Mortality Rate and Functional Outcomes Among Patients Presenting with Anticoagulation- Associated Intracranial Hemorrhage

Background Oral anticoagulants are the recommended therapy for prophylaxis and treatment of venous thromboembolism and for stroke prevention among patients with non-valvular atrial fibrillation. Given their widespread use, clinicians must balance efficacy and anticoagulation associated bleeding risks. Intracranial hemorrhage (ICH) has been the most feared complication, as this form of bleeding has been associated with the greatest morbidity and mortality. Clinical trials suggest a lower incidence of ICH among patients prescribed the direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs). While reassuring, the clinical impact on functional outcomes once an anticoagulant-associated ICH does occur is needed. The aim of this study was to evaluate the role of anticoagulation use on in-hospital mortality rates, and functional outcomes among survivors presenting with ICH. Methods In this study, we present data from a retrospective chart review of patients who presented to The Ottawa Hospital, Ottawa, Canada with ICH between January 2016 and December 2017. Patients were identified from the Ottawa Hospital Data Warehouse using ICD-10 codes. Patient demographics, type of anticoagulant/antiplatelet agent and indication for therapy were collected. The primary outcome was in-hospital mortality rates among patients prescribed oral anticoagulants compared with those not anticoagulated or on antiplatelet therapy. A secondary outcome was functional assessment of survivors at hospital discharge using the modified Rankin Scale (mRS), a validated tool used widely in contemporary stroke research to measure the degree of disability after a neurological event. Results 1457 patients were identified in the Ottawa Hospital Data and 1331 patients with ICH were confirmed by manual review. 195 patients were on an oral anticoagulant, and the primary indication for anticoagulation was atrial fibrillation (Table 1). Intraparenchymal bleeding was most common among patients on DOACs, while patients on warfarin tended to have more subdural hematomas (Table 2). In-hospital mortality was 37.7% in DOAC-related ICH, 36.4% in warfarin-related ICH and 16.8% in patients not on an antithrombotic therapy. The average modified Rankin Scale (excluding death as a competing factor) at the time of discharge was 3.4 in DOAC-related ICH, 3.6 in warfarin-related ICH and 3.2 in patients not on an anticoagulant or antiplatelet (Table 3). The majority of patients with a DOAC-related ICH were on Apixaban or Rivaroxaban. The in-hospital mortality for patients on Apixaban (N=31) and Rivaroxaban (N=39) was 29.0% and 46.2%, respectively (Table 4). Conclusions In this cohort of patients presenting with ICH to a large academic hospital, the in-hospital mortality rate was higher in patients receiving oral anticoagulation compared to those not on anticoagulants. DOAC-related ICH tended to have similar in-hospital mortality when compared to warfarin; however, among survivors, functional outcomes at discharge tended to be more favourable in the DOAC cohort. Although the DOACs are reported in the literature to have an overall lower incidence of ICH, prospective studies are needed to understand the clinical impact when a bleeding event does occur. Disclosures Castellucci: Servier: Honoraria; Bayer: Honoraria; BMS-Pfizer: Honoraria; LEO Pharma: Honoraria.

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In-Hospital Mortality and Morbidity Among Patients Presenting with Intracranial Hemorrhage: A Single Center's Experience with Vitamin K Antagonists and the Direct Oral Anticoagulants

Blood ◽

10.1182/blood-2019-131769 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3668-3668

Author(s):

Christopher Cipkar ◽

Sujitha Srinathan ◽

Philip Chiang ◽

Lana A Castellucci

Keyword(s):

Hospital Mortality ◽

Chart Review ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Bleeding Event ◽

Mortality Rates ◽

Clinical Impact ◽

Mortality And Morbidity ◽

Ottawa Hospital

Background Oral anticoagulants are the preferred therapy for the treatment of venous thromboembolism and for stroke prevention among patients with atrial fibrillation. Given their widespread use, clinicians must balance efficacy of anticoagulation with their associated bleeding risks. Specifically, intracranial hemorrhage (ICH) is the most feared complication as this form of bleeding has the highest mortality and morbidity. To date, clinical trials suggest a lower incidence of ICH and better safety profile among patients prescribed the direct oral anticoagulants (DOACs) compared with traditional vitamin k antagonists (VKAs). Although promising, further understanding is needed to appreciate the clinical impact once a DOAC-related bleeding event does occur. The aim of this study was to evaluate anticoagulation use, in-hospital mortality rates and functional outcome among patients presenting with ICH to a large tertiary care center in Canada. Methods In this study, we present data from a retrospective chart review of patients who presented to The Ottawa Hospital with ICH between January 2016 and December 2017. Patients were identified using ICD-10 codes from the Ottawa Hospital Data Warehouse. Patient demographics, type of anticoagulant/antiplatelet agent and indication for therapy were collected. The primary outcome was in-hospital mortality rates among patients prescribed oral anticoagulants compared with those not anticoagulated or on antiplatelet therapy. A secondary outcome was functional assessment of survivors at hospital discharge using the modified Rankin Scale (mRS), a validated tool used widely in contemporary stroke research to measure the degree of disability after a neurological event. Results 481 patients were identified in the Data Warehouse and manual chart review confirmed 429 patients diagnosed with ICH. Patients not taking any anticoagulant or antiplatelet therapy tended to be younger and had lengthier admissions with longer stays in the ICU. The most common indication for anticoagulation in those presenting with ICH was atrial fibrillation. Intraparenchymal bleeding was most common among patients on DOACs, while patients on warfarin tended to have more subdural hematomas (Table 1). In-hospital mortality was 45.8% in DOAC-related ICH, 29.4% in warfarin-related ICH and 15.5% in patients not on an anticoagulant or antiplatelet. Average modified Rankin Scale at the time of discharge was 4.52 in DOAC-related ICH, 4.23 in warfarin-related ICH and 3.2 in patients not on an anticoagulant or antiplatelet (Table 2). Conclusions In this cohort of patients presenting with ICH to a large academic hospital, the in-hospital mortality rate was higher in patients receiving oral anticoagulation compared to those not on anticoagulants. DOAC-related ICH tended to have worse outcomes with higher in-hospital mortality and worse functional outcomes among survivors on discharge. Although the DOACs are reported in the literature to have an overall lower incidence of ICH, further information is still needed to understand the clinical impact when a bleeding event does occur. Disclosures Castellucci: BMS: Honoraria; Pfizer: Honoraria; Bayer: Honoraria; LEO Pharma: Honoraria; Sanofi: Honoraria; Aspen: Honoraria; Servier: Honoraria.

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Abstract 13351: Association of Atrial Fibrillation With In-hospital Mortality Among Patients With Takotsubo Cardiomyopathy

Circulation ◽

10.1161/circ.142.suppl_3.13351 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Qiying Dai ◽

Abhishek Bose ◽

Pengyang Li ◽

PENG CAI ◽

Douglas Laidlaw

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Mortality Rate ◽

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Mortality Rates ◽

Primary Diagnosis ◽

Propensity Score Matching Analysis ◽

Significant Difference

Introduction: Takotsubo cardiomyopathy (TC), characterized by transient left ventricular dysfunction, is known to be precipitated by sudden physical or emotional stress. Atrial fibrillation (AF) is a common arrhythmia and its presence increases mortality in patients with chronic underlying diseases. Furthermore, multiple studies have suggested that in TC patients, underlying AF correlates with a higher in-hospital mortality. However, these studies were constrained by either a disproportionate percentage of AF patients or lack of risk factor matching. To systematically explore the association between TC and AF, we decided to perform a propensity score matching analysis. Methods: We performed a retrospective cohort analysis using the ICD-10 codes for a primary diagnosis of TC from the 2016 National Inpatient Sample. To adjust for underlying risk factors a multivariable logistic regression model was employed followed by a propensity score matching analysis for the AF group and the non-AF group. A similar analysis method was followed for the subset of patients with paroxysmal AF. In-hospital mortality rates were compared between the two groups. Results: Out of the total 3139 patients with a primary diagnosis of TC, 433 (13.7%) had AF and 243 (7.7%) had paroxysmal AF. In the unmatched group, patients with AF appeared to be older (74.7 vs. 65.3 years, P<0.001) and more likely to have comorbidities like diabetes mellitus (24.0% vs 19.2%, P=0.024), chronic kidney disease (15.7% vs 7.6%, P<0.001) and obstructive sleep apnea (8.8% vs 4.9%, P=0.002). On multivariable logistic regression, in-hospital mortality was higher in the AF group (3.9% vs 1.3%, P< 0.001). However, after propensity score matching, there was no significant difference in the mortality rate between the two groups (3.7% vs 1.9%, P=0.082). Similarly, on logistic regression followed by propensity matching for patients with paroxysmal AF, no significant difference was noted for in-hospital mortality rates (3.3% vs 1.3%, P=0.112). Conclusions: In patients with TC, the presence of underlying AF had no effect on the in-hospital mortality rate.

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Underdosed Direct Oral Anticoagulants in Atrial Fibrillation Patients Reduce Stroke Severity and Improve Outcome

Cerebrovascular Diseases ◽

10.1159/000520857 ◽

2021 ◽

pp. 1-8

Author(s):

Masaki Naganuma ◽

Yuichiro Inatomi ◽

Toshiro Yonehara ◽

Makoto Nakajima ◽

Mitsuharu Ueda

Keyword(s):

Atrial Fibrillation ◽

Functional Outcomes ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

National Institutes Of Health ◽

Stroke Severity ◽

Anticoagulant Drugs ◽

Scale Scores ◽

Anticoagulant Drug ◽

Ischemic Attack

Background and Purpose: Anticoagulant drugs, including vitamin K antagonist (VKA) and direct oral anticoagulants (DOACs), can reduce stroke severity and are associated with good functional outcomes. Some patients are prescribed lower-than-recommended doses of DOACs; whether these have similar effects has not been clarified. Methods: We retrospectively evaluated 1,139 consecutive ischemic stroke and transient ischemic attack patients with atrial fibrillation. Patients were divided into 5 groups according to their preceding anticoagulant drug therapies: no anticoagulant therapy (ACn), undercontrolling VKA doses (VKAuc), recommended, controlling VKA doses (VKArec), prescribed underdoses of DOAC (DOACud), and recommended doses of DOAC (DOACrec). We investigated the associations between these anticoagulant drug therapies and patients’ initial stroke severity and 3-month outcomes. Results: Median National Institutes of Health Stroke Scale scores at admission were as follows: ACn: 16, VKAuc: 15, VKArec: 9, DOACud: 5, and DOACrec: 7. When the ACn group was used as a reference, regression analysis showed that VKArec (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.01–2.21), DOACud (OR 2.84, 95% CI: 1.47–5.66), and DOACrec (OR 1.83, 95% CI: 1.23–2.74) were associated with milder stroke severity, while VKAuc was not. Median 3-month modified Rankin Scale scores were 2 in the DOACud and DOACrec groups and 4 in all other groups. After adjusting for confounding factors, DOACud (OR 3.14, 95% CI: 1.50–6.57) and DOACrec (OR 1.67, 95% CI: 1.05–2.64) were associated with good 3-month outcomes while VKAuc and VKArec were not. Conclusions: In patients with atrial fibrillation, recommended doses and underdoses of DOACs reduced stroke severity on admission and were associated with good 3-month outcomes.

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Abstract 17132: Atrial Fibrillation Ablation in Heart Failure: Temporal Trends and Outcomes in Hospitalized Patients

Circulation ◽

10.1161/circ.138.suppl_1.17132 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Manyoo Agarwal ◽

Brijesh Patel ◽

Lohit Garg ◽

Mahek Shah ◽

Rami Khouzam ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Mortality Rate ◽

Hospital Mortality ◽

Temporal Trends ◽

Complication Rates ◽

Af Ablation ◽

Southern Us ◽

Comorbidity Burden

Introduction: Recent studies have shown catheter ablation for atrial fibrillation (AF) in patients with heart failure (HF) to have better outcomes over medical therapy. While AF ablation is predominantly an outpatient procedure, some patients may require longer hospitalization. Limited literature exists describing the trends of hospitalizations for HF patients undergoing AF ablation. Methods: Using ICD-9 (diagnosis and procedure codes) in nationwide inpatient sample database 2003 to 2014, we identified all HF adults who were admitted with a principal diagnosis code of AF (427.31) (n= 4,670,400) (AF-HF). Among these, we identified those with a principal procedure code of catheter ablation (37.34) and studied the temporal trends of clinical characteristics and outcomes (in-hospital mortality and complications) for this cohort (Table). Results: The overall number of AF-HF patients undergoing AF ablation was 62,653; with an increase from 1,928 in 2003 to 6,860 in 2014 (p trend<0.001). As shown in Table, over this 12-year period; mean age and proportion of females decreased, while there was an increase in blacks, clinical comorbidity burden, admissions to teaching hospitals and southern US region (all p trend<0.001). The overall procedure related complications (vascular, cardiac, respiratory, neurologic) increased, the in-hospital mortality rate decreased from 1.7% to 0.5% (all p trend<0.001). Conclusions: During 2003-2014, the annual incidence of AF ablation related hospitalizations in HF patients increased significantly. Despite increase in clinical comorbidities burden and procedural complication rates, the mortality rate declined.

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Mid-term survival of patients with chronic kidney disease after extracorporeal membrane oxygenation

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa168 ◽

2020 ◽

Vol 31 (5) ◽

pp. 595-602

Author(s):

Yueh-An Lu ◽

Shao-Wei Chen ◽

Cheng-Chia Lee ◽

Victor Chien-Chia Wu ◽

Pei-Chun Fan ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Mortality Rate ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Subgroup Analysis ◽

Mortality Rates ◽

Term Survival ◽

Membrane Oxygenation ◽

Ecmo Treatment

Abstract OBJECTIVES Chronic kidney disease (CKD) impairs the elimination of fluids, electrolytes and metabolic wastes, which can affect the outcomes of extracorporeal membrane oxygenation (ECMO) treatment. This study aimed to elucidate the impact of CKD on in-hospital mortality and mid-term survival of adult patients who received ECMO treatment. METHODS Patients who received first-time ECMO treatment between 1 January 2003 and 31 December 2013 were included. Those with CKD were identified and matched to patients without CKD using a 1:2 ratio and were followed for 3 years. The study outcomes included in-hospital outcomes and the 3-year mortality rate. A subgroup analysis was conducted by comparing the dialytic patients with the non-dialytic CKD patients. RESULTS The study comprised 1008 CKD patients and 2016 non-CKD patients after propensity score matching. The CKD patients had higher in-hospital mortality rates [69.5% vs 62.2%; adjusted odds ratio 1.41; 95% confidence interval (CI) 1.15–1.72] than the non-CKD patients. The 3-year mortality rate was 80.4% in the CKD group and 68% in the non-CKD group (adjusted hazard ratio 1.17; 95% CI 1.06–1.28). The subgroup analysis showed that the 3-year mortality rates were 84.5% and 78.4% in the dialytic and non-dialytic patients, respectively. No difference in the 3-year mortality rate was noted between the 2 CKD subgroups (P = 0.111). CONCLUSIONS CKD was associated with increased risks of in-hospital and mid-term mortalities in patients who received ECMO treatment. Furthermore, no difference in survival was observed between the patients with end-stage renal disease and non-dialytic CKD patients.

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Impact of ischemic heart disease and atrial fibrillation on survival after spontaneous intracerebral hemorrhage

Journal of Neurosurgery ◽

10.3171/jns/2008/108/6/1172 ◽

2008 ◽

Vol 108 (6) ◽

pp. 1172-1177 ◽

Cited By ~ 16

Author(s):

Sami Tetri ◽

Liisa Mäntymäki ◽

Seppo Juvela ◽

Pertti Saloheimo ◽

Juhani Pyhtinen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Mortality Rate ◽

Intracerebral Hemorrhage ◽

Ischemic Heart Disease ◽

Mortality Rates ◽

Ischemic Heart ◽

University Hospital ◽

Spontaneous Intracerebral Hemorrhage

Object The well-known predictors for increased early deaths after spontaneous intracerebral hemorrhage (ICH) include the clinical and radiological severity of bleeding as well as being on a warfarin regimen at the onset of stroke. Ischemic heart disease and atrial fibrillation may also increase early deaths. In the present study the authors aimed to elucidate the role of the last 2 factors. Methods The authors assessed the 3-month mortality rate in patients with spontaneous ICH (453 individuals) who were admitted to the stroke unit of Oulu University Hospital within a period of 11 years (1993–2004). Results The 3-month mortality rate for the 453 patients was 28%. The corresponding mortality rates were 42% for the patients who had ischemic heart disease and 61% for those with atrial fibrillation on admission. The following independent predictors of death emerged after adjustment for sex and the use of warfarin or aspirin at the onset of ICH: 1) ischemic heart disease (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.12–2.48, p < 0.02); 2) atrial fibrillation on admission (HR 1.79, 95% CI 1.12–2.86, p < 0.02); 3) the Glasgow Coma Scale score on admission (HR 0.82 per unit, 95% CI 0.79–0.87, p < 0.01); 4) size of hematoma (HR 1.11 per 10 ml, 95% CI 1.07–1.16, p < 0.01); 5) intraventricular hemorrhage (HR 2.62, 95% CI 1.71–4.02, p < 0.01); 6) age (HR 1.04 per year, 95% CI 1.02–1.06, p < 0.01); and 7) infratentorial location of the hematoma (HR 1.93, 95% CI 1.26–2.97, p < 0.01). Conclusions Both ischemic heart disease and atrial fibrillation independently and significantly impaired the 3-month survival of patients with ICH.

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Excess Mortality in a Nephrology Clinic during First Months of Coronavirus Disease-19 Pandemic: A Pragmatic Approach

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.5508 ◽

2020 ◽

Vol 8 (T1) ◽

pp. 598-604

Author(s):

Lada Trajceska ◽

Aleksandra Canevska ◽

Nikola Gjorgjievski ◽

Mimoza Milenkova ◽

Adrijana Spasovska-Vasilevska ◽

...

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Death Rate ◽

Excess Mortality ◽

Mortality Rates ◽

Pragmatic Approach ◽

Related Factors ◽

Republic Of Macedonia ◽

Delayed Referral ◽

The University

BACKGROUND: Excess mortality is defined as mortality above what would be expected based on the non-crisis mortality rate in the population of interest. AIM: In this study, we aimed to access weather the coronavirus disease (COVID)-19 pandemic had impact on the in-hospital mortality during the first 6 months of the year and compare it with the data from the previous years. METHODS: A retroprospective study was conducted at the University Clinic of Nephrology Skopje, Republic of Macedonia. In-hospital mortality rates were calculated for the first half of the year (01.01–30.06) from 2015 until 2020, as monthly number of dead patients divided by the number of non-elective hospitalized patents in the same period. The excess mortality rate (p-score) was calculated as ratio or percentage of excess deaths relative to expected average deaths: (Observed mortality rate–expected average death rate)/expected average death rate *100%. RESULTS: The expected (average) overall death mortality rate for the period 2015–2019 was 8.9% and for 2020 was 15.3%. The calculated overall excess mortality in 2020 was 72% (pscore 0.72). CONCLUSION: In this pragmatic study, we have provided clear evidence of high excess mortality at our nephrology clinic during the 1st months of the COVID-19 pandemic. The delayed referral of patients due to the patient and health care system-related factors might partially explain the excess mortality during pandemic crises. Further analysis is needed to estimate unrecognized probable COVID-19 deaths.

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P4777Mortality in patients with non-valvular atrial fibrillation in South America. Warfarin has significant higher global mortality rates versus dabigatran and rivaroxaban

European Heart Journal ◽

10.1093/eurheartj/ehz745.1153 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M J Arocena ◽

G Vanerio

Keyword(s):

Atrial Fibrillation ◽

Regression Model ◽

Cause Of Death ◽

Cox Regression ◽

Oral Anticoagulants ◽

Total Mortality ◽

Mortality Rates ◽

Cox Regression Model ◽

Kaplan Meier ◽

Direct Anticoagulants

Abstract Background Oral anticoagulants are the cornerstone for the management of atrial fibrillation (AF) to reduce cardioembolic stroke Randomized controlled trials of anticoagulants have shown non-inferiority of direct oral anticoagulants (DOACs) compared to warfarin Most DOACs represent an advance in therapeutic safety when compared to warfarin for prevention of thromboembolism in patients with AF. Objectives Determine long term survival, total mortality rates and mortality cause between patients with non-valvular atrial fibrillation (AF) receiving anticoagulants (warfarin, dabigatran and rivaroxaban) Methods Retrospective analysis of consecutive patients with AF receiving anticoagulants in two Hospitals in Montevideo, using electronic registries. Demographics, co-morbidities, CHA2DS2VASc scores and mortality cause were annotated. Follow-up started on Jan 2011 and finished on Dec 2017. Anticoagulation quality was expressed as the standard deviation of INRs (SD-INRs). We performed global mortality and mortality cause analysis on patients with anti-VitK versus direct anticoagulants. Statistical analysis: Survival analysis was performed using Kaplan-Meier (log rank) and Cox regression model. All differences between groups were considered significant if the p value was <0.001. Results We studied 4501 pts., 3627 patients were on warfarin (80.6%), 456 (10.1%) were on dabigatran and 418 (9.3%) on rivaroxaban. Those receiving direct anticoagulants were older, 79±9 vs 77±11 years, (p=0.0001), 51.3% were female, with a significantly higher prevalence of HTN; 93.7% vs 88.8% and a CHA2DS2VASc score ≥2 (96% vs 91%), and a lower prevalence of CHD (5.8% vs 10.4%), CHF (3.7% vs 9.5%) and CKD (2.3% vs 6.3%).Total mortality was 818 (18%); patients receiving warfarin had significantly higher mortality rates, 727 (20.1%) vs 91 (10.4%); 63 and 28 (13.8%, 6.7% dabigatran and rivaroxaban respectively) Kaplan-Meier curves were significantly different (Figure 1) showing higher survival rates for those on DOACs. The SD-INRs were 0.85±0.47 (n=1726 alive) vs 1.05±0.46 (n=548 dead), mean difference 0.2 (99% CI 0.14–0.26). Mortality could be analysed in 759 patients (92,7%). The most important cause of death was cardiovascular disease in 26.5%. We could not find significant differences in the cause of death between groups. Using Cox regression model, variables with significant increased mortality were HTN, CHD, CHF, CKD and history of previous CVA. The only variable with a significant decrease in mortality was the use of dabigatran or rivaroxaban; HR 0.55 (95% CI 0.44–0.69) Figure 1 Conclusions In this large cohort of patients, those receiving warfarin have significantly higher mortality rates. Mortality differences were not related to stroke or major bleeding but could be explained by a higher prevalence of CHD, CHF and CKD in the warfarin group despite a significant lower CHA2DS2VASc score.

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Epidemiology, disease spectrum and economic burden of non-typhoidal Salmonella infections in Taiwan, 2006–2008

Epidemiology and Infection ◽

10.1017/s0950268812000088 ◽

2012 ◽

Vol 140 (12) ◽

pp. 2256-2263 ◽

Cited By ~ 15

Author(s):

P. L. CHEN ◽

C. Y. LI ◽

T. H. HSIEH ◽

C. M. CHANG ◽

H. C. LEE ◽

...

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Economic Burden ◽

Clinical Characteristics ◽

The Elderly ◽

Hospital Data ◽

Disease Spectrum ◽

Salmonella Infections ◽

High Incidence ◽

Taiwan National Health Insurance

SUMMARYThe purpose of this study was to understand the seasonal, geographical and clinical characteristics of Taiwanese patients hospitalized for non-typhoidal Salmonella (NTS) infections and their economic burden. Hospital data obtained from the Taiwan National Health Insurance (NHI) database between 2006 and 2008 were analysed. Infants had the highest annual incidence of 525 cases/100 000 person-years. Elderly patients aged >70 years had the highest in-hospital mortality rate (2·6%). Most (82·6%) gastroenteritis occurred in children aged <10 years. Septicaemia, pneumonia, arthritis and osteomyelitis occurred mainly in patients aged >50 years. A median medical cost for NTS-associated hospitalizations was higher for patients with septicaemia than for those with gastroenteritis. Seasonal variation of NTS-associated hospitalizations was correlated with temperature in different areas of Taiwan. In summary, infants had a high incidence of NTS-associated hospitalizations. However, the elderly had a higher in-hospital mortality rate and more invasive NTS infections than children.

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Abstract 14895: Catheter-Based Treatment for Pulmonary Embolism With Concomitant Use of Intrapulmonary Thrombolysis Improves In-Hospital Mortality Rates

Circulation ◽

10.1161/circ.132.suppl_3.14895 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Rajat Kalra ◽

Navkaranbir S Bajaj ◽

Jason L Guichard ◽

Sameer Ather ◽

William J Lancaster ◽

...

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Mortality Rate ◽

Hospital Mortality ◽

Heart Association ◽

Mortality Rates ◽

All Cause Mortality ◽

Risk Patients ◽

Rapid Clearance ◽

Meta Regression

Introduction: In-hospital mortality rates after catheter-based treatment (CBT) of high-risk pulmonary embolism (PE) are variable. Use of intrapulmonary thrombolytics with other CBT may result in rapid clearance of obstruction, prevent extremis and lead to improved mortality rates. Hypothesis: We hypothesized that the concomitant use of intrapulmonary thrombolysis in conjunction with CBT may affect mortality and explain the heterogeneity among in-hospital mortality rates. Methods: We searched SCOPUS since inception to November 2014 using predefined criteria. Studies reporting in-hospital mortality in patients with massive PE or a combination of massive and submassive PE, as defined by the American Heart Association, were included. In-hospital all-cause mortality rates were estimated in these high-risk patients using standard meta-analytic methods. Heterogeneity in mortality rates was explored with meta-regression. Results: In 54 eligible studies with 1,333 patients, 1357 CBT procedures were performed. All CBT modalities were studied. In-hospital mortality rates varied widely amongst studies (Figure, Panel A). On meta-regression with Logit-in hospital mortality rate as the dependent variable, studies that had a higher proportion of patients who received concomitant intrapulmonary thrombolysis had lower Logit in-hospital mortality rate (β = - 0.01, p <0.001; Figure, Panel B). Conclusions: Concomitant use of intrapulmonary thrombolytics is associated with lower in-hospital mortality rate in patients undergoing CBT for high-risk PE.

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