scholarly journals 802. Proton Pump Inhibitors Increase Clostridioides difficile Disease Severity Controlling for Infecting Strains

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S444-S444
Author(s):  
Saad Fallatah ◽  
Masaad Almutairi ◽  
Faris S Alnezary ◽  
Anne J Gonzales-Luna ◽  
Kevin W Garey
Keyword(s):  
Disease Severity ◽  
Proton Pump Inhibitors ◽  
Clinical Data ◽  
Proton Pump ◽  
Multicenter Study ◽  
Severe Disease ◽  
Composite Endpoint ◽  
Hospitalized Patients ◽  
Clostridioides Difficile ◽  
Poor Outcomes

Abstract Background Proton pump inhibitors (PPI) display pleotropic properties that increase the risk of poor outcomes in patients with C. difficile infection (CDI). However, clinical data on PPI and CDI outcomes is controversial perhaps due to lack of knowledge of infecting strain. The purpose of this study was to assess CDI outcomes in hospitalized patients infected with known C. difficile ribotypes based on use of PPI. Methods This was a multicenter study (20 hospitals) of hospitalized patients infected with one of three C. difficile ribotypes (RT027, RT106, and RT014-020). Electronic medical records were reviewed by investigators blinded to RT that collected data on PPI use along with other clinical data. A composite endpoint of disease severity, mortality and 90-day CDI recurrence was assessed based on receipt of PPI and ribotype using multivariate logistic regression. Results A total of 380 patients with CDI aged 66±17 years (Female: 59.5%; White: 70.5%) infected with RT 106 (115/380; 30.3%), RT027 (116/380; 30.5%), and RT014-020 (149/380; 39.2%) were included. One hundred and ninety-nine patients (52.4%) were given a PPI at the time of CDI diagnosis and 129 patients (66.1%) experienced either severe disease or CDI recurrence. Disease severity differed significantly between ribotypes (p< 0.05) and increased in patients given PPI (p=0.08). CDI recurrence also differed significantly among ribotypes (p< 0.05) and increased in patients given PPI. Using the composite endpoint, receipt of PPIs significantly increased the likelihood of poor outcomes (OR:1.78; 95% CI: 1.17-2.73; p=0.007) after controlling for infecting ribotype. Conclusion In this multicenter study, receipt of PPIs increased the likelihood of poor outcomes in CDI patients after controlling for infecting ribotype. Disclosures Kevin W. Garey, PharmD, MS, FASHP, Merck & Co. (Grant/Research Support, Scientific Research Study Investigator)

Inappropriate prescribing of proton pump inhibitors in hospitalized patients

2011 ◽  
Vol 7 (5) ◽  
pp. 421-425 ◽  
Author(s):  
Mark Reid ◽  
Angela Keniston ◽  
J. Christie Heller ◽  
Marshall Miller ◽  
Sofia Medvedev ◽  
...  
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Inappropriate Prescribing ◽  
Hospitalized Patients

scholarly journals Low FT3 is an independent marker of disease severity in patients hospitalized for COVID-19

2021 ◽  
Author(s):  
Aditya Dutta ◽  
Ganesh Jevalikar ◽  
Rutuja Sharma ◽  
Khalid J. Farooqui ◽  
Shama Mahendru ◽  
...  
Keyword(s):  
Disease Severity ◽  
Cox Regression ◽  
Severe Disease ◽  
Thyroid Stimulating Hormone ◽  
Hospitalized Patients ◽  
Thyroid Function Tests ◽  
Cox Regression Analysis ◽  
Markers Of Inflammation ◽  
Outcome Severity ◽  
Independent Marker

Aim: To study the prevalence of thyroid dysfunction and its association with disease severity in hospitalized patients of coronavirus disease-19 (COVID-19). Methods: In this retrospective cohort study, thyroid function tests (TFT) of 236 hospitalized patients of COVID-19, along with demographic, comorbid, clinical, biochemical, and disease severity records were analysed. Patients were divided into previous euthyroid or hypothyroid status to observe the effect of prior hypothyroidism on severity of COVID-19. Results: TFT abnormalities were common. Low free T3 (FT3), high thyroid stimulating hormone (TSH) and low TSH were seen in 56 (23.7%), 15 (6.4%) and 9 (3.8%) patients, respectively. The median levels of TSH (2.06 vs 1.26 mIU/mL, p=0.001) and FT3 (2.94 vs 2.47 pg/mL, p=0.000) were significantly lower in severe disease. Previous hypothyroid status (n=43) was associated with older age, higher frequency of comorbidities, higher FT4 and lower FT3. TFT did not correlate with markers of inflammation (except lactate dehydrogenase), however, FT3 and TSH negatively correlated with outcome severity score and duration of hospital stay. Cox-regression analysis showed that low FT3 was associated with severe COVID-19 (p=0.032, HR 0.302; CI 0.101-0.904), irrespective of prior hypothyroidism. Conclusions: Functional thyroid abnormalities (low FT3 and low TSH) are frequently seen in hospitalized patients of COVID-19. Although these abnormalities did not correlate with markers of inflammation, this study shows that low FT3 at admission independently predicts severity of COVID-19.

scholarly journals Investigation on Intervention Effects of Applying Proton Pump Inhibitors in Inpatients

2019 ◽  
Author(s):  
Guotong Qing ◽  
Jian Wu ◽  
Runfong Wei ◽  
Di Wu ◽  
Yipping Gou ◽  
...  
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Age Distribution ◽  
Information Management System ◽  
Hospitalized Patients ◽  
Utilization Rate ◽  
Coincidence Rate ◽  
Cross Sectional ◽  
Clinical Pharmacists ◽  
Before And After

Abstract Background. To investigate the intervention effect of clinical pharmacists on irrational use of proton pump inhibitors (PPIs) in clinicians. Methods. A cross-sectional study was used to through the hospital information management system survey, before intervention (July 15th, 2016, Aug 15th, 2016 and Sep 15th 2016) and dry prognosis (July 15th, 2017, Aug 15th, 2017 and Sep 15th, 2017) all the use of PPIs inpatients related information. According to the guidelines of "drug instructions" and "experts on stress ulcer prevention and treatment experts", the standard of drug use was formulated, and the use of PPIs before and after intervention was evaluated and analyzed in accordance with the standard, and the results of intervention were evaluated. Results. The total number of hospitalized patients surveyed before the intervention was 1,693, the average utilization rate of proton pump inhibitors was 27.05% and the coincidence rate was 52.40%. The total number of hospitalized patients investigated after the intervention was 2,095, the average utilization rate of proton pump inhibitors was 8.54%, and the coincidence rate was 68.16%. Before and after the intervention, there was no difference in gender ratio and age distribution, the decrease of the utilization rate and the improvements of the qualified rate after intervention were statistically significant.Conclusion. According to the standards of PPIs, clinical pharmacists strictly implement the special prescription review system and other intervention measures, which can significantly improve the level of PPIs rational clinical medication.

scholarly journals Combined Indexes of Serum NLR, CRP, LDH, IL-6 and D-Dimer Levels are a Biomarker of Disease Severity and Prognostic Predictor in Patients with Coronavirus Disease 2019

2021 ◽  
Author(s):  
Jing Li ◽  
Mingyang Tang ◽  
Didi Liu ◽  
Fengchao Wang ◽  
Yanqing Yang
Keyword(s):  
Disease Progression ◽  
Disease Severity ◽  
Severe Disease ◽  
Composite Endpoint ◽  
Serum Markers ◽  
Inflammatory Factors ◽  
Rna Detection ◽  
Host Immune Responses ◽  
Positive Rate ◽  
D Dimer

Abstract Background: Coronavirus disease-2019 (COVID-19) has become a worldwide emergency and has had a severe impact on human health. Inflammatory factors have the potential to either enhance the efficiency of host immune responses or damage the host organs with immune overreaction in COVID-19. Therefore, there is an urgent need to investigate the functions of inflammatory factors and serum markers that participate in disease progression. Methods: In total, 54 COVID-19 patients were enrolled in this study. Disease severity was evaluated by clinical evaluation, laboratory tests, and computed tomography (CT) scans. Data were collected at: admission, 3–5 days after admission, when severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection became negative, and composite endpoint. Results: We found that the positive rate in sputum was three times higher than that in throat swabs. Higher levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer (D-D), interleukin-6 (IL-6) and neutrophil-to-lymphocyte (NLR) or lower lymphocyte counts suggested more severe disease, and the levels of cytokines and serum markers were intrinsically correlated with disease progression. When SARS-CoV-2 RNA detection became negative, the receiver operating characteristic (ROC) curve demonstrated that LDH had the highest sensitivity independently, and four indicators (NLR, CRP, LDH, and D-D) when combined had the highest sensitivity in distinguishing critically ill patients from mild ones. Conclusions: Monitoring dynamic changes in NLR, CRP, LDH, IL-6, and D-D levels, combined with CT imaging and viral RNA detection in sputum, could aid in severity evaluation and prognosis prediction and facilitate COVID-19 treatment.

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