◽  
Nathan Roberts ◽  
Andy Shipe Dothard ◽  
...  
Keyword(s):  
Lung Cancer ◽  
At Risk ◽  
Overall Survival ◽  
High Risk ◽  
Cancer Patients ◽  
Geriatric Assessment ◽  
Hospitalized Patients ◽  
Advanced Lung Cancer ◽  
Lung Cancer Patients ◽  
Risk Patients

e21151 Background: Although predictive of chemotherapy toxicity, geriatric assessment measures are not systematically collected in clinical practice and may or may not be predictive for immune-related adverse events. Furthermore, hospitalization during immune checkpoint inhibitor (ICI) treatment for advanced lung cancer has variable prognostic significance. This study aimed to evaluate whether age and documented patient characteristics mapped to geriatric assessment domains (frailty markers, FM) predict survival in this setting. Methods: A single-center retrospective cohort of advanced stage lung cancer patients who received >1 dose of an ICI from 6/1/18 to 2/1/20, were later hospitalized, and received ≥ 1 dose of systemic corticosteroids (n=97) was analyzed. Chart review ascertained documentation of any of the following FMs prior to ICI initiation: inability to walk one block, unintentional weight loss, decreased social activities, recent falls, need for assistance with medications, visual or hearing impairments, living alone, and concern regarding social support. Patients were stratified according to age and three FM categories (0 FM [low risk], ≥1 FMs [at risk], and ≥2 FMs [high risk]). Overall survival (OS) analysis was calculated from first dose of ICI to date of death or last follow-up. Cox’s proportional hazards models were used to assess the relationship between FMs and age on OS; hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Results: Analysis of < 75 and ≥ 75 yo revealed a median OS of 15.1 and 5.4 months respectively (HR 2.76, CI 1.62-4.72). Controlled for performance status (PS), older age (≥75 yo) was associated with a higher risk of death (HR 2.39, CI 1.32-4.31). FMs were associated with higher mortality, adjusted for PS and age (at risk patients HR 1.81, CI 1.03-3.16; high risk patients HR 2.02, CI 1.07-3.78). PS prior to starting ICI was not associated with OS. Conclusions: Age ≥ 75 yo is associated with short survival among lung cancer patients hospitalized while receiving ICI. Pre-treatment FMs documented as part of usual care were associated with worse OS, even after controlling for PS and age. This study shows promise for use of machine learning algorithms to stratify risk in hospitalized patients undergoing treatment for lung cancer with ICIs. These data would allow providers to better target serious illness conversations and end-of-life resources.[Table: see text]

VTE Risk Assessment and Prophylaxis: The Reliability of Clinical Assessment by Medical Housestaff,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4199-4199
Author(s):  
Monica Reddy Muppidi ◽  
Ashima Sahni ◽  
Abhimanyu Saini ◽  
Samrat Khanna ◽  
Larissa Verda ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Stratification ◽  
Hospitalized Patients ◽  
Risk Assessments ◽  
Rater Reliability ◽  
Vte Prophylaxis ◽  
National Quality ◽  
Medical Inpatients ◽  
Very High

Abstract Abstract 4199 BACKGROUND: Hospital acquired venous thromboembolism (VTE) is a significant cause of mortality in hospitalized patients. The incidence of VTE may be as high as 40% in medical inpatients and is preventable in 50–75%. However, only one-half of eligible hospitalized patients receive adequate thromboprophylaxis. In response, national quality organizations and expert panels recommend a VTE risk assessment and risk-based prophylaxis for every inpatient. Point scoring systems have been proposed for risk stratification but have not been prospectively validated, and may be misleading; a recent study showed that medical residents using a point system made errors in risk stratification and choice of VTE prophylaxis. Thus, the optimal method of assessing VTE risk and whether these assessments can have adequate inter-rater reliability remains unknown. OBJECTIVES: 1. To compare the inter-rater reliability of VTE risk assessment by paired expert reviewers within the paired team and to the clinical team's assessment. 2. To evaluate the appropriateness of VTE prophylaxis administered by clinical teams compared to expert reviewer's determinations. METHODS: We performed a cross-sectional study at a 464-bed public teaching hospital. Medical patients were randomly selected and their charts abstracted by four expert housestaff reviewers (two teams of two reviewers) who had been trained through literature review, case discussion and participation in guideline development. Paired reviewers independently assessed VTE risk blinded to the other reviewer's determination using clinical data and a ‘3-bucket' model (low; moderate or high; very high). Appropriateness of prophylaxis was based on VTE risk as well as contraindications to prophylaxis. Reviewers also recorded the primary teams' VTE risk assessment and prophylaxis choices. Reviewer discrepancies were adjudicated through a third blinded review. We calculated the inter-rater reliability between paired reviewers and between reviewers and clinical teams using weighted Kappa scores (K). We recorded reasons for disagreement between reviewers and teams. RESULTS: A total of 40 charts were reviewed and analyzed for agreement on VTE risk. 36 charts were analyzed for appropriateness of VTE prophylaxis; 4 patients on therapeutic anticoagulation were excluded from this analysis. Compared to expert reviewers (E), medical teams (M) significantly underestimated VTE risk, as follows: low risk (E, 2.5% vs M, 20%); moderate to high risk (E,85% vs M,75%); very high risk (E, 12.5% vs M, 5%); P=0.004. In 11 of 12 cases of disagreement, team's assessment of VTE risk was lower than that determined by reviewers. Compared to the inter-rater reliability between experts and clinical teams, reliability was significantly better for the paired experts both for VTE risk assessment (P<0.01) and choice of prophylaxis (P<0.01). Among the 8 (22%) of patients for whom the reviewers determined VTE prophylaxis was suboptimal, for most (n=6) the method of prophylaxis was less intensive than recommended by the guidelines, and the most common reason was failure to restart prophylaxis after an invasive procedure or transfer of care. CONCLUSIONS: Our study shows that expert reviewers can assess VTE risk with a high degree of reliability. The risk assessments by clinical teams during routine clinical evaluation did not correlate well with expert risk stratification and underestimated the risk of VTE in medical inpatients. Incorrect risk assessments were common but the most frequent reasons for underutilization of VTE prophylaxis were oversights in ordering prophylaxis during care transitions or after invasive procedures. Although we trained our experts to be highly reliable in risk assessment this training cannot be generalized to most provider groups. An optimal approach to improving VTE risk assessment in clinical settings involving trainees would include real time decision support for risk assessment with linked VTE prophylaxis choices appropriate to the level of risk at the point of care. Disclosures: No relevant conflicts of interest to declare.

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