scholarly journals 679. Infective Endocarditis and Septic Emboli-Related Complications; Epidemiology and Impacts on Hospital Outcomes

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S441-S443
Author(s):  
Hansang Park ◽  
Monil Majmundar ◽  
Soumyajit Roy ◽  
Maria Rosa Velasquez-Espiritu ◽  
Kuldeep Ghosh ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Length Of Stay ◽  
Cox Regression ◽  
Primary Diagnosis ◽  
Cardiac Complications ◽  
Study Cohort ◽  
Hospital Outcomes ◽  
Total Cost ◽  
Septic Emboli ◽  
Baseline Characteristics

Abstract Background Infectious endocarditis (IE) remains a disease of high mortality, complications and a severe burden to the healthcare system despite advances in diagnostic techniques and treatments. There are several investigations of IE using a nation-based population cohort, however, with limited focus on septic emboli-related complications. Figure 1. Flowchart of the study cohort. IE=Infective Endocarditis Methods We used the 2016 to 2018 National Readmission Database (NRD) to identify a primary diagnosis of admissions among adults (Age≥18) with IE. International Statistical Classification (ICD-10) codes were used to identify patients with a primary diagnosis of IE who experienced in-hospital septic emboli-related complications. Primary outcomes were mortality, length of stay, total cost and 30-day all-cause readmission. Uni- and Multivariate Linear, Logistic and Cox regression were used to assess statistical significance and a two-sided p-value less than 0.05 was considered significant. Results A total of 30,870 patients were admitted with a primary diagnosis of IE from 2016 to 2018 (December admissions were omitted). After excluding the patients with omitted information, 30,289 patients went into analysis. Baseline characteristics are shown in Table 1. Septic emboli-related complications were seen in 42.6% of the patients; about 10% had central nervous system (CNS) complications, 7% had cardiac complications and 20.2% had respiratory complications. Embolic complications of any kind were associated with higher mortality (Odds Ratio = 2.11 [1.74 – 2.54]), a longer length of stay (5.72 days [5.17 – 6.27]) and higher total costs (21,812 dollars [19,856 – 23,769]) while adjusted for baseline characteristics. Multivariate Cox regression to assess the risk of 30-day readmission was not statistically significant. Predictors of 30-day all-cause readmission among baseline characteristics and subgroups of embolic complications are shown in table 4 and table 5, respectively. Conclusion The prevalence of septic emboli-related complications was up to 42.6% of patients admitted with the primary diagnosis of IE. These complications significantly impact hospital outcomes; including mortality, length of stay and total cost. Further studies are required to clarify the relationship between 30-day all-cause readmissions and embolic complications. Disclosures All Authors: No reported disclosures

P2769Racial differences in outcomes among acute pulmonary embolism patients: a nationwide analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Shi
Keyword(s):  
Pulmonary Embolism ◽  
Regression Analysis ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Pulmonary Embolism ◽  
Primary Diagnosis ◽  
Total Cost ◽  
Rehabilitation Facilities ◽  
The Impact ◽  
White Patients

Abstract Background Limited data is available regarding racial disparities in patients admitted for acute pulmonary embolism. Purpose We aimed to examine the impact of racial differences on outcomes in patients admitted for acute pulmonary embolism. Methods We used the Nationwide Inpatient Sample, which represents 20% of community hospital discharges in the US, to identify adult patients who were discharged with the primary diagnosis of acute pulmonary embolism in 2016 with ICD-10 codes. Logistic regression analysis and linear regression analysis were used to compare patients with different races. Outcomes were focused on in-hospital mortality, total cost, length of stay and disposition, adjusting gender, age, Charlson comorbid index and socioeconomic variables. Results In 2016, 35,526 patients were admitted with a primary diagnosis of acute pulmonary embolism. White patients were more likely to be older and with higher income. After adjusting for the above variables, white patients had lower total cost of hospitalization (p<0.0001), shorter length of stay (p<0.0001), lower in-hospital mortality (adjusted odds ratio = 0.79, p=0.001), and more likely to be discharged to rehabilitation facilities compared to being discharged home. Outcomes in white vs non-white patients Conclusion Among acute pulmonary embolism hospitalizations, white patients generally had better outcomes despite being older in age, and were more likely to be transferred to rehabilitation facilities after discharge.

In-hospital outcomes and prevalence of comorbidities in patients with infective endocarditis with and without heart blocks: Insight from the National Inpatient Sample

2020 ◽  
pp. jim-2020-001501
Author(s):  
Shakeel M Jamal ◽  
Asim Kichloo ◽  
Michael Albosta ◽  
Beth Bailey ◽  
Jagmeet Singh ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Heart Block ◽  
Kidney Injury ◽  
Primary Diagnosis ◽  
Cost Of Care ◽  
Adverse Outcomes ◽  
Cardiac Resynchronization ◽  
National Inpatient Sample

Infective endocarditis (IE) complicated by heart block can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart block are lacking. Patients with a primary diagnosis of IE with or without heart block were identified by querying the Healthcare Cost and Utilization Project database, specifically the National Inpatient Sample for the years 2013 and 2014, based on International Classification of Diseases Clinical Modification Ninth Revision codes. During 2013 and 2014, a total of 18,733 patients were admitted with a primary diagnosis of IE, including 867 with concurrent heart blocks. Increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), and cost of care ($282,573 vs $223,559) were found for patients with IE complicated by heart block. Additionally, these patients were more likely to develop cardiogenic shock (8.9% vs 3.2%), acute kidney injury (40.1% vs 32.6%), and hematologic complications (19.3% vs 15.2%), and require placement of a pacemaker (30.6% vs 0.9%). IE and concurrent heart block resulted in increased requirement for aortic (25.7% vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements. Conclusion was made that IE with concurrent heart block worsens in-hospital mortality, length of stay, and cost for patients. Our analysis demonstrates an increase in cardiac procedures, specifically aortic and/or mitral valve replacements, and Implantable Cardiovascular Defibrillator/Cardiac Resynchronization Therapy/ Permanent Pacemaker (ICD/CRT/PPM) placement in IE with concurrent heart block. A close telemonitoring system and prompt interventions may represent a significant mitigation strategy to avoid the adverse outcomes observed in this study.

To Pack or Not to Pack: Inpatient Management of Epistaxis in the Elderly

2018 ◽  
Vol 32 (6) ◽  
pp. 539-545 ◽  
Author(s):  
Albert H. Zhou ◽  
Sei Y. Chung ◽  
Michael J. Sylvester ◽  
Michael Zaki ◽  
Peter S. Svider ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
The Elderly ◽  
Primary Diagnosis ◽  
Pulmonary Complications ◽  
Nasal Packing ◽  
Hospital Charges ◽  
Cardiac Complications ◽  
The Impact

Background Epistaxis is common in elderly patients, occasionally necessitating hospitalization for the management of severe bleeds. In this study, we aim to explore the impact of nasal packing versus nonpacking interventions (cauterization, embolization, and ligation) on outcomes and complications of epistaxis hospitalization in the elderly. Methods The 2008–2013 National Inpatient Sample was queried for elderly patients (≥65 years) with a primary diagnosis of epistaxis and accompanying procedure codes for anterior and posterior nasal packing or nonpacking interventions. Results A total of 8449 cases met the inclusion criteria, with 62.4% receiving only nasal packing and 37.6% receiving nonpacking interventions. On average, nonpacking interventions were associated with a 9.9% increase in length of stay and a 54.0% increase in hospital charges. Comorbidity rates did not vary between cohorts, except for diabetes mellitus, which was less common in the nonpacking cohort (26.6% vs 29.0%; P = .014). Nonpacking interventions were associated with an increased rate of blood transfusion (24.5% vs. 21.8%; P = .004), but no significant differences in rates of stroke, blindness, aspiration pneumonia, infectious pneumonia, thromboembolism, urinary/renal complications, pulmonary complications, cardiac complications, or in-hospital mortality. Comparing patients receiving ligation or embolization, no differences in length of stay, complications, or in-hospital mortality were found; however, embolization patients incurred 232.1% greater hospital charges ( P < .001). Conclusion Nonpacking interventions in the elderly do not appear to be associated with increased morbidity or mortality when compared to nasal packing only but appear to be associated with increased hospital charges and length of stay. Embolization in the elderly results in greater hospital charges but no change in outcome when compared to ligation.

Outcomes associated with endovascular treatment among patients with acute ischemic stroke in the USA

2019 ◽  
Vol 12 (4) ◽  
pp. 422-426
Author(s):  
Ansaar T Rai ◽  
Concetta Crivera ◽  
Emilie Kottenmeier ◽  
Iftekhar Kalsekar ◽  
Rashmi Kumari ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Primary Diagnosis ◽  
Economic Outcomes ◽  
Trend Test ◽  
Administrative Claims ◽  
Total Cost ◽  
Economic Trends ◽  
The Usa

BackgroundFew studies have examined the trends in clinical and economic outcomes of patients with acute ischemic stroke (AIS) who receive endovascular therapy (ET) in the real-world setting.ObjectiveTo evaluate characteristics and trends in clinical and economic outcomes among commercially insured patients with AIS undergoing ET between 2011 and 2017.MethodsPatients with AIS undergoing ET from January 1, 2011 to June 30, 2017 were identified from administrative claims contained in the IBM MarketScan Commercial and Medicare Supplemental databases. The Mann–Kendall trend test was performed to examine clinical and economic trends.Between 2011 and 2017, 3411 patients (mean age 62.85±15 years) with a primary diagnosis of AIS underwent ET (coverage: Commercial 59%, n=2008; Medicare Supplemental 41%, n=1403). In the Commercial cohort, discharge to home increased significantly (from 29.54% to 39.18%, p<0.05). Length of stay declined significantly among the overall cohort (from 10.96 to 9.05 days, p<0.01) and the Medicare Supplemental cohort (from 10.03 to 8.43 days, p<0.05). All-cause 365-day readmission decreased significantly among the overall cohort (from 47.5% to 36.7%, p<0.05) and the Commercial cohort (from 51.54% to 36.43%, p<0.05) but remained unchanged in the Medicare Supplemental cohort. While index procedure cost did not change significantly ($93 955 to $87 906, p=0.8806), total cost significantly declined in the overall cohort (from $166 922 to $130 678, p<0.05).ConclusionsAlthough with some variation across the samples studied, outcomes including discharge to home, length of stay, readmission, and total cost associated with endovascular stroke therapy seemed to have improved between 2011 and 2017. Index admission cost remained unchanged.

Use of Damage Control and the Open Abdomen in Combat

2013 ◽  
Vol 79 (8) ◽  
pp. 747-753 ◽  
Author(s):  
Benjamin Bograd ◽  
Carlos Rodriguez ◽  
Richard Amdur ◽  
Fred Gage ◽  
Eric Elster ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Multivariate Regression ◽  
Injury Severity ◽  
Open Abdomen ◽  
Damage Control ◽  
Unit Length ◽  
Significant Risk ◽  
Hospital Length Of Stay ◽  
Study Cohort ◽  
Regression Analyses

Despite the well-documented use of damage control laparotomy (DCL) in civilian trauma, its use has not been well described in the combat setting. Therefore, we sought to document the use of DCL and to investigate its effect on patient outcome. Prospective data were collected on 1603 combat casualties injured between April 2003 and January 2009. One hundred seventy patients (11%) underwent an exploratory laparotomy (ex lap) in theater and comprised the study cohort. DCL was defined as an abbreviated ex lap resulting in an open abdomen. Patients were stratified by age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), mechanism of injury, and blood product administration. Multivariate regression analyses were used to determine risks factors for intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), and the need for DCL. Mean age of the cohort was 24 ± 5 years, ISS was 21 ± 11, and 94 per cent sustained penetrating injury. Patients with DCL comprised 50.6 per cent (n = 86) of the study cohort and had significant increases in ICU admission ( P < 0.001), ICU LOS ( P < 0.001), HLOS ( P < 0.05), ventilator days ( P < 0.001), abdominal complications ( P < 0.05), but not mortality ( P = 0.65) compared with patients without DCL. When compared with the non-DCL group, patients undergoing DCL required significantly more blood products (packed red blood cells, fresh-frozen plasma, platelets, and cryoprecipitate; P < 0.001). Multivariate regression analyses revealed blood transfusion and GCS as significant risk factors for DCL ( P < 0.05). Patients undergoing DCL had increased complications and resource use but not mortality compared with patients not undergoing DCL. The need for combat DCL may be different compared with civilian use. Prospective studies to evaluate outcomes of DCL are warranted.

Impact of immunosuppressive agents on clinical manifestations and outcome of Staphylococcus aureus bloodstream infection – A propensity score matched analysis in two large, prospectively evaluated cohorts

2021 ◽  
Author(s):  
Johannes Camp ◽  
Lina Glaubitz ◽  
Tim Filla ◽  
Achim J Kaasch ◽  
Frieder Fuchs ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Propensity Score ◽  
Bloodstream Infection ◽  
Cox Regression ◽  
Immunosuppressive Agents ◽  
Late Complications ◽  
Competing Risk ◽  
Immunosuppressed Patients ◽  
Staphylococcus Aureus Bloodstream Infection ◽  
Baseline Characteristics

Abstract Background Staphylococcus aureus bloodstream infection (SAB) is a common, life-threatening infection. The impact of immunosuppressive agents on the outcome of patients with SAB is incompletely understood. Methods Data from two large prospective, international, multicenter cohort studies (INSTINCT and ISAC) between 2006 and 2015 were analyzed. Patients receiving immunosuppressive agents were identified and a 1:1 propensity score (PS) matched analysis was performed to adjust for baseline characteristics of patients. Overall survival and time to SAB-related late complications (SAB relapse, infective endocarditis, osteomyelitis, or other deep-seated manifestations) were analyzed by Cox regression and competing risk analyses, respectively. This approach was then repeated for specific immunosuppressive agents (corticosteroids [CSMT] and immunosuppressive agents other than steroids [IMOTS]). Results Of 3,188 analyzed patients, 309 were receiving immunosuppressive treatment according to our definitions and were matched to 309 non-immunosuppressed patients. After PS matching, baseline characteristics were well balanced. In the Cox regression analysis, we observed no significant difference in survival between the two groups (death during follow-up: 105/309 (33.9 %) immunosuppressed patients vs. 94/309 (30.4 %) non-immunosuppressed, hazard ratio 1.20 (95% CI 0.84–1.71). Competing risk analysis showed a cause-specific hazard ratio (CSHR) of 1.81 (95% CI 0.85–3.87) for SAB-related late-complications in patients receiving immunosuppressive agents. CSHR was higher in patients taking IMOTS (3.69; 95% CI 1.41–9.68). Conclusions Immunosuppressive agents were not associated with an overall higher mortality. The risk for SAB-related late complications in patients receiving specific immunosuppressive agents such as IMOTs warrants further investigations.

scholarly journals Risk of infective endocarditis among patients with tetralogy of fallot

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Havers-Borgersen ◽  
J.H Butt ◽  
M Groening ◽  
M Smerup ◽  
G.H Gislason ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Cox Regression ◽  
Pulmonary Valve Replacement ◽  
Varying Coefficients ◽  
Background Population ◽  
Increased Risk

Abstract Introduction Patients with tetralogy of Fallot (ToF) are considered at high risk of infective endocarditis (IE) as a result of altered hemodynamics and multiple surgical and interventional procedures including pulmonary valve replacement (PVR). The overall survival of patients with ToF has increased in recent years. However, data on the risk of adverse outcomes including IE are sparse. Purpose To investigate the risk of IE in patients with ToF compared with controls from the background population. Methods In this nationwide observational cohort study, all patients with ToF born in 1977–2017 were identified using Danish nationwide registries and followed from date of birth until occurrence of an outcome of interest (i.e. first-time IE), death, or end of study (July 31, 2017). The comparative risk of IE among ToF patients versus age- and sex-matched controls from the background population was assessed. Results A total of 1,156 patients with ToF were identified and matched with 4,624 controls from the background population. Among patients with ToF, 266 (23.0%) underwent PVR during follow-up. During a median follow-up time of 20.4 years, 38 (3.3%) patients and 1 (0.03%) control were admitted with IE. The median time from date of birth to IE was 10.8 years (25th-75th percentile 2.8–20.9 years). The incidence rates of IE per 1,000 person-years were 2.2 (95% confidence interval (CI) 1.6–3.0) and 0.01 (95% CI 0.0001–0.1) among patients and controls, respectively. In multivariable Cox regression models, in which age, sex, pulmonary valve replacement, and relevant comorbidities (i.e. chronic renal failure, diabetes mellitus, presence of cardiac implantable electronic devices, other valve surgeries), were included as time-varying coefficients, the risk of IE was significantly higher among patients compared with controls (HR 171.5, 95% CI 23.2–1266.7). Moreover, PVR was associated with an increased risk of IE (HR 3.4, 95% CI 1.4–8.2). Conclusions Patients with ToF have a substantial risk of IE and the risk is significantly higher compared with the background population. In particular, PVR was associated with an increased risk of IE. With an increasing life-expectancy of these patients, intensified awareness, preventive measures, and surveillance of this patient group are advisable. Figure 1. Cumulative incidence of IE Funding Acknowledgement Type of funding source: None

Infective endocarditis in patients who use IV drugs: a single centre cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Alraddadi ◽  
A Alsagheir ◽  
S Gao ◽  
K An ◽  
H Hronyecz ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Long Term Outcomes ◽  
Replacement Surgery ◽  
Short Term Mortality ◽  
History Of ◽  
Short And Long Term ◽  
Baseline Characteristics

Abstract Background Managing endocarditis in intravenous drug use (IVDU) patients is challenging: unless patients successfully quit IVDU, the risk of re-infection is high. Clinicians often raise concerns with ethical and resource allocation principles when considering valve replacement surgery in this patient population. To help inform practice, we sought to determine the long-term outcomes of IVDU patients with endocarditis who underwent valve surgery in our center. Method After research ethics board approval, infective endocarditis cases managed surgically at our General Hospital between 2009 and 2018 were identified through the Cardiac Care Network. We reviewed patients' charts and included those with a history of IVDU in this study. We abstracted data on baseline characteristics, peri-operative course, short- and long-term outcomes. We report results using descriptive statistics. Results We identified 124 IVDU patients with surgically managed endocarditis. Mean age was 37 years (SD 11), 61% were females and 8% had redo surgery. During admission, 45% (n=56) of the patients had an embolic event: 63% pulmonary, 30% cerebral, 18% peripheral and 11% mesenteric. Causative organisms included Methicillin-Sensitive Staphylococcus Aureus (51%, n=63), Methicillin-Resistant Staphylococcus Aureus (15%, n=19), Streptococcus Viridans (2%, n=2), and others (31%, n=38). Emergency cardiac surgery was performed for 42% of patients (n=52). Most patients (84%) had single valve intervention: 53% tricuspid, 18% aortic and 13% mitral. Double valve interventions occurred in 15% (n=18). Overall, bioprosthetic replacement was most commonly chosen (79%, n=98). In-hospital mortality was 7% (n=8). Median length of stay in hospital was 13 days (IQR 8,21) and ICU 2 days (IQR 1,6). Mortality at longest available follow-up was 24% (n=30), with a median follow-up of 129 days (IQR 15,416). Valve reintervention rate was 11% (n=13) and readmission rate was 14% (n=17) at a median of 275 days (IQR 54,502). Conclusion Despite their critical condition, IVDU patients with endocarditis have good intra-hospital outcomes. Challenges occur after hospital discharge with loss of follow-up and high short-term mortality. IVDU relapse likely accounts for some of these issues. In-hospital and community comprehensive addiction management may improve these patients' outcomes beyond the surgical procedure. Annual rate 2009–2018 Funding Acknowledgement Type of funding source: None

scholarly journals The “Intermediate” CD14 + CD16 + monocyte subpopulation plays a role in IVIG responsiveness of children with Kawasaki disease

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yi Seul Kim ◽  
Hyun Jin Yang ◽  
Seung-Jung Kee ◽  
Insu Choi ◽  
Kisoo Ha ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Laboratory Tests ◽  
Febrile Illness ◽  
Cardiac Complications ◽  
Study Cohort ◽  
Ivig Infusion ◽  
Functional Studies ◽  
Ivig Resistance ◽  
Resistant Group ◽  
Intermediate Monocytes

Abstract Background Kawasaki disease (KD) is an acute, self-limited febrile illness of unknown cause. Intravenous immunoglobulin (IVIG)-resistance are related to greater risk for permanent cardiac complications. We aimed to determine the correlation between monocytes and the phenotype of KD in relation to IVIG responsiveness in children. Materials and methods The study cohort included 62 patients who were diagnosed with KD, 20 non febrile healthy controls (NFC), and 15 other febrile controls (OFC). In all enrolled patients, blood was taken at least 4 times and laboratory tests were performed. In addition, subtypes of monocytes were characterized via flow cytometry. Results The numbers of intermediate monocytes were significantly lower in IVIG-resistant group compared to IVIG-responsive group before IVIG infusion (p < 0.0001). After infusion, intermediate monocytes decreased in the responsive group, while a trend of increase was observed in the resistant group. Only intermediate monocytes were significant in logistic regression with adjusted OR of 0.001 and p value of 0.03. Conclusions CD14 + CD16 + intermediate monocyte may play an important role in IVIG responsiveness among KD children. Low starting levels of intermediate monocytes, followed by a dramatic increase post-IVIG infusion during acute phase of KD are associated with IVIG-resistance. Functional studies on intermediate monocyte may help to reveal the pathophysiology.

scholarly journals Population Characteristics of Cats Adopted from an Urban Cat Shelter and the Influence of Physical Traits and Reason for Surrender on Length of Stay

Animals ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. 940 ◽  
Author(s):  
Miller ◽  
Ward ◽  
Beatty
Keyword(s):  
Length Of Stay ◽  
Animal Welfare ◽  
Coat Color ◽  
Population Characteristics ◽  
Study Cohort ◽  
Potential Predictor ◽  
Use Of Resources ◽  
Stray Cats ◽  
Hazard Ratios ◽  
Physical Traits

Measures aimed at reducing the length of stay (LOS) of cats in shelters can promote animal welfare and more efficient use of resources. The extent to which variables shown to impact LOS are broadly applicable is unclear. The aim of this study was to describe a population of cats adopted from an urban shelter, and to analyze the association between potential predictor variables and LOS. A study cohort was identified retrospectively from shelter records (n = 2584), 48.8% of which were < 12 weeks old at admission, and 80.7% were stray. Among 445 cats relinquished by owners, reasons for surrender were primarily owner-related (87.2%). Overall, reason for surrender and coat color were significantly associated with LOS. Hazard ratios showed that all reasons for surrender for owner-relinquished cats were associated with a shorter LOS than stray cats and this association was significant (p < 0.05) for all except cat behavioral or medical reasons. In contrast to previous reports, white cats had a significantly (p < 0.05) longer LOS than black cats. This study highlights an important role for shelter-specific baseline data to inform and measure the effect of interventional studies aimed at improving animal welfare by reducing LOS in shelter-housed cats

Sign in / Sign up

Export Citation Format

Share Document