Abstract 17073: In Hospital Outcomes in Patients With Infective Endocarditis With and Without Liver Cirrhosis - Insight From National Inpatient Sample

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shakeel Jamal ◽  
muhammad shah zaib ◽  
Asim Kichloo ◽  
Iqra Riaz ◽  
Beth Bailey ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Bleeding Complications ◽  
National Inpatient Sample ◽  
Preoperative Risk ◽  
Preoperative Risk Assessment ◽  
General Data

Introduction: Chronic liver disease is known to be an important prognostic factor in determining morbidity and mortality in preoperative risk assessment and mortality in general. Data are limited on outcomes in patients with infective endocarditis (IE) and comorbid concurrent liver cirrhosis. Objective of our study is to evaluate the clinical outcomes of patient with IE with and without underlying liver cirrhosis and determining in-hospital mortality and outcomes of interest i.e. renal failure, cardiogenic shock, hematologic (coagulopathy/thrombocytopenia) and hepatic complications (hepatic encephalopathy/hepatitis). Hypothesis: Liver Cirrhosis worsen clinical outcomes in patients with IE. Methods: Patients with principle diagnosis of IE with and without liver cirrhosis were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, National Inpatient Sample for year 2013 and 2014 based on ICD9 codes. Results: During 2013 and 2014, a total of 17, 952 patients were admitted with diagnosis of IE, out of whom 780 had concurrent liver cirrhosis. There was an increased in-hospital mortality [15.6% vs 10.2%, aOR 1.57(1.27-1.93)], acute kidney injury [41.4% vs 32.6%, aOR 1.45(1.24-1.69)], coagulopathy/thrombocytopenia [32.1 vs 14.7%, aOR 2.87(2.44-3.37)] in patients with IE with liver cirrhosis when compared to patients with IE without liver cirrhosis. IE without liver cirrhosis underwent increased number of interventions i.e. aortic (7.2 vs 3.7%, 0.51(0.34-0.76)] and mitral (4.9% vs 3.4%, aOR 0.39(0.23-0.69)] valvular replacements as compared to without liver cirrhosis. Conclusions: Liver cirrhosis is an important prognostic marker of in-hospital mortality in patients with concurrent IE. High risk surgical state with coagulopathy, bleeding complications, worsening hepatic complications and renal dysfunction lead to higher mortality.

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.

Abstract 17260: In Hospital Outcomes and Prevalence of Comorbidities in Patients With ST Elevation Myocardial Infarction With and Without Infective Endocarditis - Insight From National Inpatient Sample (2013-2014)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shakeel Jamal ◽  
farah Wani ◽  
Amina Khan ◽  
Asim Kichloo ◽  
Beth Bailey ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Respiratory Failure ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Valve Replacement ◽  
Kidney Injury ◽  
St Elevation Myocardial Infarction ◽  
National Inpatient Sample ◽  
St Elevation

Introduction: In infective endocarditis (IE), embolization to the coronary arteries is an uncommon phenomenon but can contribute to transmural infarction presenting as ST elevation myocardial infarction (STEMI). Due to limited date, we intend to evaluate the clinical outcomes in hospitalized patients with STEMI with and without underlying IE. Hypothesis: Morbidity and morbidity exponentiates in STEMI with comorbid IE when compared to without IE. Methods: Patients with primary diagnosis of STEMI with and without IE were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, National Inpatient Sample for year 2013 and 2014 based on ICD9 codes Results: During 2013 and 2014, a total of 117, 386 patients were admitted with the principle diagnosis of STEMI, out of whom 305 had comorbid IE. There was an increased in-hospital mortality (27.5% vs 10.8%, increased length of stay (14 vs 5 days), acute kidney injury (44.9% vs 18.7%), stroke (23.6% vs 3%), aortic valve replacement (9.5% vs 0.3%), mitral valve replacement (0.2%-5.2%), sepsis (50% vs 6%) and acute respiratory failure (36.7% vs 16.7%) in patients with STEMI with IE when compared to patients with STEMI and without comorbid IE. STEMI without IE had higher number of angiographies (58.7% vs 25.9%) and percutaneous coronary interventions (50.7% vs 14.4%) during their hospital course when compared to STEMI with IE. Conclusions: We conclude that hospitalized STEMI patients with concomitant diagnosis of IE are at higher risk of in-hospital mortality, increased LOS, AKI, stroke, valve replacements, and acute respiratory failure. Clinical trials that compare optimal interventions in these patients would be needed in future.

Abstract 15593: In Hospital Outcomes and Prevalence of Comorbidities in Patients With Infective Endocarditis With and Without Heart Blocks - Insight From a National Inpatient Sample

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shakeel Jamal ◽  
Asim Kichloo ◽  
michael Albosta ◽  
Beth Bailey ◽  
Ronak Soni ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Heart Block ◽  
Kidney Injury ◽  
Cost Of Care ◽  
Adverse Outcomes ◽  
National Inpatient Sample ◽  
Cardiac Procedures ◽  
Inpatient Outcomes ◽  
Tele Monitoring

Objective: To study inpatient outcomes of infective endocarditis (IE) with concurrent heart blocks Introduction: IE complicated with heart blocks can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart blocks are lacking. Methods: Patients with a principle diagnosis of IE with or without heart blocks were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, the National Inpatient Sample for year 2013 and 2014 based on ICD9 codes. Results: During 2013 and 2014, a total of 18,733 patients were admitted with a diagnosis of IE, out of whom 867 had concurrent heart blocks. There was an increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), cost of care (282,573 vs 223,559), cardiogenic shock (8.9% vs 3.2%), placement of an ICD/CRT/PPM (30.6% vs 0.9%), acute kidney injury (40.1% vs 32.6%) and hematologic complications (19.3 vs 15.2%) in patients admitted with IE with heart blocks as compared to those with IE but without heart block. Infective endocarditis and concurrent heart block resulted in increased requirement for aortic (25.7 vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements as compared to IE without heart block. Conclusions: IE with concurrent heart block worsens in-hospital mortality, length and cost of hospital stay. Our analysis clearly demonstrates an increase in the indications for cardiac procedures, specifically aortic and/or mitral valve replacements and ICD/CRT/PPM placement. A close tele monitoring system and prompt interventions may represent a significant mitigation strategy to avoid adverse outcomes observed in this study.

scholarly journals Preoperative risk assessment improves biomarker detection for predicting acute kidney injury after cardiac surgery

PLoS ONE ◽  
2018 ◽  
Vol 13 (9) ◽  
pp. e0203447 ◽  
Author(s):  
Cheng-Chia Lee ◽  
Chih-Hsiang Chang ◽  
Shao-Wei Chen ◽  
Pei-Chun Fan ◽  
Su-Wei Chang ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
Biomarker Detection ◽  
Preoperative Risk ◽  
Preoperative Risk Assessment

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 ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Poor Prognosis ◽  
Kidney Injury ◽  
Blood Type ◽  
Blood Types ◽  
Severe Burns ◽  
Icu Length Of Stay ◽  
Abo Blood Type ◽  
The Impact

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.

P676Percutaneous coronary intervention and clinical outcomes in patients with lymphoma: a 10-year period United States nationwide inpatient sample (NIS) analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J A Borovac ◽  
C S Kwok ◽  
M Konopleva ◽  
P Y Kim ◽  
N L Palaskas ◽  
...  
Keyword(s):  
United States ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Transient Ischemic Attack ◽  
Nationwide Inpatient Sample ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Hodgkin's Lymphoma ◽  
Bleeding Complications ◽  
Ischemic Attack

Abstract Background Clinical outcomes and characteristics of patients with lymphoma undergoing percutaneous coronary intervention (PCI) are unknown. Purpose To describe clinical characteristics and procedural outcomes in patients that underwent PCI and had a concurrent diagnosis of Hodgkin (HL) or non-Hodgkin (NHL) lymphoma and compare risks of complications and in-hospital mortality in lymphoma subtypes to patients without lymphoma. Methods A total of 6,413,175 PCI procedures undertaken in the United States between 2004 and 2014 in the Nationwide Inpatient Sample were included in the analysis. Multivariable regression analysis was performed in order to examine the association between lymphoma diagnosis and clinical outcomes post-PCI including complications and in-hospital mortality. Results Patients with lymphoma generally had a significantly higher incidence of post-PCI complications and in-hospital mortality compared to patients without lymphoma (Figure 1). Patients with lymphoma were more likely to experience in-hospital mortality (OR 1.34, 95% CI 1.20–1.49), stroke or transient ischemic attack (TIA) (OR 1.59, 95% CI 1.47–1.73), and any in-hospital complication (OR 1.19, 95% CI 1.14–1.25), following PCI. In the lymphoma subtype-analysis, diagnosis of HL was associated with an increased likelihood of in-hospital death (OR 1.31, 95% CI 1.17–1.48), any in-hospital complication (OR 1.20, 95% CI 1.14–1,26), bleeding complications (OR 1.12 95% CI 1.05–1.19) and vascular complications (OR 1.10 95% CI 1.03–1.17) while these risks were not significantly associated with NHL diagnosis. Finally, both types of lymphoma were associated with an increased likelihood of stroke/TIA following PCI, with this effect being twice greater for HL than NHL diagnosis (OR 1.66, 95% CI 1.52–1.81 and OR 1.33, 95% CI 1.06–1.66, respectively) (Table 1). Table 1. ORs for clinical outcomes Variable HL vs. No Lymphoma NHL vs. No Lymphoma Bleeding complications 1.12 (1.05–1.19) 1.07 (0.89–1.27) Vascular complications 1.10 (1.03–1.17) 1.13 (0.92–1.27) Cardiac complications 0.94 (0.85–1.03) 0.86 (0.68–1.11) Post-procedural stroke/TIA 1.66 (1.52–1.81) 1.33 (1.06–1.66) Any complication 1.20 (1.14–1.26) 1.04 (0.91–1.18) In-hospital mortality 1.31 (1.17–1.48) 0.89 (0.65–1.21) HL, Hodgkin's Lymphoma; NHL, non-Hodgkin's Lymphoma; TIA, Transient Ischemic Attack. Figure 1. Type of lymphoma and outcomes Conclusions While the incidence of lymphoma in the observed PCI cohort was low, a diagnosis of lymphoma was associated with an adverse prognosis following PCI, primarily in patients with a diagnosis of HL.

scholarly journals Sex Differences in the Utilization and Outcomes of Cardiac Valve Replacement Surgery for Infective Endocarditis: Insights From the National Inpatient Sample

2021 ◽  
Author(s):  
Agam Bansal ◽  
Paul C. Cremer ◽  
Wael A. Jaber ◽  
Penelope Rampersad ◽  
Venu Menon
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Valve Surgery ◽  
Cardiac Valve ◽  
National Inpatient Sample ◽  
Men And Women ◽  
Replacement Surgery ◽  
Cardiac Valve Replacement ◽  
Valve Replacement Surgery

Background The data on the differential impact of sex on the utilization and outcomes of valve replacement surgery for infective endocarditis are limited to single‐center and small sample size patient population. Methods and Results We utilized the National Inpatient Sample database to identify patients with a discharge diagnosis of infective endocarditis from 2004 to 2015 to assess differences in the characteristics and clinical outcomes of patients hospitalized with infective endocarditis stratified by sex. We also evaluated trends in utilization of cardiac valve replacement and individual valve replacement surgeries in women versus men over a 12‐year period, and compared in‐hospital mortality after surgical treatment in women versus men. A total of 81 942 patients were hospitalized with a primary diagnosis of infective endocarditis from January 2004 to September 2015, of whom 44.31% were women. Women were less likely to undergo overall cardiac valve replacement (6.92% versus 12.12%), aortic valve replacement (3.32% versus 8.46%), mitral valve replacement (4.60% versus 5.57%), and combined aortic and mitral valve replacement (0.85% versus 1.81%) but had similar in‐hospital mortality rates. From 2004 to 2015, the overall rates of cardiac valve replacement increased from 11.76% to 13.96% in men and 6.34% to 9.26% in women and in‐hospital mortality declined in both men and women. Among the patients undergoing valve replacement surgery, in‐hospital mortality was higher in women (9.94% versus 6.99%, P <0.001). Conclusions Despite increased utilization of valve surgery for infective endocarditis in both men and women and improving trends in mortality, we showed that there exists a treatment bias with underutilization of valve surgeries for infective endocarditis in women and demonstrated that in‐hospital mortality was higher in women undergoing valve surgery in comparison to men.

Outcome of dialysis-requiring acute kidney injury in patients with infective endocarditis: A nationwide study

2020 ◽  
Author(s):  
Jeppe Kofoed Petersen ◽  
Andreas Dalsgaard Jensen ◽  
Niels Eske Bruun ◽  
Anne-Lise Kamper ◽  
Jawad Haider Butt ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Valve Surgery ◽  
Cardiac Valve ◽  
Post Discharge ◽  
Dialysis Treatment ◽  
Cardiac Valve Surgery ◽  
One Year

Abstract Background Infective endocarditis (IE) may be complicated by acute kidney injury, yet data on the use of dialysis and subsequent reversibility are sparse. Methods Using Danish nationwide registries, we identified patients with first-time IE from 2000 to 2017. Dialysis naïve patients were grouped into: those with and those without dialysis during admission with IE. Continuation of dialysis was followed one year post-discharge. Multivariable adjusted Cox proportional hazard analysis was used to examine one-year mortality for patients surviving IE according to use of dialysis. Results We included 7,307 patients with IE; 416 patients (5.7%) initiated dialysis treatment during admission with IE and these were younger, had more comorbidities and more often underwent cardiac valve surgery compared with non-dialysis patients (47.4% vs. 20.9%). In patients with both cardiac valve surgery and dialysis treatment (n=197), 153 (77.7%) initiated dialysis on- or after the date of surgery. The in-hospital mortality was 40.4% and 19.0% for patients with and without dialysis, respectively (p&lt;0.0001). Of those who started dialysis and survived hospitalization, 21.6% continued dialysis treatment within one year after discharge. In multivariable adjusted analysis, dialysis during admission with IE was associated with an increased one-year mortality from IE discharge, HR=1.64 (95% CI: 1.21-2.23). Conclusion In dialysis-naïve patients with IE, approximately 1 in 20 patients initiated dialysis treatment during admission with IE. Dialysis identified a high-risk group with an in-hospital mortality of 40% and an approximately 20% risk of continued dialysis. Those with dialysis during admission with IE showed worse long-term outcomes than those without.

P2759Value of biomarkers (urinary KIM-1, NGAL, albumin, serum Cys C) for predicting renal lesions and prognosis in patients with infective endocarditis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Pisaryuk ◽  
N Povalyaev ◽  
M Sorokina ◽  
M Teterina ◽  
A Balatskiy ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Serum Creatinine ◽  
Hospital Mortality ◽  
Cystatin C ◽  
Late Onset ◽  
Kidney Injury ◽  
Kidney Damage ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
C Value

Abstract Background Infective endocarditis (IE) is frequently complicated by kidney damage of various pathogenesis. The essential differences in pathophysiological mechanisms of kidney lesions (glomerular and tubular damage, mixed mechanisms) create different therapeutical targets. Nowadays these mechanisms are only possible to differentiate with the use of nephrobiopsy or autopsy. Non-invasive methods to assess the genesis of kidney damage are eagerly wanted. It is possible that kidney biomarkers may be such method. Materials and methods 209 patients with verified IE (DUKE 2009, 2015), hospitalized and treated in city clinical hospital named after V.V. Vinogradov in Moscow from January 2010 to June 2018, were included in the study. Kidney function was assessed using CKD-EPI formula. Acute kidney injury (AKI) and acute kidney disease (AKD) were diagnosed according to current guidelines (KDIGO 2012) and the work group consensus (ADQI 16 Workgroup 2017). Serum creatinine decrease on ≥26,5 mcmol/L in 48 hours after the hospitalization was counted as early-onset AKI. Patients with serum creatinine elevation on ≥26,5 mcmol/L in 48 hours during the hospitalization were diagnosed with late-onset AKI. Biomarkers were assessed at the admission. Cystatin C level was assessed in serum; neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), albumin levels were assessed in urine. Results Kidney damage biomarkers' levels were analyzed in 65 patients with IE. Patients with kidney dysfunction (n=45) comparing to ones without AKI (n=20) had higher mean value of all kidney biomarkers, however, the significant difference was established only for cystatin C. (1.9 vs 1.3 mg/l respectively; p<0.001). Patients with early-onset AKI (n=11) next to patients without AKI had significantly higher cystatin C value at admission (1.9 vs 1.3 mg/l respectively; p=0,0186). In similar manner patients with late-onset had had significantly higher cystatin C value at admission (1.9 vs 1.3 mg/l respectively; p=0,002). Cystatin C appeared to be an independent AKI predictor with threshold value 1.35 mg/l (OR 14.0; 95% CI 1.74–112.2; p=0.013), and also cystatin C was an independent predictor of the in-hospital mortality with threshold 1.87 mg/l (OR 3.16; 95% CI 1.25–7.99; p=0.006). After analysis of patients with AKD it was established that they had significantly higher levels of cystatin C (1.7 vs 1.3 mg/l respectively; p=0.035) and NGAL (19 vs 1.9 ng/ml; p=0.05) in comparison with patients without AKD. Albumin and KIM-1 didn't show significant associations. Conclusions The results of a study allow to consider serum cystatin C as AKI marker, AKI predictor and in-hospital mortality predictor in patients with IE, and urinal NGAL and serum cystatin C may be considered as AKD markers.

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