scholarly journals Atrioventricular Valve Repair in Single Ventricle Physiology: Timing Matters

2019 ◽  
Vol 11 (1) ◽  
pp. 22-28
Author(s):  
Leonardo A. Miana ◽  
Valdano Manuel ◽  
Aida Luísa Turquetto ◽  
Hugo Neder Issa ◽  
Gustavo Pampolha Guerreiro ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hospital Mortality ◽  
Protective Factor ◽  
Single Ventricle ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
High Risk Group ◽  
Atrioventricular Valve ◽  
Stage 1 ◽  
The Impact

Objectives: Atrioventricular valve (AVV) regurgitation in patients with single ventricle (SV) physiology severely impacts prognosis; the appropriate timing for surgical treatment is unknown. We sought to study the results of surgical treatment of AVV regurgitation in SV patients and evaluate risk factors for mortality. Methods: Medical records of 81 consecutive patients with moderate or severe AAV regurgitation who were submitted to AVV repair or replacement during any stage of univentricular palliation between January 2013 and May 2017 were examined. We studied demographic data and perioperative factors looking for predictors that might have influenced the results. Binary logistic regression was used to assess the impact on postoperative ventricular dysfunction and mortality. Results: Median age and weight were seven months (interquartile range [IQR]: 3-24) and 5.2 kg (IQR: 3.7-11.2), respectively. Seventy (86.4%) patients underwent AVV repair, and 11 (13.6%) patients underwent AVV replacement. There was an association between AVV repair effectiveness and timing of intervention ( P = .004). Atrioventricular valve intervention at the time of initial surgical palliation was associated with more ineffective repairs ( P = .001), while AVV replacement was more common between Glenn and Fontan procedures ( P = .004). Overall 30-day mortality was 30.5% (25 patients). In-hospital mortality was 49.4%, and it was higher when AVV repair was performed concomitant with initial (stage 1) palliation (64.1% vs 35.7%; P = .01) and when an effective repair was not achieved (75% vs 41%; P = .008). Multivariable analysis identified timing concomitant with stage 1 palliation as an independent risk factor for mortality ( P = .01); meanwhile, an effective repair was a protective factor against in-hospital mortality ( P = .05). Conclusion: Univentricular physiology with AVV regurgitation is a high-risk group of patients. Surgery for AVV regurgitation at stage 1 palliation was associated with less effective repair and higher mortality in this initial experience. On the other hand, effective repair determined better outcomes, highlighting the importance of experience and the learning curve in the management of such patients.

scholarly journals The Impact of Preoperative Risk on the Association between Hypotension and Mortality after Cardiac Surgery: An Observational Study

2020 ◽  
Vol 9 (7) ◽  
pp. 2057
Author(s):  
Vanja Ristovic ◽  
Sophie de Roock ◽  
Thierry G. Mesana ◽  
Sean van Diepen ◽  
Louise Y. Sun
Keyword(s):  
Cardiac Surgery ◽  
Risk Factor ◽  
High Risk ◽  
Hospital Mortality ◽  
Risk Group ◽  
High Risk Group ◽  
Group Care ◽  
Intermediate Risk ◽  
Intraoperative Hypotension ◽  
The Impact

Background: Despite steady improvements in cardiac surgery-related outcomes, our understanding of the physiologic mechanisms leading to perioperative mortality remains incomplete. Intraoperative hypotension is an important risk factor for mortality after noncardiac surgery but remains relatively unexplored in the context of cardiac surgery. We examined whether the association between intraoperative hypotension and in-hospital mortality varied by patient and procedure characteristics, as defined by the validated Cardiac Anesthesia Risk Evaluation (CARE) mortality risk score. Methods: We conducted a retrospective cohort study of consecutive adult patients who underwent cardiac surgery requiring cardiopulmonary bypass (CPB) from November 2009–March 2015. Those who underwent off-pump, thoracic aorta, transplant and ventricular assist device procedures were excluded. The primary outcome was in-hospital mortality. Hypotension was categorized by mean arterial pressure (MAP) of <55 and between 55–64 mmHg before, during and after CPB. The relationship between hypotension and death was modeled using multivariable logistic regression in the intermediate and high-risk groups. Results: Among 6627 included patients, 131 (2%) died in-hospital. In-hospital mortality in patients with CARE scores of 1, 2, 3, 4 and 5 was 0 (0%), 7 (0.3%), 35 (1.3%), 41 (4.6%) and 48 (13.6%), respectively. In the intermediate-risk group (CARE = 3–4), MAP < 65 mmHg post-CPB was associated with increased odds of death in a dose-dependent fashion (adjusted OR 1.30, 95% CI 1.13–1.49, per 10 min exposure to MAP < 55 mmHg, p = 0.002; adjusted OR 1.18 [1.07–1.30] per 10 min exposure to MAP 55–64 mmHg, p = 0.001). We did not observe an association between hypotension and mortality in the high-risk group (CARE = 5). Conclusions: Post-CPB hypotension is a potentially modifiable risk factor for mortality in intermediate-risk patients. Our findings provide impetus for clinical trials to determine if hemodynamic goal-directed therapies could improve survival in these patients.

scholarly journals The Impact of COPD in Trends of Urinary Tract Infection Hospitalizations in Spain, 2001–2018: A Population-Based Study Using Administrative Data

2020 ◽  
Vol 9 (12) ◽  
pp. 3979
Author(s):  
Javier de Miguel-Diez ◽  
Romana Albaladejo-Vicente ◽  
Domingo Palacios-Ceña ◽  
David Carabantes-Alarcon ◽  
José Javier Zamorano-Leon ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Protective Factor ◽  
Multivariable Analysis ◽  
Population Based ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Men And Women ◽  
Tract Infections ◽  
The Impact ◽  
Over Time

(1) Background: To examine trends in incidence and outcomes of urinary tract infections (UTIs) among men and women with or without chronic obstructive pulmonary disease (COPD), and to identify the predictors for in-hospital mortality (IHM). (2) Methods: We included patients (aged ≥40 years) who were hospitalized with UTIs between 2001 and 2018. Data were collected from the Spanish National Hospital Discharge Database. (3) Results: We identified 748,458 UTI hospitalizations, 6.53% with COPD. The UTIs incidence increased over time. It was 1.55 times higher among men COPD patients than among non-COPD men (incidence rate ratio (IRR) 1.55; 95% CI 1.53–1.56). The opposite happened in women with COPD compared to non-COPD women (IRR 0.30; 95% CI 0.28–0.32). IHM was higher in men with COPD than non-COPD men (5.58% vs. 4.47%; p < 0.001) and the same happened in women (5.62% vs. 4.92%; p < 0.001). The risk of dying increased with age and comorbidity, but the urinary catheter was a protective factor among men (OR 0.75; 95% CI 0.64–0.89). Multivariable analysis showed a significant reduction in the IHM over time for men and women with COPD. Suffering from COPD only increased the risk of IHM among men (OR 1.07; 95% CI 1.01–1.13). (4) Conclusions: The incidence of UTIs increased over time. Suffering COPD increased the risk of IHM among men, but not among women.

Does increasing time to surgery affect survival in stage I renal cell carcinoma? Analysis of the national cancer database.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 635-635
Author(s):  
Brittney Cotta ◽  
Stephen Ryan ◽  
Ahmed Eldefrawy ◽  
Reith Sarkar ◽  
Aaron Bradshaw ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Multivariable Analysis ◽  
Surgical Care ◽  
National Cancer Database ◽  
Factors Associated ◽  
Time To Surgery ◽  
Kaplan Meier ◽  
Stage 1

635 Background: Optimal timing for surgical treatment of localized renal cell carcinoma (RCC) remains undefined. We sought to determine the survival impact of time to definitive surgical treatment for Stage 1 RCC and elucidate factors associated with a delay in surgical care utilizing the National Cancer Database (NCDB). Methods: The NCDB was queried for Stage 1 RCC cases (cT1N0M0) from 2004-2013 treated with partial or radical nephrectomy. Quartiles were formed from the range of time to surgery of the entire cohort in days: early defined as the first two quartiles and delayed as the fourth. Descriptive analyses were conducted between early and delayed groups. Overall survival (OS) between early and delayed groups was calculated with Kaplan-Meier analysis. Multivariable analysis was performed to determine factors associated with delay in surgical care. Results: 38,859 patients were analyzed. Median time to treatment was 40 days (IQR 22-68). Early (≤40 days, n = 23,712) and delayed ( > 68 days, n = 15,147) groups had a median follow-up of 44.8 and 41 months, respectively (p < 0.001). Delayed surgery was more frequent with African-Americans (14.8% vs. 9.1%, p < 0.001), patients with government or no insurance (53.7% vs. 45.1%, p < 0.001), males (60.7% vs. 58.3%, p = 0.001), and Charlson Comorbidity Index (CCI) ≥2 (9.7% vs. 6.7%, p < 0.001). Kaplan-Meier analysis demonstrated survival benefit to the earlier treatment group, with 5 year OS of 85.5% and 80.9% (p < 0.001; Figure). On multivariable analysis, increasing age (OR = 1.001, p = 0.015), African-American race (OR = 1.5, p < 0.001), increasing distance from treatment center (OR = 1.005, p = 0.001), residence in areas with low high school graduation rates (OR = 1.42, p < 0.001), residence in an area of > 1 million population (OR = 1.6, p < 0.001), and CCI ≥2 (OR = 1.4, p < 0.001) were independently associated with increasing time to surgery. Conclusions: Surgery of T1 RCC carried out beyond 9 weeks after diagnosis is associated with reduced overall survival compared to patients treated within 6 weeks. Time to definitive surgical treatment should be a quality of care metric, with special attention given to populations most at risk for delays in care.

A prospective analysis of hypovitaminosis D and mortality in 400 patients in the neurocritical care setting

2017 ◽  
Vol 127 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Jian Guan ◽  
Michael Karsy ◽  
Andrea A. Brock ◽  
Ilyas M. Eli ◽  
Holly K. Ledyard ◽  
...  
Keyword(s):  
Vitamin D ◽  
Critical Care ◽  
Hospital Mortality ◽  
Vitamin D Deficiency ◽  
Neurocritical Care ◽  
Care Center ◽  
Demographic Data ◽  
Hypovitaminosis D ◽  
Vitamin D Levels ◽  
The Impact

OBJECTIVEHypovitaminosis D is highly prevalent among the general population. Studies have shown an association between hypovitaminosis D and multiple negative outcomes in critical care patients, but there has been no prospective evaluation of vitamin D in the neurological critical care population. The authors examined the impact of vitamin D deficiency on in-hospital mortality and a variety of secondary outcomes.METHODSThe authors prospectively collected 25-hydroxy vitamin D levels of all patients admitted to the neurocritical care unit (NCCU) of a quaternary-care center over a 3-month period. Demographic data, illness acuity, in-hospital mortality, infection, and length of hospitalization were collected. Univariate and multivariable logistic regression were used to examine the effects of vitamin D deficiency.RESULTSFour hundred fifteen patients met the inclusion criteria. In-hospital mortality was slightly worse (9.3% vs 4.5%; p = 0.059) among patients with deficient vitamin D (≤ 20 ng/dl). There was also a higher rate of urinary tract infection in patients with vitamin D deficiency (12.4% vs 4.2%; p = 0.002). For patients admitted to the NCCU on an emergency basis (n = 285), higher Simplified Acute Physiology Score II (OR 13.8, 95% CI 1.7–110.8; p = 0.014), and vitamin D deficiency (OR 3.0, 95% CI 1.0–8.6; p = 0.042) were significantly associated with increased in-hospital mortality after adjusting for other factors.CONCLUSIONSIn the subset of patients admitted to the NCCU on an emergency basis, vitamin D deficiency is significantly associated with higher in-hospital mortality. Larger studies are needed to confirm these findings and to investigate the role of vitamin D supplementation in these patients.

scholarly journals Does routine ultrasound change management in the follow-up of patients with vesicoureteral reflux?

2013 ◽  
Vol 7 (7-8) ◽  
pp. 467 ◽  
Author(s):  
Jan K. Rudzinski ◽  
Bryce Weber ◽  
Petra Wildgoose ◽  
Armando Lorenzo ◽  
Darius Bagli ◽  
...  
Keyword(s):  
Vesicoureteral Reflux ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
Renal Ultrasound ◽  
Dysfunctional Voiding ◽  
Voiding Symptoms ◽  
Previous Diagnosis ◽  
History Of ◽  
The Impact

Introduction: Children with vesicoureteral reflux (VUR) usually need a renal ultrasound (RUS). There is little data on the role of follow-up RUS in VUR. We evaluated the impact of follow-up RUS on the change in clinical management in patients with VUR.Methods: We prospectively analyzed children with a previous diagnosis of VUR seen in the outpatient clinic with a routine follow-up RUS within 4 months. Variables collected included: demographic data, VUR history, dysfunctional voiding symptoms and concurrent ultrasound findings. Change in management was defined as addition of new medication, nurse counselling, surgery or further investigations.Results: The study included 114 consecutive patients. The mean patient age was 4.5 years old, mean age of VUR diagnosis was 1.7 years, with average follow-up of 2.8 years. A change in management with stable RUS occurred in 14 patients, in which the change included ordering a DMSA in 9, nurse counselling for dysfunctional voiding in 3, and booking surgery in 2 patients. Change on RUS was seen in 4 patients. Multivariable analysis showed that history of urinary tract infection (UTI) since the last follow-up visit was more significant than RUS findings.Conclusions: The RUS findings in most patients followed for VUR remain stable or with minimal changes. The variable showing a significant effect on change in management in our study was history of UTI since the last follow-up visit rather than RUS findings. The value of follow-up RUS for children with VUR may need to be revisited.

scholarly journals Effects of dietary style on adult enterovirus infection risk factors: a retrospective analysis

2020 ◽  
Author(s):  
Linghua Yu ◽  
Linlin Wang ◽  
Huixing Yi ◽  
Xiaojun Wu ◽  
Fei Sun
Keyword(s):  
Risk Factors ◽  
Gut Microbiota ◽  
Dietary Patterns ◽  
Dietary Pattern ◽  
Clinical Characteristics ◽  
Protective Factor ◽  
Demographic Data ◽  
Adult Patients ◽  
Phone Calls ◽  
The Impact

Abstract Background: Gut microbiota serves as a defense against enteric pathogens, whereas dietary intake influences the composition and function of gut microbiota. We aimed to examine the impact of diet on the enteroviral infection in adult patients of hand, foot, and mouth disease (HFMD). Methods: A total of 266 adult patients of HFMD were recruited in this study, with 80 healthyvolunteers served as the control. Swab samples and clinical characteristics were collected. Enteroviral genotype was further assessed by PCR testing. Social-demographic data and dietary records were obtained through follow-up phone calls. Dietary patterns were derived with PCA analysis. Correlation between dietary patterns and clinical characteristics, enterovirus genotype, and HFMD risk factors were evaluated. Results:Three distinct dietary patterns were identified in the participants, which were modern, "atypical south", and "traditional north", respectively. This study found the dietary pattern of adult HFMD significantly differed from that of the controls. A vast majority of controls followed the modern pattern, which was a healthy diet. In contrast, the result showed unhealthy dietary patterns ('atypical south' and 'traditional north') were risk factors for adult HFMD. Besides, the dining place was a leading contributor to the dietary pattern. Our data showed eating at a food stall, or take-out is a risk factor of adult HFMD, whereas eating at the dining room is a protective factor. Conclusions:Our study indicated dietary pattern was associated with the incidence of adult HMFD. Improving the dietetic habit might contribute to HFMD prevention.

scholarly journals Development and validation of a predictive model of in-hospital mortality in COVID-19 patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247676
Author(s):  
Diego Velasco-Rodríguez ◽  
Juan-Manuel Alonso-Dominguez ◽  
Rosa Vidal Laso ◽  
Daniel Lainez-González ◽  
Aránzazu García-Raso ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Predictive Model ◽  
Predictive Value ◽  
Demographic Data ◽  
Smoking Habit ◽  
Fatal Outcome ◽  
Multivariable Analysis ◽  
Male Gender ◽  
Correlated Factors ◽  
D Dimer

We retrospectively evaluated 2879 hospitalized COVID-19 patients from four hospitals to evaluate the ability of demographic data, medical history, and on-admission laboratory parameters to predict in-hospital mortality. Association of previously published risk factors (age, gender, arterial hypertension, diabetes mellitus, smoking habit, obesity, renal failure, cardiovascular/ pulmonary diseases, serum ferritin, lymphocyte count, APTT, PT, fibrinogen, D-dimer, and platelet count) with death was tested by a multivariate logistic regression, and a predictive model was created, with further validation in an independent sample. A total of 2070 hospitalized COVID-19 patients were finally included in the multivariable analysis. Age 61–70 years (p<0.001; OR: 7.69; 95%CI: 2.93 to 20.14), age 71–80 years (p<0.001; OR: 14.99; 95%CI: 5.88 to 38.22), age >80 years (p<0.001; OR: 36.78; 95%CI: 14.42 to 93.85), male gender (p<0.001; OR: 1.84; 95%CI: 1.31 to 2.58), D-dimer levels >2 ULN (p = 0.003; OR: 1.79; 95%CI: 1.22 to 2.62), and prolonged PT (p<0.001; OR: 2.18; 95%CI: 1.49 to 3.18) were independently associated with increased in-hospital mortality. A predictive model performed with these parameters showed an AUC of 0.81 in the development cohort (n = 1270) [sensitivity of 95.83%, specificity of 41.46%, negative predictive value of 98.01%, and positive predictive value of 24.85%]. These results were then validated in an independent data sample (n = 800). Our predictive model of in-hospital mortality of COVID-19 patients has been developed, calibrated and validated. The model (MRS-COVID) included age, male gender, and on-admission coagulopathy markers as positively correlated factors with fatal outcome.

Abstract TP334: Clinical Impact of Hematoma Expansion in LVAD Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kara Melmed ◽  
David Roh ◽  
Josh Willey
Keyword(s):  
Hospital Mortality ◽  
Medical Center ◽  
Demographic Data ◽  
Similar Rate ◽  
Left Ventricular ◽  
Hematoma Expansion ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Ich Score ◽  
The Impact

Background: Intracerebral hemorrhage (ICH) in left ventricular assist device (LVAD) patients is a devastating complication. Hematoma expansion (HE) is associated with poor outcomes in ICH patients, but the impact of HE on LVAD patients is not known. Prevention of HE includes rapid and complete coagulopathy reversal, adding further potential complications in LVAD patients given the inherent risk of hardware thrombosis. We aimed to define the occurrence of HE in the LVAD population and to determine the association between HE and mortality in this population. Methods: We performed a retrospective cohort study of ICH patients with preceding LVAD implantation admitted to Columbia University Irving Medical Center between Jan 2008 and April 2019. Intentionally matched ICH controls without LVADs were identified to compare rate of HE in LVAD and non LVAD patients. ICH volume was measured using ABC/2 method.We defined HE as an increase in hematoma volume of 6 ml or 33% comparing the first and last scan in 24 hours. Demographic data was compared using Pearson’s χ2 test for categorical variables and students T test and Wilcoxon rank sum test for normal and non-parametric continuous variables. The association between HE and hospital mortality in LVAD patients was examined using regression modeling after adjusting for Glasgow coma scale, age, hematoma size and location and admission INR. Results: Of605 LVAD patients, we identified 40 patients with ICH. Of these, 28 patients met the inclusion criteria. Mean (SD) age of LVAD patients was 56 (10), 29% of patients were female and the majority (81%) of LVAD patients were supported by Heartmate II. The median (interquartile range [IQR]) baseline hematoma size was 20.1 ml (8.6-46.9), median (IQR) ICH score was 1 (1-2). HE occurred in 16 (57%) patients supported by LVAD, and in 50% of patients without LVAD with no difference (p=0.6).There was an association between HE and in-hospital mortality in LVAD patients after adjusting for admission ICH score and INR (OR of 20.5, 95% CI: 1.8-232.8). Conclusions: HE is a potentially modifiable risk factor for mortality. We demonstrate that LVAD patients experience HE at a similar rate to matched controls. We show that prevention of HE with anticoagulation reversal does not increase mortality.

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