16 Clinical Outcomes in Patients with Diabetes, Prediabetes, and No Diabetes Following Acute Burn Injury

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S13-S14
Author(s):  
Rebecca Coffey ◽  
Richard V Zhelezny ◽  
Kyle Porter ◽  
Charles Zhang ◽  
Claire V Murphy
Keyword(s):  
Propensity Score ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Burn Injury ◽  
Cost Of Care ◽  
Adult Patients ◽  
Smoke Inhalation ◽  
Geometric Means ◽  
Diabetes Status ◽  
Secondary Outcomes

Abstract Introduction Based on the National Burn Repository Data (2002–2011), the incidence of diabetes is increasing among adult patients with burn injury. Diabetes has been associated with increased morbidity and mortality following burn injury. There is limited data related to prediabetes in burn injury, and no studies to date have compared clinical outcomes in patients without diabetes, with prediabetes, and with diabetes. Therefore, this study aimed to compare the impact of diabetes status, defined as no diabetes (ND), prediabetes (PD), or diabetes (DM), on clinical outcomes after burn injury. Methods A single-center, retrospective cohort study of adult patients admitted for initial management of burn injury between January 1, 2009 and February 28, 2019 who had a hemoglobin A1c (HbA1c) upon admission was performed. Patients with chemical or electrical injury, isolated smoke inhalation injury, total body surface area (TBSA) burn injury < 1%, patients who expired or transitioned to comfort care within 24 hours of admission, or were incarcerated or pregnant were excluded. Patients were categorized as ND, PD, or DM based on their past medical history and admission HbA1c. The primary outcome was LOS/%TBSA burn. Secondary outcomes included mortality, LOS, discharge disposition, re-grafting of same site, and amputations. Propensity score methods were used to account for imbalance between groups. Separate propensity score weights were calculated for analysis of DM versus ND and DM versus PD. The primary outcome LOS/%TBSA burn was compared between groups using weighted linear models. Since the outcome was right-skewed, LOS/%TBSA burn was log-transformed for analysis, yielding estimates of the ratio of geometric means. Results A total of 1137 patients were included (710 ND, 191 PD, 236 DM). Patients were predominately male (70.3% ND, 67.4% PD, 70.2% DM) and Caucasian (85.5% ND, 73.8% PD, 82.1% DM). The mean BMI was highest in DM (31.8 kg/m2) and lowest in ND (27.8 kg/m2). After inverse probability weighing to adjust for potentially confounding factors, DM had longer LOS/%TBSA burn than patients with ND (ratio of geometric means (95% CI) = 1.61 (1.21, 2.15), p = 0.001) or PD (ratio (95% CI) = 1.53 (1.14, 2.05), p =0.01). No differences in secondary outcomes were observed between the DM and ND groups and between DM and PD groups with the exception of amputations (2.8% DM vs. 0.7% ND, p=0.06; 2.6% DM vs. 0% PD, p=0.04). Conclusions Diabetes in the burn patient significantly increases LOS/%TBSA index and amputation rates compared to both PD and ND. Applicability of Research to Practice Diabetes may contribute to increased cost of care in burn injury. Early identification of diabetes status may aid management of this patient population.

scholarly journals 1611. Evaluating Clinical Outcomes and Efficacy of Daptomycin in Combination with a Beta-Lactam for the Treatment of Vancomycin-Resistant Enterococcus (VRE) Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S799-S800
Author(s):  
Nerea Irusta ◽  
Ana Vega ◽  
Yoichiro Natori ◽  
Lilian M Abbo ◽  
Lilian M Abbo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Small Sample Size ◽  
Univariate Analysis ◽  
Small Sample ◽  
Significant Difference ◽  
Vancomycin Resistant ◽  
Secondary Outcomes ◽  
Related Mortality

Abstract Background In-vitro studies have shown synergistic bactericidal activity with daptomycin (DAP) plus β-lactam antimicrobials against vancomycin resistant enterococci (VRE). There is a paucity of data regarding clinical outcomes with this combination in VRE bloodstream infections (BSI). The purpose of this study was to assess the efficacy of DAP plus a β-lactam with in-vitro activity vs. other therapies for treatment of VRE BSI. Methods IRB-approved, single-center, retrospective study of patients with VRE BSI from 01/2018-09/2019. Patients were excluded if < 18 years old, pregnant, or incarcerated. The primary outcome was time-to-microbiological clearance. Secondary outcomes included infection-related mortality, 30-day all-cause mortality, and incidence of recurrent BSI within 30 days of index culture. Targeted DAP doses were ≥ 8mg/kg and based on MIC. Factors associated with significance for outcomes, via univariate analysis, were evaluated with multivariable logistic regression (MLR), removed in a backward-step approach. Results A total of 85 patients were included, 23 of which received DAP plus a β-lactam. The comparator arm included linezolid or DAP monotherapy. Patients with combination therapy had significantly higher Charlson Comorbidity Index (CCI) (p=0.013) and numerically higher Pitt Bacteremia scores (PBS) (p=0.087) (Table 1). There was no difference seen in the primary outcome (Table 2). Secondary outcomes are provided in Table 2. The presence of polymicrobial infection and higher PBS were significantly associated with infection-related mortality (p=0.008 and p=0.005, respectively) by MLR. A Mann Whitney U test indicated that presence of infection-related mortality was greater for patients with higher MICS (U=20.5, p=0.06). The presence of an underlying source may be related to recurrence of BSI (p=0.075). Table 1: Patient Characteristics Table 2. Primary and Secondary Outcomes Conclusion We did not find a significant difference in time-to-microbiological clearance, although patients treated with DAP and a β-lactam had higher CCI and PBS. These results are limited by retrospective design, small sample size, and potential selection bias. Prospective randomized studies are needed to further validate these findings. Disclosures All Authors: No reported disclosures

Abstract TMP5: Secondary Analysis of Eptifibatide Plus Full Dose rt-PA in Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Opeolu Adeoye ◽  
Heidi Sucharew ◽  
Jane Khoury ◽  
Pamela Schmit ◽  
Joseph Broderick ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Propensity Score ◽  
Logistic Model ◽  
Primary Outcome ◽  
Secondary Analysis ◽  
Full Dose ◽  
Control Subjects ◽  
Secondary Outcomes ◽  
And Control ◽  
Consistent Direction

Background: The Phase 2 Combined approach to Lysis utilizing Eptifibatide And Rt-PA in Acute Ischemic Stroke - Full Dose Regimen (CLEAR-FDR) trial was a single arm trial that demonstrated the safety of full dose (0.9mg/kg) rt-PA plus eptifibatide in AIS patients treated with rt-PA within three hours of symptom onset. Interventional Management of Stroke (IMS) III randomized AIS patients to rt-PA plus endovascular therapy versus standard r-tPA. Albumin in Acute Stroke (ALIAS) Part 2 randomized patients to albumin±rt-PA versus saline±rt-PA. We compared outcomes in CLEAR-FDR patients to propensity score-matched rt-PA only subjects in ALIAS Part 2 and IMS. Methods: All datasets were restricted to subjects with baseline modified Rankin score (mRS) of 0 or 1. Controls were selected using propensity score matching of CLEAR-FDR subjects and rt-PA only subjects from both IMS III and ALIAS. Age, gender, race, baseline mRS, baseline NIHSS score, and time from stroke onset to rt-PA were included in the logistic model used to generate a propensity score for each subject. The greedy matching algorithm was then used to match 1:3. The primary outcome was 90-day severity-adjusted mRS dichotomization based on baseline NIHSS. Secondary outcomes were 90-day mRS dichotomized as excellent (mRS 0-1); favorable (mRS 0-2); and, nonparametric analysis of the ordinal mRS. Results: Eighteen CLEAR-FDR subjects were matched with 52 controls. Median age in CLEAR-FDR and control subjects was 67 and 68 years respectively. Median NIHSS in both CLEAR-FDR and control subjects was 11. At 90 days, CLEAR-FDR subjects had a nonsignificant greater proportion of patients with a favorable primary outcome (61% versus 38%; unadjusted RR 1.59; 95%CI 0.96-2.63; P=0.10). Secondary outcomes also favored CLEAR-FDR subjects: excellent outcomes - 67% versus 38% (RR 1.73; 95%CI 1.08-2.79; P=0.04); favorable outcomes - 67% versus 58% (RR 1.16; 95%CI 0.77-1.73; P=0.50); and ordinal Cochran-Mantel-Haenszel, P=0.13. Conclusion: The outcomes for combination of full dose rt-PA plus eptifibatide showed a consistent direction of effect in favor of the combination over rt-PA alone. A trial to establish the efficacy of rt-PA plus eptifibatide for improving AIS outcomes is warranted and in the planning stages.

scholarly journals The effect of dobutamine in sepsis: a propensity score matched analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Youfeng Zhu ◽  
Haiyan Yin ◽  
Rui Zhang ◽  
Xiaoling Ye ◽  
Jianrui Wei
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Large Scale ◽  
Primary Outcome ◽  
Severity Of Illness ◽  
Public Database ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Secondary Outcomes ◽  
Mimic Iii

Abstract Background The use of dobutamine in patients with sepsis is questionable currently. As the benefit of dobutamine in septic patients is unclear, we aimed to evaluate whether the use of dobutamine was associated with decreased hospital mortality in sepsis patients. Methods Based on the analysis of MIMIC III public database, we performed a big-data, real world study. According to the use of dobutamine or not, patients were categorized as the dobutamine group or non dobutamine group.We used propensity score matched (PSM) analysis to adjust for confoundings. The primary outcome was hospital mortality. Results In the present study, after screening 38,605 patients, 2826 patients with sepsis were included. 121 patients were in dobutamine group and 2165 patients were in non dobutamine group. Compared with patients in non-dobutamine group, patients in dobutamine group had a lower MAP, higher HR, higher RR, higher severity of illness scores. 72 of 121 patients (59.5%) in the dobutamine group and 754 of 2165 patients (34.8%) in the non-dobutamine group died in the hospital, which resulted in a significant between-group difference (OR 1.56, 95% CI 1.01–2.40; P = 0.000). For the secondary outcomes, patients in dobutamine group received more MV use, more renal replacement therapy use, had longer ICU stay durations and more cardiac arrhythmias than those in non-dobutamine group. After adjusting for confoundings between groups by PSM analysis, hospital mortality was consistently higher in dobutamine group than that in non-dobutamine group (60.2% vs. 49.4%, OR 1.55, 95% CI 1.01–2.37; P = 0.044). Conclusions Among patients with sepsis, our study showed that the use of dobutamine was not associated with decreased hospital mortality. Further large scale, randomized controlled studies are warrented to confirm our findings.

scholarly journals Clinical and Economical Outcomes Associated with Parathyroidectomy: A 5-Year Population-Based Study in a Middle-Income Country with Universal Health Coverage

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Kateir Contreras ◽  
Romar Baquero ◽  
Giancarlo Buitrago
Keyword(s):  
Health System ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Postoperative Period ◽  
Hospital Readmission ◽  
Regional Differences ◽  
Admission Rate ◽  
Cost Of Care ◽  
Adult Patients ◽  
Icu Admission

Parathyroidectomy (PTX) is one of the most frequently performed surgeries in chronic kidney disease (CKD) patients. The objective of this study was to determine the intensive care unit (ICU) admission, mortality and hospital readmission rates within the 30-day postoperative period, and the total cost of the care episode and to determine possible prognostic factors in end-stage renal disease (ESRD) adult patients taken to PTX in the Colombian contributory health system. Methods. Retrospective cohort study of ESRD adult patients affiliated to the Colombian contributory health system, on dialysis for at least 3 months, undergoing PTX between January 1, 2012, and November 30, 2016. The clinical outcomes evaluated were rehospitalization at 30 days, hospital stay, and ICU requirement. The costs associated with the hospitalization event in which the PTX was performed from the perspective of the third payer were estimated. Results. The study included 478 patients. The mortality rate was 2.09 per 100 surgeries, the ICU admission rate was 32.64 per 100 surgeries, the 30-day hospital readmission percentage of the postoperative period was 16.74%, and the average length of hospital stay was 5.02 days. The median total costs of care for the entire procedure was USD $ 7,814.27 (p25-p75: 3,922.03–9,372.68), with significant regional differences. The geographical region was shown as a prognostic factor associated with clinical outcomes and the cost of care. Conclusions. There are large regional differences in readmission, ICU admission and mortality rates, and costs of dialysis ESRD patients undergoing PTX belonging to the Colombian contributory regime. The geographic region behaves as an independent predictor of clinical outcomes and costs.

scholarly journals Predicting Clinical Outcomes After Thrombolysis Using the iScore

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2755-2759 ◽  
Author(s):  
Gustavo Saposnik ◽  
Mathew J. Reeves ◽  
S. Claiborne Johnston ◽  
Philip M.W. Bath ◽  
Bruce Ovbiagele
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Favorable Outcome ◽  
Tissue Type ◽  
Modified Rankin Scale ◽  
Secondary Outcomes

Background and Purpose— The ischemic stroke risk score (iScore) is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. Our goal was to determine the ability of the iScore to estimate clinical outcomes after intravenous thrombolysis tissue-type plasminogen activator (tPA) in the Virtual International Stroke Trials Archive (VISTA). Methods— We applied the iScore ( www.sorcan.ca/iscore ) to patients with an acute ischemic stroke within the VISTA collaboration to examine the effect of tPA. We explored the association between the iScore (<200 and ≥200) and the primary outcome of favorable outcome at 3 months defined as a modified Rankin scale score of 0 to 2. Secondary outcomes included death at 3 months, catastrophic outcomes (modified Rankin scale, 4–6), and Barthel index >90 at 3 months. Results— Among 7140 patients with an acute ischemic stroke, 2732 (38.5%) received tPA and 711 (10%) had an iScore ≥200. Overall, tPA treatment was associated with a significant improvement in the primary outcome among patients with an iScore <200 (38.9% non-tPA versus 47.5% tPA; P <0.001) but was not associated with a favorable outcome among patients with an iScore ≥200 (5.5% non-tPA versus 7.6% tPA; P =0.45). In the multivariable analysis after adjusting for age, baseline National Institutes of Health Stroke Scale, and onset-to-treatment time, there was a significant interaction between tPA administration and iScore; tPA administration was associated with 47% higher odds of a favorable outcome at 3 months among patients with an iScore <200 (odds ratio, 1.47; 95% confidence interval, 1.30–1.67), whereas the association between tPA and favorable outcome among those with an iScore ≥200 remained nonsignificant (odds ratio, 0.80; 95% confidence interval, 0.45–1.42). A similar pattern of benefit with tPA among patients with an iScore <200, but not ≥200, was observed for secondary outcomes including death. Conclusions— The iScore is a useful and validated tool that helps clinicians estimate stroke outcomes. In stroke patients participating in VISTA, an iScore <200 was associated with better outcomes at 3 months after tPA.

8 The Adoption of Rescue Colloid During Resuscitation Decreases Fluid Administered and Returns End Organ Perfusion

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S8-S9
Author(s):  
Paul Comish ◽  
Manuel Castillo-Angeles ◽  
Deborah Carlson ◽  
Herb Phelan ◽  
Brett Arnoldo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Urine Output ◽  
Primary Outcome ◽  
Organ Function ◽  
Significant Difference ◽  
Thermal Injuries ◽  
Secondary Outcomes ◽  
Total Urine ◽  
A Prospective Study ◽  
Injured Patients

Abstract Introduction Traditionally lactated ringers (LR) has been utilized for the resuscitation of thermally injured patients. Both the Parkland and Brooke formula’s include the addition of albumin as part of their ongoing resuscitation after the initial 24 hours. Over the last five years, the addition of albumin to current protocols has been reported to decrease fluid creep. Our institution has adopted these practices and here we present our findings during the adoption phase of rescue albumin during resuscitation. Methods A prospectively collected burn registry was queried for patients greater than 18 years, between July 2017 and December 2018, who sustained a thermal injury and required a formal resuscitation. Patients were included in the rescue albumin group if the treating team administered 25% albumin for a sustained urine output less than 0.5ml/kg over 2–3 hours. Our primary outcome was a total volume of resuscitation ml LR/%TBSA/kg. Our secondary outcomes were the change in resuscitation rate and the change in urine output three hours before and three hours after the administration of albumin normalized to %TBSA/kgs. Finally, we compared clinical outcomes of ICU days and length of stay (LOS) between the rescue albumin and no rescue albumin group. Results A total of 92 patients with thermal injuries were included: median age was 40 (IQR 31–57), 73% were male, and 30 patients received rescue albumin. The TBSA was increased in those who received rescue albumin (47% vs 38% p=0.02). Despite a higher TBSA in the albumin group the total LR given during resuscitation normalized to TBSA and KG was not significantly different (ml LR/%TBSA/kg: 3.66 vs. 4.31, p=0.149). Similarly, the total urine output (UOP) and the adjusted UOP showed no significant difference, total UOP 1,781 ml no albumin vs 1,483ml rescue albumin (p=0.149) and UOP/kg 21.7ml no albumin vs 18.9 ml rescue albumin (p=0.341). But our secondary outcomes did demonstrate there was a decrease in the LR rate by -0.06 ml/%TBSA/kg/hr (SD 0.13) and an increase in the UOP by 1.61 ml/kg/hr (SD 3.25), see Figure 1. Conclusions Rescue albumin administration decreases the amount of fluid administered during resuscitation, and increases end organ function as evidenced by increase UOP. This was observed in patients who sustained larger burns and were failing traditional increases in resuscitation LR. These findings are the basis for a modification to our current protocol and a prospective study of the clinical outcomes. Applicability of Research to Practice We believe these findings support the limited use of albumin in patients who fail a conventional LR based resuscitation.

scholarly journals Outcomes of neonatal hypoxic-ischaemic encephalopathy in centres with and without active therapeutic hypothermia: a nationwide propensity score-matched analysis

2021 ◽  
pp. fetalneonatal-2020-320966
Author(s):  
Lara Shipley ◽  
Aarti Mistry ◽  
Don Sharkey
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Therapeutic Hypothermia ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Research Database ◽  
Short Term ◽  
Free Survival ◽  
Secondary Outcomes ◽  
Level 2

ObjectiveTherapeutic hypothermia (TH) for neonatal hypoxic-ischaemic encephalopathy (HIE), delivered mainly in tertiary cooling centres (CCs), reduces mortality and neurodisability. It is unknown if birth in a non-cooling centre (non-CC), without active TH, impacts short-term outcomes.DesignRetrospective cohort study using National Neonatal Research Database and propensity score-matching.SettingUK neonatal units.PatientsInfants ≥36 weeks gestational age with moderate or severe HIE admitted 2011–2016.InterventionsBirth in non-CC compared with CC.Main outcome measuresPrimary outcome was survival to discharge without recorded seizures. Secondary outcomes were recorded seizures, mortality and temperature on arrival at CCs following transfer.Results5059 infants were included with 2364 (46.7%) born in non-CCs. Birth in a CC was associated with improved survival without seizures (35.1% vs 31.8%; OR 1.15, 95% CI 1.02 to 1.31; p=0.02), fewer seizures (60.7% vs 64.6%; OR 0.84, 95% CI 0.75 to 0.95, p=0.007) and similar mortality (15.8% vs 14.4%; OR 1.11, 95% CI 0.93 to 1.31, p=0.20) compared with birth in a non-CC. Matched infants from level 2 centres only had similar results, and birth in CCs was associated with greater seizure-free survival compared with non-CCs. Following transfer from a non-CC to a CC (n=2027), 1362 (67.1%) infants arrived with a recorded optimal therapeutic temperature but only 259 (12.7%) of these arrived within 6 hours of birth.ConclusionsAlmost half of UK infants with HIE were born in a non-CC, which was associated with suboptimal hypothermic treatment and reduced seizure-free survival. Provision of active TH in non-CC hospitals prior to upward transfer warrants consideration.

scholarly journals Therapeutic Plasma Exchange for the Treatment of Thrombotic Microangiopathy without Severe ADAMTS13 Deficiency: A Propensity Score-Matched Study

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3471-3471 ◽  
Author(s):  
Ang Li ◽  
Robert S Makar ◽  
Shelley Hurwitz ◽  
Lynne Uhl ◽  
Richard M. Kaufman ◽  
...  
Keyword(s):  
Platelet Count ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Activity Level ◽  
Adamts13 Activity ◽  
Adamts13 Deficiency ◽  
Baseline Characteristics ◽  
Secondary Outcomes ◽  
Count Recovery

Abstract Introduction: Thrombotic microangiopathies (TMA) are a group of uncommon disorders characterized clinically by the presence of thrombocytopenia and microangiopathic hemolytic anemia (MAHA). Therapeutic plasma exchange (TPE) is a proven treatment for cases of autoimmune thrombotic thrombocytopenic purpura (TTP) characterized by an ADAMTS13 activity level of ≤10%, but the efficacy of TPE in TMA with an ADAMTS13 activity level of >10% remains controversial. Methods: We conducted a retrospective cohort study of 186 adult patients included in the Harvard TMA Research Collaborative registry who presented with MAHA and thrombocytopenia concerning for TTP but an ADAMTS13 activity level of >10%. A propensity score (PS) logistic regression model was constructed based on 11 clinically relevant confounding variables: age; sex; ethnicity; Charlson Comorbidity Index (CCI); history of prior solid organ or bone marrow transplant; the presence of neurologic symptoms; the presence of sepsis, shock, or multiorgan failure (MOF); platelet count; creatinine; LDH; and INR. Matching was performed using a 1:1 nearest neighbor method without replacement within a set caliper distance. Standardized differences were used to assess the quality of matching and ensure balance of baseline characteristics. The primary outcome was 90-day survival. Secondary outcomes included in-hospital mortality, percent of patients experiencing platelet count recovery, time to platelet count recovery, and hospital length of stay (LOS). Results: Prior to matching, patients treated with TPE (N=71) had a lower acuity of illness compared to untreated patients (N=115) as reflected by a lower mean CCI (2.3 vs. 3.4, P = 0.003), lower mean INR (1.1 vs. 1.3, P = 0.02), and lower incidence of sepsis, shock or MOF (23% vs. 36%, P = 0.06). Consistent with this confounding, TPE in the pre-matched cohort appeared to be associated with reduced mortality at 90 days (HR 0.51, P = 0.01). The PS match was performed to address these imbalances and resulted in 59 TPE-treated patients paired to 59 untreated controls. After matching, baseline characteristics of the treated and untreated groups were well balanced, with a standardized difference of ≤11% in all PS variables (see Figure). In contrast to the unmatched cohort, Cox regression analysis stratified by matched pairs showed no significant difference in the primary outcome of 90-day survival between the treated and untreated groups (HR 0.88, 95% CI 0.44-1.8, P = 0.72) (see Table). We performed subgroup analyses by age, diagnostic category, and ADAMTS13 activity level and again did not observe any benefit to TPE. With regard to secondary outcomes, in-hospital mortality (OR 0.77, P = 0.53), percent of patients with platelet count recovery (OR 1.6, P = 0.21), median time to platelet count recovery (6 vs. 6 days, P = 0.99), and median hospital LOS (14 vs. 18 days, P = 0.93) did not differ significantly between the two groups. Conclusions: In the absence of a randomized controlled trial, PS matching represents a rigorous statistical approach to study the effect of treatment while adjusting for differences in baseline characteristics across groups of patients. Here we have used PS matching to assess the efficacy of TPE in the management of TMA associated with an ADAMTS13 activity level of >10%. Our data indicate that there is no benefit from TPE for this diverse group of TMA patients without severe ADAMTS13 deficiency. Figure 1. Figure 1. Figure 2. Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals Effect of Anti-Hypertensive Drugs in Geriatric Trauma Patients: A Single-Centre, Retrospective Cohort Study

2021 ◽  
Author(s):  
Hiroki Nagasawa ◽  
Kouhei Ishikawa ◽  
Souichirou Ota ◽  
Ken-ichi Muramatsu ◽  
Yoshihiro Kushida ◽  
...  
Keyword(s):  
Cohort Study ◽  
Relative Risk ◽  
Propensity Score ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Adjusted Relative Risk ◽  
Single Centre ◽  
Secondary Outcomes

Abstract Background: The relationship between the administration of oral anti-hypertensive drugs and mortality after hospitalisation in trauma patients has not yet been investigated. We conducted a single-centre, retrospective cohort study to determine the effect of anti-hypertensive drugs on mortality and complications in geriatric trauma patients.Methods: Trauma patients aged ≥ 65 years who were admitted to our hospital between January 2018 and December 2020 were analysed. Patients who had not received anti-hypertensive drugs before admission [AHT(–) group] and those who had received anti-hypertensive drugs before admission [AHT(+) group] were compared using 1:1 propensity score-matched analysis. The primary outcome was 28-day mortality, and the secondary outcomes were in-hospital mortality and the incidence of complications during hospitalisation. Outcomes were analysed by calculating the relative risk.Results: A total of 637 patients were included in our study. After propensity score matching, each study group had 223 patients. There was no significant difference in the primary outcome between the two groups [28-day mortality: AHT(–) group vs. AHT(+) group: 3.6% vs. 3.6%, respectively; adjusted relative risk: 1.00; 95% confidence interval: 0.38–2.62]. Regarding secondary outcomes, only the incidence of in-hospital delirium was significantly different between the AHT(–) group and the AHT(+) group (25.1% vs. 13.9%, respectively; adjusted relative risk: 0.55; 95% confidence interval: 0.37–0.82).Conclusions: Regular use of anti-hypertensive drugs did not affect the outcome of geriatric trauma patients. However, the incidence of in-hospital delirium was reduced in patients regularly receiving anti-hypertensive drugs.

scholarly journals Meropenem Assessment before and after Implementation of a Small-Dose, Short-Interval Standard Dosing Regimen

2018 ◽  
Vol 71 (1) ◽  
Author(s):  
Ivy Chow ◽  
Vincent Mabasa ◽  
Connor Chan
Keyword(s):  
Clinical Outcomes ◽  
Small Dose ◽  
Primary Outcome ◽  
Clinical Success ◽  
Short Interval ◽  
Care Hospital ◽  
Dosing Regimen ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
Résultats Cliniques

<p><strong>ABSTRACT</strong></p><p><strong>Background: </strong>Small-dose, short-interval dosing for meropenem has been shown to yield pharmacokinetic and pharmacodynamic properties similar to those associated with traditional dosing of this drug. However, few studies have examined clinical outcomes in the general population.</p><p><strong>Objectives: </strong>To characterize differences in effects between a small-dose, short-interval dosing regimen for meropenem (500 mg every 6 h) and the traditional regimen (1000 mg every 8 h) on clinical outcomes and costs to the health care system.</p><p><strong>Methods: </strong>This retrospective cohort study included 194 patients who received the traditional meropenem dosage (July 2006 to August 2008) and 188 patients who received the small-dose, short-interval regimen (December 2008 and October 2009) at a large tertiary care hospital and a community hospital. The primary outcome (clinical success), the secondary outcomes (30-day in-hospital mortality, time to defervescence, duration of therapy, and length of stay), and drug costs were compared between cohorts.</p><p><strong>Results: </strong>The 2 cohorts did not differ significantly in terms of baseline characteristics. There was no statistically significant difference between the small-dose, short-interval regimen and the traditional dosing regimen in terms of the primary outcome: clinical success was achieved in 83.5% (162/194) and 80.8% (152/188) of the patients, respectively. Likewise, there was no statistically significant difference in any of the secondary outcomes. The average drug cost per patient per visit was $222.23 with small-dose, short-interval dosing and $355.90 with traditional dosing, a significant difference of more than $130 per patient per visit.</p><p><strong>Conclusion: </strong>The small-dose, short-interval meropenem dosing regimen resulted in clinical outcomes similar to those achieved with the traditional dosing regimen at significantly lower cost.</p><p> <strong>RÉSUMÉ</strong></p><p><strong>Contexte : </strong>Selon des études, un schéma posologique de méropénème avec administration d’une faible dose à intervalle réduit produit des résultats pharmacocinétiques et pharmacodynamiques semblables à ceux obtenus avec une posologie traditionnelle. Mais peu d’études ont examiné les résultats cliniques dans la population générale.</p><p><strong>Objectif : </strong>Offrir un portrait des différences entre les effets d’un schema posologique de méropénème avec administration d’une faible dose à intervalle réduit (500 mg toutes les 6 heures) et d’une posologie traditionnelle (1000 mg toutes les 8 heures) pour ce qui est des résultats cliniques et des coûts pour le système de santé.</p><p><strong>Méthodes : </strong>La présente étude de cohorte rétrospective incluait 194 patients ayant reçu le méropénème selon le schéma posologique traditionnel (entre juillet 2006 et août 2008) et 188 patients l’ayant reçu avec administration d’une faible dose à intervalle réduit (entre décembre 2008 et octobre 2009) dans un grand hôpital de soins tertiaires et un hôpital communautaire. Le principal paramètre d’évaluation (succès clinique), les paramètres d’évaluation secondaires (taux de mortalité à l’hôpital dans les 30 jours, période de défervescence, durée du traitement et durée du séjour) et les coûts des médicaments ont été comparés entre les cohortes.</p><p><strong>Résultats : </strong>Les deux cohortes n’étaient pas significativement différentes en ce qui touche aux caractéristiques de base. Il n’y avait aucune difference statistiquement significative entre le schéma posologique avec administration d’une faible dose à intervalle réduit et la posologie traditionnelle en ce qui concerne le principal paramètre d’évaluation : le succès clinique a été obtenu respectivement chez 83,5 % (162/194) et chez 80,8 % (152/188) des patients. De même, aucune différence statistiquement significative n’a été relevée pour les paramètres d’évaluation secondaires. Par contre, le coût moyen des médicaments par patient par visite était de 222,23 $ pour le schéma posologique avec administration d’une faible dose à intervalle réduit et de 355,90 $ pour la posologie traditionnelle, une difference significative de plus de 130 $ par patient par visite (<em>p </em>&lt; 0,001).</p><strong>Conclusion : </strong>Le schéma posologique de méropénème avec administration d’une faible dose à intervalle réduit produisait des résultats cliniques semblables à ceux de le posologie traditionnelle, et ce, pour un prix significativement plus faible.

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