Mechanical Ventilation Outcomes in Patients With Pulmonary Hypertension in the United States: A National Retrospective Cohort Analysis

2016 ◽  
Vol 32 (10) ◽  
pp. 588-592 ◽  
Author(s):  
Barret Rush ◽  
Bradly J. Biagioni ◽  
Landon Berger ◽  
Robert McDermid
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Cohort Analysis ◽  
Invasive Mechanical Ventilation ◽  
The United States ◽  
Retrospective Cohort Analysis ◽  
Hospital Stays ◽  
Pulmonary Arterial ◽  
Future Work ◽  
Overall Mortality

Objective: The outcome of patients with pulmonary arterial hypertension (PAH) who undergo mechanical ventilation is not well known. Methods: The Nationwide Inpatient Sample for 2006 to 2012 was used to isolate patients with a diagnosis of PAH who also underwent invasive (MV) and noninvasive (NIMV) mechanical ventilation. The primary outcome was in-hospital mortality. Results: The hospital records of 55 208 382 patients were studied, and there were 21 070 patients with PAH, of whom 1646 (7.8%) received MV and 834 (4.0%) received NIMV. Those receiving MV had higher mortality (39.1% vs 12.6%, P < .001) and longer hospital stays (11.9 days, interquartile range [IQR] 6.1-22.2 vs 6.7 days, IQR 3.4-11.9, P < .001) than those undergoing NIMV. Of the patients treated with MV, 4.4% also used home oxygen therapy and had similar overall mortality to those who did not use home oxygen (35.3% vs 39.1%, P = .46). Similarly, there was no relationship between home oxygen use and mortality in patients treated with NIMV (10.6% vs 12.6%, P = .48). Notably, more patients treated with NIMV used home oxygen than those treated with MV (14.4% vs 4.4%, P < .001). Conclusion: Patients with PAH who undergo invasive mechanical ventilation have an in-hospital mortality of 39.1%. Future work may help identify the types of patients who benefit most from advanced respiratory support in a critical care setting.

scholarly journals All-cause Healthcare Costs and Mortality in Patients with Systemic Sclerosis with Lung Involvement

2017 ◽  
Vol 45 (2) ◽  
pp. 235-241 ◽  
Author(s):  
Aryeh Fischer ◽  
Amanda M. Kong ◽  
Jeffrey J. Swigris ◽  
Ashley L. Cole ◽  
Karina Raimundo
Keyword(s):  
Systemic Sclerosis ◽  
Healthcare Costs ◽  
Cohort Analysis ◽  
International Classification Of Diseases ◽  
The United States ◽  
Newly Diagnosed ◽  
Diagnosis Codes ◽  
Retrospective Cohort Analysis ◽  
Classification Of Diseases ◽  
Pulmonary Arterial

Objective.Patients with systemic sclerosis (SSc) often develop interstitial lung disease (ILD) and/or pulmonary arterial hypertension (PAH). The effect of ILD and PAH on healthcare costs among patients with SSc is not well described. The objective of this analysis was to describe healthcare costs in patients with newly diagnosed SSc and SSc patients newly diagnosed with ILD and/or PAH in the United States.Methods.This retrospective cohort analysis was conducted in the Truven Health MarketScan Commercial and Medicare Supplemental healthcare claims databases from 2003 to 2014. Based on International Classification of Diseases-9-Clinical Modification diagnosis codes on medical claims, patients were classified into 3 groups: incident SSc, SSc with incident ILD (SSc-ILD), and SSc with incident PAH (SSc-PAH). Patients were required to have continuous enrollment for 5 years to measure all-cause healthcare costs. Costs (adjusted to US$) were reported overall and by service type and year following diagnosis. Because of the overlap between groups, statistical comparisons were not conducted.Results.There were 1957 patients with incident SSc, 219 with incident SSc-ILD, and 108 patients with incident SSc-PAH. Average (mean ± SD) all-cause healthcare costs over followup were higher for patients with incident SSc-ILD ($191,107 ± $322,193) or patients with incident SSc-PAH ($254,425 ± $240,497), compared to patients with incident SSc ($101,839 ± $167,155). Average annual costs over the 5-year period ranged from $18,513 to $23,268 for patients with incident SSc, from $31,285 to $55,446 for patients with incident SSc-ILD, and from $44,454 to $63,320 for patients with incident SSc-PAH. Costs tended to be the highest in the fifth year of followup.Conclusion.Among patients with SSc, ILD and PAH can result in substantial increases in healthcare costs.

scholarly journals Association between the level of plasma B-type natriuretic peptide and in-hospital mortality in patients with acute exacerbation of COPD without a history of coronary ischemic heart disease: a retrospective study

2021 ◽  
Author(s):  
Jiyun Cui ◽  
Jie Liu ◽  
Jing Wang ◽  
Meng Lv ◽  
Chunyan Xing ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Heart Disease ◽  
Hospital Mortality ◽  
Ischemic Heart Disease ◽  
Natriuretic Peptide ◽  
Invasive Mechanical Ventilation ◽  
Ischemic Heart ◽  
Composite Outcome ◽  
History Of ◽  
Secondary Outcomes

Abstract Background: Previous studies suggested that plasma B-type natriuretic peptide (BNP) level was often elevated in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and was associated with increased mortality. However, most studies did not consider the fact that conditions such as coronary ischemic heart disease can also increase BNP level. Therefore, we aimed to explore the association between BNP level and in-hospital mortality in patients with AECOPD without a history of coronary ischemic heart disease.Methods: In this retrospective cohort study, patients who were diagnosed with AECOPD using International Statistical Classification of Diseases and Related Health Problems, Nineth Revision (ICD-9 codes) between January 2017 and December 2019. All data were obtained from electronic patient files and medical data intelligence platform of Jinan Central Hospital. BNP level was determined within 24 hours after admission, and the value was log2 transformed. The primary outcome was in-hospital mortality, and the secondary outcome was a composite outcome of in-hospital mortality or invasive mechanical ventilation.Results: A total of 300 patients were included in this study. Univariate cox regression analysis showed that the unadjusted HRs of the primary and secondary outcomes were 1.85 (95% CI, 1.39-2.47) and 1.45 (95% CI, 1.20-1.75), respectively. After adjustment for age, sex, past medical history, smoking status, drinking status, CURB65 (Confusion, Urea > 7mmol/L, Respiratory rate≥30/min, Blood pressure systolic < 90 mmHg or diastolic <60 mmHg and age > 65 years), arterial partial pressure of O2(PaO2), the adjusted HRs of the primary and secondary outcomes were 3.65 (95% CI, 2.54-5.26) and 1.43 (95% CI, 1.14-1.97), respectively. The results of subgroup analysis by age, sex, and lung function were robust. This study was retrospective, so there was no clinical trial registration.Conclusions: The plasma log2BNP level was significantly associated with in-hospital mortality and a composite outcome of in-hospital mortality or invasive mechanical ventilation.

Abstract 17292: Does Morbid Obesity Worsens Outcomes in COVID-19?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sohaib Roomi ◽  
Waqas Ullah ◽  
Nayab Nadeem ◽  
Rehan Saeed ◽  
Donald Haas ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Invasive Mechanical Ventilation ◽  
Multivariate Logistic Regression Analysis ◽  
Odds Ratios ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean ◽  
Mean Differences

Introduction: Given the high prevalence of obesity around the globe, patients with coronavirus disease 2019 (COVID-19) are at an increased risk of devastating complications. Hypothesis: We hypothesize that morbid obesity is independently associated with increased risk of in-hospital mortality, upgrade to intensive care unit, invasive mechanical ventilation(IVM), and acute renal failure necessitating dialysis. Methods: A retrospective cohort study was performed to determine the association of basal metabolic index (BMI) with the above-mentioned outcomes. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI), respectively. Results: A total of 176 patients with confirmed COVID-19 diagnosis were included. The mean age was 62.2 years, with 51% of male patients. The mean BMI for non-surviving patients was significantly higher compared to patients surviving on the 7th day of hospitalization (35 vs. 30 kg/m2, p=0.022) and patients with a higher BMI had higher in-hospital mortality (21% vs. 9%, OR 3.2, 95% CI 1.3-8.2, p=0.01) compared to patients with a normal BMI. Similarly, patients requiring IMV had a higher BMI (33 vs. 29, p=0.002) compared to non-intubated patients. aOR of patients needing IMV (56% vs. 28%, OR 3.3, 95% CI 1.6-7.0, p=0.002) and upgrade to ICU (46% vs. 28%, OR 2.2, 1.07-4.6, p=0.04) were significantly higher compared to patients with a lower BMI. There was no significant difference between the two groups in terms of the need for dialysis (5% vs. 13%, OR 3.8, 13% vs. 4%, 1.1-14.1, p=0.07). Adjusted odds ratios controlled for baseline comorbidities and medications mirrored the overall results, except for the need to upgrade to ICU. Conclusions: In patients with confirmed COVID-19, morbid obesity serves as an independent risk factor of high in-hospital mortality and the need for invasive mechanical ventilation.

scholarly journals Low ALT values amongst hospitalized patients are associated with increased risk of hypoglycemia and overall mortality: a retrospective, big-data analysis of 51 831 patients

QJM ◽  
2020 ◽  
Author(s):  
E Itelman ◽  
A Segev ◽  
L Ahmead ◽  
E Leibowitz ◽  
M Agbaria ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Cohort Analysis ◽  
Surrogate Marker ◽  
Tertiary Hospital ◽  
Big Data Analysis ◽  
Hospitalized Patients ◽  
Retrospective Cohort Analysis ◽  
Increased Risk ◽  
Overall Mortality

Summary Background Sarcopenia and frailty influence clinical patients’ outcomes. Low alanine aminotransferase (ALT) serum activity is a surrogate marker for sarcopenia and frailty. In-hospital hypoglycemia is associated, also with worse clinical outcomes. Aim We evaluated the association between low ALT, risk of in-hospital hypoglycemia and subsequent mortality. Design This was a retrospective cohort analysis. Methods We included patients hospitalized in a tertiary hospital between 2007 and 2019. Patients’ data were retrieved from their electronic medical records. Results The cohort included 51 831 patients (average age 70.88). The rate of hypoglycemia was 10.8% (amongst diabetics 19.4% whereas in non-diabetics 8.3%). The rate of hypoglycemia was higher amongst patients with ALT &lt; 10 IU/l in the whole cohort (14.3% vs. 10.4%, P &lt; 0.001) as well as amongst diabetics (24.6% vs. 18.8%, P &lt; 0.001). Both the overall and in-hospital mortality were higher in the low ALT group (57.7% vs. 39.1% P &lt; 0.001 and 4.3% vs. 3.2%, P &lt; 0.001). A propensity score matching, after which a regression model was performed, showed that patients with ALT levels &lt; 10 IU/l had higher risk of overall mortality (HR = 1.21, CI 1.13–1.29, P &lt; 0.001). Conclusions Low ALT values amongst hospitalized patients are associated with increased risk of in-hospital hypoglycemia and overall mortality.

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