Coagulopathy from Severe Postpartum Hemorrhage.

Abstract OBJECTIVE: The purpose of this study was to estimate the incidence and risk factors associated with coagulopathy from severe postpartum hemorrhage. STUDY DESIGN: After approval by the Institutional Review Board at Duke University Medical Center, records with the ICD-9 code 666.12 for immediate postpartum hemorrhage were reviewed for the 5-year period from January 1, 2000, to December 31, 2004. Severe postpartum hemorrhage was defined as postpartum hemorrhage requiring transfusion. Coagulopathy from postpartum hemorrhage was defined as severe postpartum hemorrhage requiring factor replacement. RESULTS: During this period there were 12,476 deliveries. 108 had severe postpartum hemorrhage. 30/108 became coagulopathic. They received a total of 108 units of fresh frozen plasma (FFP) and 12 units of cryoprecipitate (cryo). 28/30 also received 1 to 20 units of packed red blood cells and 5/30 received 1 to 3 units of platelets. All of the women who received cryo had also received FFP. The trigger for administration of factor replacement was clinical (oozing, continued bleeding) in 13/30 cases and a prolonged partial thromboplastin time (PTT) in 17/30 cases. Peak PTTs ranged from 27 to > 150 seconds. Lowest fibrinogen levels ranged from 27 to 580. In 2 cases, however, no fibrinogen levels were obtained. Hemorrhage was attributed to uterine atony in 11/30 cases, placenta accreta in 6/30, lacerations or incisions in 6/30, HELLP syndrome in 2/30, acute fatty liver of pregnancy in 1/30, amniotic fluid embolism in 1/30, fibroids, in 1/30, hemorrhage into an ovarian fibroma in 1/30, and chronic hepatitis B in 1/30. 22/30 cases were associated with cesarean delivery. In 12/30 cases hysterectomy was performed. Hospital length of stay ranged from 2 to 11 days with a mean of 5.4. 9/30 women spent from 1 to 3 days in the ICU. There were no deaths. 2 women had evidence of organ dysfunction from HELLP syndrome or acute fatty liver of pregnancy, but none developed organ dysfunction as a consequence of severe postpartum hemorrhage. CONCLUSION: 2.4 per 1000 women developed coagulopathy as a result of severe postpartum hemorrhage. They received an average of 4 units of either FFP or cryo. 90% of the units were FFP and 10% were cryo. While 30% of the women required intensive care, all survived with no sequelae.

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Disagreement between emergency department admission diagnosis and hospital discharge diagnosis: mortality and morbidity

Diagnosis ◽

10.1515/dx-2015-0028 ◽

2016 ◽

Vol 3 (1) ◽

pp. 23-30 ◽

Cited By ~ 5

Author(s):

James Eames ◽

Arie Eisenman ◽

Richard J. Schuster

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Medical Center ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Admission Diagnosis ◽

Mortality And Morbidity ◽

Emergency Department Admission ◽

Icu Length Of Stay ◽

Discordant Group

AbstractPrevious studies have shown that changes in diagnoses from admission to discharge are associated with poorer outcomes. The aim of this study was to investigate how diagnostic discordance affects patient outcomes.: The first three digits of ICD-9-CM codes at admission and discharge were compared for concordance. The study involved 6281 patients admitted to the Western Galilee Medical Center, Naharyia, Israel from the emergency department (ED) between 01 November 2012 and 21 January 2013. Concordant and discordant diagnoses were compared in terms of, length of stay, number of transfers, intensive care unit (ICU) admission, readmission, and mortality.: Discordant diagnoses was associated with increases in patient mortality rate (5.1% vs. 1.5%; RR 3.35, 95% CI 2.43, 4.62; p<0.001), the number of ICU admissions (6.7% vs. 2.7%; RR 2.58, 95% CI 2.07, 3.32; p<0.001), hospital length of stay (3.8 vs. 2.5 days; difference 1.3 days, 95% CI 1.2, 1.4; p<0.001), ICU length of stay (5.2 vs. 3.8 days; difference 1.4 days, 95% CI 1.0, 1.9; p<0.001), and 30 days readmission (14.11% vs. 12.38%; RR 1.14, 95% CI 1.00, 1.30; p=0.0418). ED length of stay was also greater for the discordant group (3.0 vs. 2.9 h; difference 8.8 min; 95% CI 0.1, 0.2; p<0.001): These findings indicate discordant admission and discharge diagnoses are associated with increases in morbidity and mortality. Further research should identify modifiable causes of discordance.

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ACUTE FATTY LIVER OF PREGNANCY MASQUERADING AS HELLP SYNDROME

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2018/335 ◽

2018 ◽

Vol 5 (20) ◽

pp. 1592-1595

Author(s):

Santhosh Narayanan ◽

Divya Prakash ◽

Gomathy Subramaniam ◽

Lakshminarayanan Lakshminarayanan

Keyword(s):

Fatty Liver ◽

Hellp Syndrome ◽

Acute Fatty Liver

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Comparison of Maternal and Neonatal Outcomes between Acute Fatty Liver of Pregnancy and Hemolysis, Elevated Liver Enzymes and Low Platelets Syndrome: A Retrospective Cohort Study

10.21203/rs.3.rs-111120/v1 ◽

2020 ◽

Author(s):

Sau Xiong Ang ◽

Chie-Pein Chen ◽

Fang-Ju Sun ◽

Chen-Yu Chen

Keyword(s):

Cohort Study ◽

Fatty Liver ◽

Retrospective Cohort Study ◽

Hellp Syndrome ◽

Retrospective Cohort ◽

Liver Enzymes ◽

Neonatal Outcomes ◽

Elevated Liver Enzymes ◽

Acute Fatty Liver ◽

Maternal And Neonatal Outcomes

Abstract Background: Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome are two uncommon disorders that mimic each other clinically, but are distinct pathophysiologically. This study aimed to compare maternal and neonatal outcomes between AFLP and HELLP syndrome.Methods: This retrospective cohort study was performed at a tertiary referral center in Taiwan between June 2004 and April 2020. We used the Swansea Criteria to diagnose AFLP, and the Tennessee Classification System to diagnose HELLP syndrome. Maternal characteristics, laboratory data, complications, and neonatal outcomes were analyzed.Results: During the study period, 21 women had AFLP and 80 women had HELLP syndrome. There was a higher rate of preeclampsia (95.0% versus 23.8%) in the HELLP syndrome group compared to the AFLP group. However, the AFLP group had more other maternal complications including jaundice (85.7% versus 13.8%), acute kidney injury (61.9% versus 15.0%), disseminated intravascular coagulopathy (66.7% versus 8.8%), and sepsis (47.6% versus 10.0%) compared to the HELLP syndrome group. Nevertheless, higher rates of small for gestational age neonates (57.1% versus 33.3%), neonatal respiratory distress syndrome (39.2% versus 8.3%) and neonatal sepsis (34.2% versus 12.5%) were noted in the HELLP syndrome group.Conclusions: AFLP is associated with a higher rate of multiple organ dysfunction in mothers, whereas HELLP syndrome is associated with a higher rate of neonatal morbidity.

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High incidence of asymptomatic SARS-CoV-2 infection, Chongqing, China

10.1101/2020.03.16.20037259 ◽

2020 ◽

Cited By ~ 4

Author(s):

Yang Tao ◽

Panke Cheng ◽

Wen Chen ◽

Peng Wan ◽

Yaokai Chen ◽

...

Keyword(s):

Asymptomatic Patient ◽

Medical Center ◽

Age Groups ◽

The Elderly ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Asymptomatic Patients ◽

Imported Cases ◽

History Of ◽

Epidemiological Characteristics

SummaryBackgroundSARS-CoV-2 has been a global pandemic, but the emergence of asymptomatic patients has caused difficulties in the prevention of the epidemic. Therefore, it is significant to understand the epidemiological characteristics of asymptomatic patients with SARS-CoV-2 infection.MethodsIn this single-center, retrospective and observational study, we collected data from 167 patients with SARS-CoV-2 infection treated in Chongqing Public Health Medical Center (Chongqing, China) from January to March 2020. The epidemiological characteristics and variable of these patients were collected and analyzed.Findings82.04% of the SARS-CoV-2 infected patients had a travel history in Wuhan or a history of contact with returnees from Wuhan, showing typical characteristics of imported cases, and the proportion of severe Covid-19 patients was 13.2%, of which 59% were imported from Wuhan. For the patients who was returnees from Wuhan, 18.1% was asymptomatic patients. In different infection periods, compared with the proportion after 1/31/2020, the proportion of asymptomatic patient among SARS-CoV-2 infected patient was higher(19% VS 1.5%). In different age groups, the proportion of asymptomatic patient was the highest(28.6%) in children group under 14, next in elder group over 70 (27.3%). Compared with mild and common Covid-19 patients, the mean latency of asymptomatic was longer (11.25 days VS 8.86 days), but the hospital length of stay was shorter (14.3 days VS 16.96 days).ConclusionThe SARS-CoV-2 prevention needs to focus on the screening of asymptomatic patients in the community with a history of contact with the imported population, especially for children and the elderly population.

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Markedly higher sFlt-1/PlGF ratio in a woman with acute fatty liver of pregnancy compared with HELLP syndrome

Journal of Obstetrics and Gynaecology Research ◽

10.1111/jog.13786 ◽

2018 ◽

Vol 45 (1) ◽

pp. 96-103 ◽

Cited By ~ 4

Author(s):

Hirotada Suzuki ◽

Shiho Nagayama ◽

Chikako Hirashima ◽

Kayo Takahashi ◽

Hironori Takahashi ◽

...

Keyword(s):

Fatty Liver ◽

Hellp Syndrome ◽

Acute Fatty Liver ◽

Plgf Ratio

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Abstract 2623: Racial Disparities in Hospital Length of Stay among Native Hawaiians and other Pacific Islanders with Ischemic Stroke

Stroke ◽

10.1161/str.43.suppl_1.a2623 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Kazuma Nakagawa ◽

Matthew Koenig ◽

Todd Seto ◽

Susan Asai ◽

Cherylee Chang

Keyword(s):

Ischemic Stroke ◽

Length Of Stay ◽

Medical Center ◽

Parameter Estimate ◽

Hospital Length ◽

Pacific Islanders ◽

Native Hawaiians ◽

Hospital Length Of Stay ◽

Primary Stroke Center ◽

Stroke Center

Introduction: Native Hawaiians and other Pacific Islanders (NHPI) with ischemic stroke are younger and have more comorbidities compared to other major racial-ethnic groups. However, their impact on hospital length of stay (LOS) after ischemic stroke has not been studied. Hypothesis: We assessed the hypothesis that NHPI race is associated with a longer hospital LOS after ischemic stroke. Methods: Data from 2004 to 2010 were retrospectively obtained from the Get With the Guidelines-Stroke (GWTG-Stroke) database from The Queen’s Medical Center, the only primary stroke center for the state of Hawaii. Multivariable analyses were performed using a stepwise linear regression model to identify factors predictive of hospital LOS after ischemic stroke. Results: A total of 1921 patients hospitalized for ischemic stroke (NHPI 20%, Asians 53%, whites 24%, blacks 0.8%, others 2%) were studied. Univariate analyses showed that NHPI were younger (mean ages, NHPI 60±14 vs. Asians 72±14, p <0.0001; vs. whites 71±14, p <0.0001) and had higher prevalence of diabetes (NHPI 53% vs. Asians 67%, p <0.0001; vs. whites 22%, p <0.0001), hypertension (NHPI 82% vs. whites 22%, p <0.0001), prior stroke or TIA (NHPI 30% vs. Asians 23%, p =0.01), smoking (NHPI 19% vs. Asians 14%, p =0.01), dyslipidemia (NHPI 43% vs. whites 34%, p <0.01), and longer hospital LOS (NHPI 11±17 days vs. Asians 7±9 days, p <0.0001; whites 8±17 days, p <0.05). After adjusting for age, race, gender, and risk factors with predefined significance ( p <0.1), independent predictors for hospital LOS were NHPI race (parameter estimate, 2.67; 95% CI, 1.09 - 4.22, p =0.001), atrial fibrillation/atrial flutter (parameter estimate, 2.22; 95% CI, 0.53 - 3.90, p =0.01), and age (parameter estimate, -0.04; 95% CI, -0.09 - -0.002, p =0.04). Conclusions: Native Hawaiians and other Pacific Islanders with ischemic stroke have a longer hospital length of stay compared to Asians and whites. Further studies are needed to assess if other socioeconomic factors contribute to the observed differences.

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863: Pragmatic laboratory studies to differentiate acute fatty liver of pregnancy and HELLP syndrome on admission

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2018.11.886 ◽

2019 ◽

Vol 220 (1) ◽

pp. S561 ◽

Cited By ~ 1

Author(s):

John J. Byrne ◽

Angela Seasely ◽

Donald McIntire ◽

David B. Nelson ◽

F. Gary Cunningham

Keyword(s):

Fatty Liver ◽

Hellp Syndrome ◽

Laboratory Studies ◽

Acute Fatty Liver

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P3.11.10 HELLP syndrome and acute fatty liver of pregnancy

International Journal of Gynecology & Obstetrics ◽

10.1016/s0020-7292(00)85443-0 ◽

2000 ◽

Vol 70 ◽

pp. C111-C111

Author(s):

P. Vigil-De Garcia

Keyword(s):

Fatty Liver ◽

Hellp Syndrome ◽

Acute Fatty Liver

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Does Travel Distance Affect Readmission Rates after Cardiac Surgery?

The American Surgeon ◽

10.1177/000313481708301032 ◽

2017 ◽

Vol 83 (10) ◽

pp. 1170-1173

Author(s):

Yen-yi Juo ◽

Alexis Woods ◽

Ryan Ou ◽

Gianna Ramos ◽

Richard Shemin ◽

...

Keyword(s):

Medical Center ◽

Surgical Care ◽

Hospital Length ◽

Travel Distance ◽

Hospital Length Of Stay ◽

Readmission Rates ◽

Logistic Regression Models ◽

Caucasian Race ◽

The Impact ◽

The Relationship

With emphasis on value-based health care, empiric models are used to estimate expected read-mission rates for individual institutions. The aim of this study was to determine the relationship between distance traveled to seek surgical care and likelihood of readmission in adult patients undergoing cardiac operations at a single medical center. All adults undergoing major cardiac surgeries from 2008 to 2015 were included. Patients were stratified by travel distance into regional and distant travel groups. Multivariable logistic regression models were developed to assess the impact of distance traveled on odds of readmission. Of the 4232 patients analyzed, 29 per cent were in the regional group and 71 per cent in the distant. Baseline characteristics between the two groups were comparable except mean age (62 vs 61 years, P < 0.01) and Caucasian race (59 vs 73%, P < 0.01). Distant travel was associated with a significantly longer hospital length of stay (11.8 vs 10.5 days, P < 0.01) and lower risk of readmission (9.5 vs 13.4%, P < 0.01). Odds of readmission was inversely associated with logarithm of distance traveled (odds ratio 0.75). Travel distance in patients undergoing major cardiac surgeries was inversely associated with odds of readmission.

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