The Impact of Blood Type O on Major Outcomes in Patients With Severe Burns

2020 ◽  
Vol 41 (5) ◽  
pp. 1111-1117 ◽  
Author(s):  
Renqi Yao ◽  
Wenjia Hou ◽  
Tuo Shen ◽  
Shuo Zhao ◽  
Xingfeng He ◽  
...  

Abstract ABO blood type has been reported to be a predictor of poor prognosis in critically ill patients. Here, we aim to correlate different blood types with clinical outcomes in patients with severe burns. We conducted a single-center retrospective cohort study by enrolling patients with severe burn injuries (≥40% TBSA) between January 2012 and December 2017. Baseline characteristics and clinical outcomes were compared between disparate ABO blood types (type O vs non-O type). Multivariate logistic and linear regression analyses were performed to identify an association between ABO blood type and clinical outcomes, including in-hospital mortality, the development of acute kidney injury (AKI), and hospital or ICU length of stay. A total of 141 patients were finally enrolled in the current study. Mortality was significantly higher in patients with type O blood compared with those of other blood types. The development of AKI was significantly higher in patients with blood type O vs non-O blood type (P = .001). Multivariate analysis demonstrated that blood type O was independently associated with in-hospital mortality and AKI occurrence after adjusting for other potential confounders. Our findings indicated the blood type O was an independent risk factor of both increased mortality and the development of AKI postburn. More prudent and specific treatments are required in treating these patients to avoid poor prognosis.

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Cheng-Wei Lin ◽  
Hui-Mei Yang ◽  
Shih-Yuan Hung ◽  
I-Wen Chen ◽  
Yu-Yao Huang

Abstract Background Diabetic foot infection (DFI) is a limb- and life-threatening complication for diabetic patients needing immediate and comprehensive treatment. Early referral of DFI patients to a diabetic foot center is recommended but there appears limited validated evidence, with the association between referral time and clinical outcomes of limb- preservation or in-hospital mortality still lacking. Methods This retrospective research studied consecutive type 2 diabetic patients with DFI treated at the major diabetic foot center in Taiwan from 2014 to 2017. Six hundred and sixty-eight patients presented with limb-threatening DFI. After stratifying their referral days into quartiles, the demographic information and clinical outcomes were analyzed. Results One hundred and seventy-two patients were placed in the first quartile (Q1) with less than 9 days of referral time; 164 in the second quartile (Q2) with 9-21 days; 167 in the third quartile (Q3) with 21-59 days; and 165 in the fourth quartile (Q4) with >59 days. End-stage renal disease (ESRD), major adverse cardiac events (MACE) and peripheral arterial disease (PAD) were noted as being higher in the Q4 group compared with the Q1 group (25.45% vs 20.35% in ESRD, 47.27% vs 26.16% in MACE and 78.79% vs 52.33% in PAD respectively). The Q1 group had more patients presenting with systemic inflammatory responsive syndrome (SIRS) (29.07% in Q1 vs 25.45% in Q4 respectively, P=0.019). Regarding poor outcome (major lower-extremity amputation (LEA) or in-hospital mortality), the Q4 group had 21.21% of patients in this category and the Q1 group had 10.47%. The odds ratio of each increased referral day on poor prognosis was 1.006 with 95% confidence interval 1.003–1.010 (P=<0.001). In subgroups, the impact on poor prognosis by day was most obvious in patients with SIRS (OR 1.011, 95% CI 1.004–1.018, P=0.003) and those with PAD (OR 1.004, 95% CI 1.001–1.008, P=0.028). Conclusions The deferred referral of DFI patients to the diabetic foot center might be associated with poor treatment outcome either in major LEA or mortality, particularly in patients with SIRS or PAD. Both physician and patient awareness of disease severity and overcoming the referral barrier is suggested. Trial registration Not applicable.


Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 14-14
Author(s):  
Yan Cheng ◽  
Sharif Mohammed ◽  
Alexis Okoh ◽  
Ki (Steve) Lee ◽  
Corinne Raczek ◽  
...  

Introduction: Early studies from Wuhan, China have reported an association between blood type and outcomes in COVID-19 infected patients. Conflicting reports in literature have investigated the protective role of blood type O against worst outcomes associated with COVID-19 infections. Approximately 50% of Black/African Americans (AA) have blood group O. Our study is the only study to date looking at the association between Black/AA and blood type. We aimed to determine the association between blood type and Black/AA patients hospitalized for COVID-19. Methods: We retrospectively reviewed data on patients with known blood type, who were admitted for COVID-19 at a single center between March and April 2020. We excluded other races in our study because only about 2% of the population was Caucasian and 8% representing other races, representing a small subset of patients under study whereas Black/AA represented about 90% of our hospitalized patients. Patients were stratified into 4 groups based on their ABO blood type. Baseline demographic, clinical characteristics and clinical course of the disease were compared. The primary end point was in-hospital mortality. Secondary endpoints included admission to the intensive care unit (ICU), acute kidney injury requiring hemodialysis and length of stay (LOS). Results: During the study period, a total of 256 patients were reviewed. Distribution of ABO type was as follows; A: (N=65) 25%, B: (N=62) 24%, AB: (N=9) 4%, O: (N=120) 47%. Compared to blood types A, B and O, AB patients were younger (mean; yrs. 63 vs. 63 vs. 62 vs. 43 yrs. p=0.0242). Blood type B patients were more likely to present with nausea, than groups A, AB, and O. (27% vs. 10% vs. 0% vs. 5%; p=0.017). All other characteristics including baseline inflammatory markers were comparable. There was no difference among groups regarding in-hospital mortality (A: 39% B: 29% AB: 33% O: 31% p value: 0.676) or admission to the ICU (A:31% B: 28% AB: 33% O: 34% p value: 0.840). The incidence of acute kidney injury requiring hemodialysis was higher in blood type A patients compared to B, AB, and O. (31% vs. 0% vs. 23% vs. 19%; p=0.046). In hospital LOS was comparable among all groups. Conclusions: In this single center analysis of black/AA patients admitted for COVID-19, there was no association between blood type and in-hospital mortality or admission to ICU. Blood type A patients had a higher propensity of kidney injury, but this did not translate into worse in-hospital survival. Disclosures Cohen: GBT: Speakers Bureau.


2021 ◽  
Vol 12 ◽  
Author(s):  
Mona Laible ◽  
Ekkehart Jenetzky ◽  
Markus Alfred Möhlenbruch ◽  
Martin Bendszus ◽  
Peter Arthur Ringleb ◽  
...  

Background and Purpose: Clinical outcome and mortality after endovascular thrombectomy (EVT) in patients with ischemic stroke are commonly assessed after 3 months. In patients with acute kidney injury (AKI), unfavorable results for 3-month mortality have been reported. However, data on the in-hospital mortality after EVT in this population are sparse. In the present study, we assessed whether AKI impacts in-hospital and 3-month mortality in patients undergoing EVT.Materials and Methods: From a prospectively recruiting database, consecutive acute ischemic stroke patients receiving EVT between 2010 and 2018 due to acute large vessel occlusion were included. Post-contrast AKI (PC-AKI) was defined as an increase of baseline creatinine of ≥0.5 mg/dL or &gt;25% within 48 h after the first measurement at admission. Adjusting for potential confounders, associations between PC-AKI and mortality after stroke were tested in univariate and multivariate logistic regression models.Results: One thousand one hundred sixty-nine patients were included; 166 of them (14.2%) died during the acute hospital stay. Criteria for PC-AKI were met by 29 patients (2.5%). Presence of PC-AKI was associated with a significantly higher risk of in-hospital mortality in multivariate analysis [odds ratio (OR) = 2.87, 95% confidence interval (CI) = 1.16–7.13, p = 0.023]. Furthermore, factors associated with in-hospital mortality encompassed higher age (OR = 1.03, 95% CI = 1.01–1.04, p = 0.002), stroke severity (OR = 1.05, 95% CI = 1.03–1.08, p &lt; 0.001), symptomatic intracerebral hemorrhage (OR = 3.20, 95% CI = 1.69–6.04, p &lt; 0.001), posterior circulation stroke (OR = 2.85, 95% CI = 1.72–4.71, p &lt; 0.001), and failed recanalization (OR = 2.00, 95% CI = 1.35–3.00, p = 0.001).Conclusion: PC-AKI is rare after EVT but represents an important risk factor for in-hospital mortality and for mortality within 3 months after hospital discharge. Preventing PC-AKI after EVT may represent an important and potentially lifesaving effort in future daily clinical practice.


2020 ◽  
Author(s):  
Bo You ◽  
Zi Chen Yang ◽  
Yu Long Zhang ◽  
Yu Chen ◽  
Yun Long Shi ◽  
...  

Abstract BackgroundAcute kidney injury (AKI) is a morbid complication and the main cause of multiple organ failure and death in severely burned patients. The objective of this study was to explore the epidemiological characteristics, the risk factors, and impact of both early and late AKIs, respectively.MethodsThis retrospective study was performed with prospectively collected data of severely burned patients from the Institute of Burn Research in Southwest Hospital during 2011-2017. AKI was diagnosed according to Kidney Disease Improving Global Outcomes (KDIGO) criteria (2012), and it was divided into early and late AKIs depending on its onset time (within the first 3 days or >3 days post burn). The baseline characteristics, clinical data, and outcomes of the three groups (early AKI, late AKI and non-AKI) were compared using logistic regression analysis. Mortality predictors of patients with AKI were assessed.ResultsA total of 637 patients were included in analysis. The incidence of AKI was 36.9% (early AKI 29.4%, late AKI 10.0%). The mortality of patients with AKI was 32.3% (early AKI 25.7%, late AKI 56.3%), and that of patients without AKI was 2.5%. AKI was independently associated with obviously increased mortality of severely burned patients [early AKI, OR = 12.98 (6.08-27.72); late AKI, OR = 34.02 (15.69-73.75)]. Multiple logistic regression analysis revealed that age, gender, total burn surface area (TBSA), full-thickness burns of TBSA, chronic comorbidities (hypertension or/and diabetes), hypovolemic shock of early burn, and tracheotomy were independent risk factors for both early and late AKIs. However, sepsis was only a risk factor for late AKI. Decompression escharotomy was a protective factor for both AKIs. ConclusionsAKI remains prevalent and is associated with high mortality in severely burned patients. Compared with early AKI, late AKI has a lower occurrence rate, but greater severity and worse prognosis,is a devastating complication. Late AKI is a poor prognosis sign in severe burns.


2021 ◽  
Vol 9 ◽  
Author(s):  
Huabin Wang ◽  
Zhongyuan He ◽  
Jiahong Li ◽  
Chao Lin ◽  
Huan Li ◽  
...  

Objective: Identifying high-risk children with a poor prognosis in pediatric intensive care units (PICUs) is critical. The aim of this study was to assess the predictive value of early plasma osmolality levels in determining the clinical outcomes of children in PICUs.Methods: We retrospectively assessed critically ill children in a pediatric intensive care database. The locally weighted-regression scatter-plot smoothing (LOWESS) method was used to explore the approximate relationship between plasma osmolality and in-hospital mortality. Linear spline functions and stepwise expansion models were applied in conjunction with a multivariate logistic regression to further analyze this relationship. A subgroup analysis by age and complications was performed.Results: In total, 5,620 pediatric patients were included in this study. An approximately “U”-shaped relationship between plasma osmolality and mortality was detected using LOWESS. In the logistic regression model using a linear spline function, plasma osmolality ≥ 290 mmol/L was significantly associated with in-hospital mortality [odds ratio (OR) 1.020, 95% confidence interval (CI) 1.010–1.031], while plasma osmolality &lt;290 mmol/L was not significantly associated with in-hospital mortality (OR 0.990, 95% CI 0.966–1.014). In the logistic regression model with plasma osmolality as a tri-categorical variable, only high osmolality was significantly associated with in-hospital mortality (OR 1.90, 95% CI 1.38–2.64), whereas low osmolality was not associated with in-hospital mortality (OR 1.28, 95% CI 0.84–1.94). The interactions between plasma osmolality and age or complications were not significant.Conclusion: High osmolality, rather than low osmolality, can predict a poor prognosis in children in PICUs.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S271-S271
Author(s):  
Gauri Chauhan ◽  
Nikunj M Vyas ◽  
Todd P Levin ◽  
Sungwook Kim

Abstract Background Vancomycin-resistant Enterococci (VRE) occurs with enhanced frequency in hospitalized patients and are usually associated with poor clinical outcomes. The purpose of this study was to evaluate the risk factors and clinical outcomes of patients with VRE infections. Methods This study was an IRB-approved multi-center retrospective chart review conducted at a three-hospital health system between August 2016-November 2018. Inclusion criteria were patients ≥18 years and admitted for ≥24 hours with cultures positive for VRE. Patients pregnant or colonized with VRE were excluded. The primary endpoint was to analyze the association of potential risk factors with all-cause in-hospital mortality (ACM) and 30-day readmission. The subgroup analysis focused on the association of risk factors with VRE bacteremia. The secondary endpoint was to evaluate the impact of different treatment groups of high dose daptomycin (HDD) (≥10 mg/kg/day) vs. low dose daptomycin (LDD) (< 10 mg/kg/day) vs. linezolid (LZD) on ACM and 30-day readmission. Subgroup analysis focused on the difference of length of stay (LOS), length of therapy (LOT), duration of bacteremia (DOB) and clinical success (CS) between the treatment groups. Results There were 81 patients included for analysis; overall mortality was observed at 16%. Utilizing multivariate logistic regression analyses, patients presenting from long-term care facilities (LTCF) were found to have increased risk for mortality (OR 4.125, 95% CI 1.149–14.814). No specific risk factors were associated with 30-day readmission. Patients with previous exposure to fluoroquinolones (FQ) and cephalosporins (CPS), nosocomial exposure and history of heart failure (HF) showed association with VRE bacteremia. ACM was similar between HDD vs. LDD vs. LZD (16.7% vs. 15.4% vs. 0%, P = 0.52). No differences were seen between LOS, LOT, CS, and DOB between the groups. Conclusion Admission from LTCFs was a risk factor associated with in-hospital mortality in VRE patients. Individuals with history of FQ, CPS and nosocomial exposure as well as history of HF showed increased risk of acquiring VRE bacteremia. There was no difference in ACM, LOS, LOT, and DOB between HDD, LDD and LZD. Disclosures All authors: No reported disclosures.


2021 ◽  
Vol 12 (3) ◽  
pp. 352-359
Author(s):  
Kyle W. Riggs ◽  
John T. Broderick ◽  
Nina Price ◽  
Clifford Chin ◽  
Farhan Zafar ◽  
...  

Background: Varying single center data exist regarding the posttransplant outcomes of patients with single ventricle circulation, particularly following the Fontan operation. We sought to better elucidate these results in patients with congenital heart disease (CHD) through combining two national databases. Methods: The United Network for Organ Sharing (UNOS) transplantation database was merged with the Pediatric Health Information System (PHIS), an administrative database with 71% of UNOS patients matched. Patients undergoing transplantation at a PHIS hospital from 2006 to 2017 were categorized as single ventricle or biventricular strategy based on their diagnoses and procedures in 90% of patients. When known, single ventricle patients were further analyzed by their palliative stage post-Glenn or post-Fontan (known in 31%). Results: A total of 1,517 CHD transplantations were identified, 67% with single ventricle strategy (1,016). Single ventricle, biventricular, and indeterminate patients had similar survival (log-rank P > .1). Risk factors for mortality in patients with CHD were extracorporeal membrane oxygenation (ECMO) support at transplant (hazard: 2.27), ABO blood type incompatibility (hazard: 1.61), African American recipient (hazard 1.42), and liver dysfunction (hazard 1.29). A total of 130 confirmed Fontan and 185 confirmed bidirectional Glenn patients underwent transplantation, each with survival equivalent to biventricular patients (log-rank P > .500). For Fontan patients, renal dysfunction (hazard: 5.40) and transplant <1 year after Fontan (hazard 2.82) were found to be associated with mortality. Conclusions: Single ventricle patients, as a group, experience similar outcomes as biventricular patients with CHD undergoing transplantation, and this extends to Fontan patients. Risk factors for mortality correlate with end-organ dysfunction as well as race and ABO blood type incompatibility in the CHD population.


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 568-568 ◽  
Author(s):  
Chunhui Fang ◽  
Henny Heisler Billett

Abstract Abstract 568 Venous thromboembolism (VTE) prevalence has been noted to be different for different racial groups: Non-Hispanic blacks tend to have a higher risk compared with non-Hispanic whites. Different ABO blood types have also been previously shown to be associated with different risk of VTE, with individuals with O blood type carry the lowest VTE risk. Given that blacks have a higher percentage of O blood type, one would expect to see a lower prevalence of VTE. In order to explain this paradoxical finding, we utilized the Clinical Looking Glass (CLG) system to study the relative influence of race, gender, age, and ABO blood type on the VTE risk. A total of 61,077 adult patients admitted to our large diverse urban hospital between 2000 and 2009 who had blood typing performed were included in the study. Four cohorts were established according to ABO blood group and the prevalence of VTE among each cohort was examined. We confirmed the higher prevalence of VTE in blacks (7.05% vs. 6.75%, p<0.001). While it has been previously shown that male gender is associated with higher VTE risk, we found this to be true only for the younger patient population: in adult patients less than 45yrs, male carried a higher prevalence of VTE (5.97% vs. 3.06%, p<0.001); in patients aged between 45 and 64yrs, no gender difference in the prevalence of VTE could be determined (8.40% vs. 8.33%, p=0.86). For patients aged between 65 and 84yrs, male gender was actually associated with lower prevalence of VTE (10.11% vs. 12.07%, p=0.009). No gender difference was seen in patients older than 80 (11.11% vs. 11.99%, p=0.356). When the prevalence of VTE was examined within each blood type, we confirmed that O blood type in general carries a lower VTE risk compared with other non-O blood types (6.9% vs. 8.4%, p<0.001); this held true for both genders (See Figure). To better analyze this complex interaction between race, ABO blood type, gender, age and VTE risk, we used logistic regression analysis. Race appeared to be the strongest determinant (black vs. white OR 1.43; 95% CI: 1.33, 1.52), followed by ABO blood type (Type A 1.2, 95% CI: 1.13–1.3; Type AB 1.2, 95% CI: 1.05, 1.40; Type B 1.33, 95% CI 1.23, 1.44), then gender (male vs. female OR 1.11; 95% CI: 1.04, 1.18) and finally, age (OR 1.03; 95% CI 1.03 – 1.03).). In conclusion, VTE risk for any individual is a composite of multiple variables. Our study suggests that race, gender, ABO blood type and age might allow us, in combination with other known risk factors, to develop a prognostic score for VTE risk stratification for each patient. Disclosures: No relevant conflicts of interest to declare.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3651-3651
Author(s):  
Richard J Cook ◽  
Nancy Heddle ◽  
Ker-Ai Lee ◽  
Yang Liu ◽  
Rebecca Barty, MLT ◽  
...  

Abstract Background Transfusions that are ABO compatible but not group identical (mismatched) are given for a variety of reasons including inventory availability, avoiding wastage from outdating, and clinical urgency. A recent observation at our centre suggested that patient outcome was different for those patients that received a transfusion of units with a compatible but mismatched ABO group compared to those receiving ABO group identical blood. Hence, we performed a retrospective hospital registry study to explore the association between mismatched blood and in-hospital mortality in transfused patients. Study Design Our patient/blood utilization database included 35,487 transfused hospitalized patients from 3 acute care academic centres from April 1, 2002 to October 31, 2011. Information on transfused RBCs included duration of storage (days) and ABO type. Patient data included: sex; age; hemoglobin; creatinine; diagnosis; interventions; ABO blood group and hospital discharge status. Factors associated with mismatched blood and in-hospital mortality were examined using generalized estimating equations to account for the potential serial dependence over multiple transfusions. The effect of exposure to ABO mismatched blood on in-hospital death was examined through Cox regression with time-dependent strata defined by: year of first admission; disease group; and the cumulative number of units transfused (≤ 7 days of storage; > 7 days but ≤ 28 days storage; and, >28 days of storage); and, controlling for available baseline and time-varying characteristics. Results 18,843 patients (blood groups A, B and AB), with complete covariates contributed to the analysis. Factors associated with transfusion of mismatched blood included: younger patient age (p<0.0001); lower hemoglobin (p<0.0001); higher creatinine (p<0.0001); intervention during hospitalization (OR=4.6, p<0.0001); and, patient ABO group whereby blood types A and B were much less likely to receive a mismatched unit compared to type AB patients (p<0.0001). There was a statistically significant interaction between patient blood type and the effect of receiving mismatched blood (p=0.034) with type A patients incurring a 79% higher risk of death (RR=1.79, 95% CI: 1.20, 2.67; p=0.0047); other patient blood types did not suggest increased risk. Similar results were observed when suspected trauma patients (≥ 6 units within 24 hours) were excluded from the analysis (Table 1). Conclusion Controlling for known potential confounders through Cox regression yielded evidence of increased risk of in-hospital mortality among blood type A patients receiving group O red cells. This association remained after suspected trauma patients were excluded from the analyses. Further study of the association observed in this study is warranted. Disclosures: Cook: CIHR: Research Funding. Heddle:CIHR: Research Funding; Canadian Blood Services: Membership on an entity’s Board of Directors or advisory committees, Research Funding; Health Canada: Research Funding. Eikelboom:CIHR: Research Funding.


Sign in / Sign up

Export Citation Format

Share Document