Abstract 17288: Clinical Outcomes of Hyponatremia in Patients Undergoing TAVR - A National Inpatient Sample Database

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
yasar sattar ◽  
Waqas Ullah ◽  
Salman Zahid ◽  
Houman Moussa Pacha ◽  
Uneza Rauf Khawaja ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Cardiopulmonary Arrest ◽  
Continuous Variables ◽  
National Inpatient Sample ◽  
International Classification Of Disease ◽  
Transcatheter Aortic Valve ◽  
Cerebral Herniation ◽  
History Of ◽  
Outcome Differences ◽  
New Onset

Introduction: The in-hospital outcomes and complications of hyponatremia in patients who are undergoing transcatheter aortic valve replacement (TAVR) remains uncertain. Hypothesis: Hyponatremia effect on TAVR outcomes Methods: We queried National Inpatient Sample (NIS) (2011-2014) using the International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM) codes for TAVR and hyponatremia (level<135 mEq/L). Categorical and continuous variables were reported as percentages and weighted means and were compared using unadjusted odds ratio (OR) and t-test, respectively. Univariate and multiple logistic regression analyses were used to control the outcomes variables. Results: A total of 33790 (no-hyponatremia 31683, hyponatremia 2107; ,mean age = 81 year) patients were included. The unadjusted odds for in-hospital mortality (5.7% vs. 3.8%, uOR 0.43, 95% CI, 0.23-0.618, p=<0.001) and new-onset seizures (0.5% vs. 0.2%%, uOR 2.15; 95% CI, 1.02-4.18, P = 0.037) were significantly higher for patients with hyponatremia compared to no-hyponatremia, respectively. Intriguingly, patients with hyponatremia had significantly higher odds of developing cardiopulmonary arrest (4.9% vs. 3.0%, uOR 0.53; 95% CI, 0.33-0.74, P=<0.001) compared to patients without hyponatremia. The odds for cerebral herniation and in-hospital new-onset coma (0.2% vs 0.2%, uOR 0.31 ;95% CI, 0.60-1.2, P = 0.69) did not differ significantly between the two groups. The adjusted odds ratio based on baseline comorbidities (hypertension, renal failure, diabetes, history of seizures), demographics (race, hospital, month of admission) and age followed the unadjusted odds ratios. Outcome differences of complications of TAVR with or without hypernatremia are shown in figure 1. (bue= without hyponatremia; red=hyponatremia). Conclusions: Patients with hyponatremia undergoing TAVR have higher odds of all-cause mortality, seizures and cardiopulmonary arrest.

scholarly journals Neurocysticercosis: a commonest neuroimaging abnormalitiy in children with first afebrile seizure in central India

2016 ◽  
Vol 4 (1) ◽  
pp. 241
Author(s):  
Agarwal G. ◽  
Lazarus M. ◽  
Roy A. ◽  
Ajmariya M.
Keyword(s):  
Parietal Lobe ◽  
Central India ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Abnormal Chest ◽  
First Onset ◽  
History Of ◽  
Afebrile Seizure ◽  
New Onset

Background: Seizures are the commonest neurological ailments in paediatrics in ~10%, even though the role of emergent neuroimaging in first onset afebrile seizure is not well defined.Methods: A prospective observational study was conducted in NSCB Medical College, Jabalpur, Madhya Pradesh, India to determine the incidence of neuroimaging abnormalities in children with first onset afebrile seizure and to make specific recommendations for use of routine neuroimaging in the new onset afebrile seizure. A total of 75 children (1 month to 14 years of age) with the new-onset afebrile seizure were enrolled and underwent clinical examination & neuroimaging. We defined first seizure using the international league against epilepsy (ILAE). The data were recorded and analysed by Student ‘t’ test for continuous variables, Fisher’s Exact Test or Chi square test for categorical variables. The critical level of significance was considered at P < 0.05 level.Results: Neuroimaging abnormalities were found in 66.7% of the cases, mostly in the children above 2 years of age (72.6 %) (P value <0.05). A significant relationship (P <0.001) was observed between focality (partial seizures (83.8%)) and abnormal neuroimaging, among these neurocysticercosis (26.7%) were in highest proportion with parietal lobe as the commonest involvement. The cases with contact history of tuberculosis /mantoux positivity/abnormal chest radiography were found significantly interrelated with tuberculoma (P <0.05).Conclusions: In developing countries like India the prevalence of neurocysticercosis and tuberculoma is high, hence neuroimaging in all cases of first onset afebrile seizure/ focal seizure with mantoux positive/ history of Contact /abnormal chest radiograph can be kept in a view for better management of child.

scholarly journals New-onset atrial fibrillation: incidence, characteristics, and related events following a national COVID-19 lockdown of 5.6 million people

2020 ◽  
Vol 41 (32) ◽  
pp. 3072-3079 ◽  
Author(s):  
Anders Holt ◽  
Gunnar H Gislason ◽  
Morten Schou ◽  
Bochra Zareini ◽  
Tor Biering-Sørensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Odds Ratio ◽  
Patient Characteristics ◽  
Related Event ◽  
History Of ◽  
Rate Ratios ◽  
Onset Atrial Fibrillation ◽  
History Of Cancer ◽  
New Onset

Abstract Aim To determine the incidence, patient characteristics, and related events associated with new-onset atrial fibrillation (AF) during a national COVID-19 lockdown. Methods and results Using nationwide Danish registries, we included all patients, aged 18–90 years, receiving a new-onset AF diagnosis during the first 3 months of 2019 and 2020. The main comparison was between patients diagnosed during lockdown (12 March 12–1 April 2020) and patients diagnosed in the corresponding period 1 year previously. We found a lower incidence of new-onset AF during the 3 weeks of lockdown compared with the corresponding weeks in 2019 [incidence rate ratios with 95% confidence intervals (CIs) for the 3 weeks: 0.66 (0.56–0.78), 0.53 (0.45–0.64), and 0.41 (0.34–0.50)]. There was a 47% drop in total numbers (562 vs. 1053). Patients diagnosed during lockdown were younger and with a lower CHA2DS2-VASc score, while history of cancer, heart failure, and vascular disease were more prevalent. During lockdown, 30 (5.3%) patients with new-onset AF suffered an ischaemic stroke and 15 (2.7%) died, compared with 45 (4.3%) and 14 (1.3%) patients during the corresponding 2019 period, respectively. The adjusted odds ratio of a related event (ischaemic stroke or all-cause death) during lock-down compared with the corresponding weeks was 1.41 (95% CI 0.93–2.12). Conclusions Following a national lockdown in Denmark, a 47% drop in registered new-onset AF cases was observed. In the event of prolonged or subsequent lockdowns, the risk of undiagnosed AF patients developing complications could potentially translate into poorer outcomes in patients with AF during the COVID-19 pandemic.

scholarly journals Predicting posttransplantation diabetes mellitus by regulatory T-cell phenotype: implications for metabolic intervention to modulate alloreactivity

Blood ◽  
2012 ◽  
Vol 119 (10) ◽  
pp. 2417-2421 ◽  
Author(s):  
Brian G. Engelhardt ◽  
Shubhada M. Jagasia ◽  
James E. Crowe ◽  
Michelle L. Griffith ◽  
Bipin N. Savani ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Immune Regulation ◽  
Odds Ratio ◽  
Cell Phenotype ◽  
Hematopoietic Stem ◽  
Skin Homing ◽  
History Of ◽  
Visceral Adipose ◽  
Treg Phenotype ◽  
New Onset

Abstract Chronic inflammation and decreased frequency of regulatory T cells (Tregs) in visceral adipose tissue contribute to the propagation of insulin resistance to diabetes mellitus. We tested the hypothesis that new-onset posttransplantation diabetes mellitus (PTDM) is associated with measurable changes in Treg subsets after allogeneic hematopoietic stem cell transplantation (HSCT). PTDM before day 100 and Treg phenotype at engraftment were determined in 36 HSCT recipients without preceding history of diabetes mellitus. Among patients with new-onset PTDM (N = 24), the frequency of circulating CLA+ (skin-homing) Tregs was decreased (1.53% vs 3.99%; P = .002) and the percentage of α4β7+ (gut-homing) Tregs was increased (17.9% vs 10.7%; P = .048). In multivariate analysis, patients with PTDM continued to demonstrate elevated ratios of α4β7+ Tregs to CLA+ Tregs (odds ratio, 18.1; P = .020). PTDM is associated with altered immune regulation after HSCT and could represent a target to modulate alloreactivity.

Combined use of QRISK3 and SCORE as predictors of carotid plaques in patients with rheumatoid arthritis

Rheumatology ◽  
2020 ◽  
Author(s):  
Alfonso Corrales ◽  
Nuria Vegas-Revenga ◽  
Belén Atienza-Mateo ◽  
Cristina Corrales-Selaya ◽  
Diana Prieto-Peña ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Cardiovascular Events ◽  
Diagnostic Odds Ratio ◽  
Population Based ◽  
Continuous Variables ◽  
Carotid Plaques ◽  
Eular Recommendations ◽  
Combined Use ◽  
History Of ◽  
Risk Charts

Abstract Objective Because carotid plaques predict the development of cardiovascular events in RA, we aimed to assess if the combined use of the systematic coronary risk evaluation (SCORE) and the QRISK3 algorithms allows for the identification of RA patients with carotid plaques in a defined population-based RA inception cohort. Methods A set of consecutive RA patients without a history of diabetes, chronic kidney disease or cardiovascular events were studied by carotid US between 2012 and 2019. Modified SCORE (mSCORE) for RA based on the 2015/2016 updated EULAR recommendations and QRISK3 algorithms were retrospectively tested using baseline data obtained at the time of the carotid US assessment. Results A total of 466 (54%) of 865 patients had carotid plaques. Using dichotomized QRISK3 and EULAR mSCORE, 73.2% (95% CI: 68.4.8, 77.6) of patients with QRISK ≥ 10% and EULAR mSCORE &lt; 5% had plaque. In this group, the diagnostic odds ratio was 5.79 (95% CI: 4.14, 8.10). However, if both algorithms were above their thresholds of high cardiovascular risk (QRISK ≥ 10% and EULAR mSCORE ≥ 5%), the sensitivity increased up to 83.3% (95% CI: 72.1, 91.4) and the diagnostic odds ratio up to 10.6 (95% CI: 5.13, 22.0). When the risk charts scales were used as continuous variables, both QRISK3 and EULAR mSCORE were found positively associated with plaque. For each 1% QRISK3 or EULAR mSCORE increase, the probability of having plaques multiplied by 1.14 and 1.22, respectively. However, the effects of both algorithms did not multiply by each other. Conclusions . The combined use of QRISK3 and EULAR mSCORE allows for the identification of most RA patients at high risk of carotid plaques.

scholarly journals General Anesthesia Increased the Risk of Atrial Fibrillation and Acute Kidney Injury in Transcatheter Aortic Valve Replacement

2021 ◽  
Vol 24 (1) ◽  
pp. E082-E100
Author(s):  
Ying Liang ◽  
Wei Wang ◽  
Xu Wang ◽  
Mingzheng Liu ◽  
Feilong Hei ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Odds Ratio ◽  
Transcatheter Aortic Valve Replacement ◽  
Kidney Injury ◽  
Transcatheter Aortic Valve ◽  
New Onset

Purpose: To examine key impacts of anesthesia on new-onset atrial fibrillation (AF) and acute kidney injury (AKI) in transcatheter aortic valve replacement (TAVR). Methods: All consecutive patients who underwent transfemoral, transapical, and transaortic TAVR in Fuwai Hospital from 2012 to 2018 were retrospectively analyzed and dichotomized into 2 groups: TAVR under conscious sedation (CS) and under general anesthesia (GA). The primary endpoint was a composite of all-cause mortality, stroke, AF, permanent pacemaker implantation, myocardial infarction, heart failure, high-grade atrioventricular block, and AKI at 1 year. Binary logistic regression and adjusted multilevel logistic regression were performed to analyze the predictors of AF and AKI. Results: A total of 107 patients were under CS and 66 patients under GA. No significant difference was observed in the composite endpoint (51.5% vs. 41.2%, GA vs. CS, P = .182) and ≥ mild paravalvular leakage (36.4% vs. 31.4%, GA vs. CS, P = .589) at 1 year. However, the GA group had a significantly higher rate of intensive care unit (ICU) admission (84.8% vs. 6.5%, P < .001), AKI (28.8% vs. 14.0%, P = .018), new-onset AF (15.2% vs. 5.5% at 1 year, P = .036). Multivariable analysis revealed GA to be the significant predictor of new-onset AF (odds ratio 3.237, 95% confidence interval 1.059 to 9.894, P = .039) and AKI (odds ratio 2.517, 95% confidence interval 1.013 to 6.250, P = .047). Conclusion: GA was associated with higher rates of ICU admission, postoperative AKI, and new-onset AF. The results may provide new evidence that CS challenges universal GA.

Abstract WP408: Risk of Lobar Intracerebral Hemorrhage From Hypertension is Greatest at an Early Age

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Robert Stanton ◽  
Matthew Gusler ◽  
Charles Moomaw ◽  
Lee Gilkerson ◽  
Tyler P Behymer ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Odds Ratio ◽  
Case Control Study ◽  
Age Groups ◽  
Random Digit Dialing ◽  
Random Digit ◽  
Racial Variations ◽  
History Of ◽  
Control Study ◽  
New Onset

Background: The risk of intracerebral hemorrhage (ICH) with hypertension (HTN) is well documented, with prior studies showing that HTN is the most important risk factor associated with ICH. Prior studies have shown that while the prevalence of HTN increases with age, the odds ratio (OR) of HTN for non-lobar ICH is greater earlier in life. We have previously found a lack of Apolipoprotein E allele association with lobar ICH in minority populations. Here we seek to determine if, similar to non-lobar ICH, the odds ratio of HTN for lobar ICH is greater at an earlier age. Methods: The Ethnic/Racial Variations of ICH (ERICH) study is a prospective multicenter case-control study of ICH among whites, blacks, and Hispanics. Cases were enrolled from 42 sites. Controls matched to cases 1:1 by age (±5 years), sex, ethnicity/race, and metropolitan area were identified by random-digit dialing. Participants were interviewed to determine history of HTN. Participants were divided into age groups based on ethnicity-specific quartiles. Cases in each ethnic/age group were compared to controls using logistic regression (i.e., cases and controls unmatched). ORs were calculated to show the risk of lobar ICH associated with HTN by quartile. Results: Overall, 917 lobar ICH cases and 932 controls were included. The Table shows the multivariable OR. ORs were highest in the youngest age quartile across all races (6.47 for blacks, 5.72 for Hispanics and 2.74 for whites). HTN produced a significant increase in risk for the youngest two quartiles in blacks and Hispanics, but only the youngest quartile in whites. However, the age of the lowest quartile in whites was equivalent to the bottom two quartiles in minorities. Discussion: Similar to non-lobar ICH, HTN earlier in life bears a greater risk of lobar ICH than later in life and this risk is across a greater range in disproportionately affected minorities. Research into how new onset or early life HTN leads to disproportionate risk compared to late life is needed.

Laboratory Evaluation and Clinical Characteristics of 2,132 Consecutive Unselected Patients with Venous Thromboembolism – Results of the Spanish Multicentric Study on Thrombophilia (EMET*-Study)

1997 ◽  
Vol 77 (03) ◽  
pp. 444-451 ◽  
Author(s):  
José Mateo ◽  
Artur Oliver ◽  
Montserrat Borrell ◽  
Núria Sala ◽  
Jordi Fontcuberta ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Odds Ratio ◽  
Protein C ◽  
Protein S ◽  
Laboratory Evaluation ◽  
Clinical Factors ◽  
Recurrent Thrombosis ◽  
Heparin Cofactor Ii ◽  
Crude Odds Ratio ◽  
History Of

SummaryPrevious studies on the prevalence of biological abnormalities causing venous thrombosis and the clinical characteristics of thrombotic patients are conflicting. We conducted a prospective study on 2,132 consecutive evaluable patients with venous thromboembolism to determine the prevalence of biological causes. Antithrombin, protein C, protein S, plasminogen and heparin cofactor-II deficiencies, dysfibrinoge-nemia, lupus anticoagulant and antiphospholipid antibodies were investigated. The risk of any of these alterations in patients with familial, recurrent, spontaneous or juvenile venous thrombosis was assessed. The overall prevalence of protein deficiencies was 12.85% (274/2,132) and antiphospholipid antibodies were found in 4.08% (87/2,132). Ten patients (0.47%) had antithrombin deficiency, 68 (3.19%) protein C deficiency, 155 (7.27%) protein S deficiency, 16 (0.75%) plasminogen deficiency, 8 (0.38%) heparin cofactor-II deficiency and 1 had dysfib-rinogenemia. Combined deficiencies were found in 16 cases (0.75%). A protein deficiency was found in 69 of 303 (22.8%) patients with a family history of thrombosis and in 205/1,829 (11.2%) without a history (crude odds ratio 2.34, 95% Cl 1.72-3.17); in 119/665 (17.9%) patients with thrombosis before the age of 45 and in 153/1,425 (10.7%) after the age of 45 (crude odds ratio 1.81, 95% Cl 1.40-2.35); in 103/616 (16.7%) with spontaneous thrombosis and in 171/1,516 (11.3%) with secondary thrombosis (crude odds ratio 1.58, 95% Cl 1.21-2.06); in 68/358 (19.0%) with recurrent thrombosis and in 206/1,774 (11.6%) with a single episode (crude odds ratio 1.78,95% Cl 1.32-2.41). Patients with combined clinical factors had a higher risk of carrying some deficiency. Biological causes of venous thrombosis can be identified in 16.93% of unselected patients. Family history of thrombosis, juvenile, spontaneous and recurrent thrombosis are the main clinical factors which enhance the risk of a deficiency. Laboratory evaluation of thrombotic patients is advisable, especially if some of these clinical factors are present.

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