scholarly journals Risk of Adverse Clinical Outcomes in Hyponatremic Adult Patients Hospitalized for Acute Medical Conditions: A Population-Based Cohort Study

2020 ◽  
Vol 105 (11) ◽  
Author(s):  
Alexander Kutz ◽  
Fahim Ebrahimi ◽  
Soheila Aghlmandi ◽  
Ulrich Wagner ◽  
Miluska Bromley ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Population Based ◽  
Control Group ◽  
Short Term ◽  
Patient Disposition ◽  
Increased Risk ◽  
Medical Inpatients

Abstract Context Hyponatremia has been associated with excess long-term morbidity and mortality. However, effects during hospitalization are poorly studied. Objective The objective of this work is to examine the association of hyponatremia with the risk of in-hospital mortality, 30-day readmission, and other short-term adverse events among medical inpatients. Design and Setting A population-based cohort study was conducted using a Swiss claims database of medical inpatients from January 2012 to December 2017 Patients Hyponatremic patients were 1:1 propensity-score matched with normonatremic medical inpatients. Main Outcome Measure The primary outcome was a composite of all-cause in-hospital mortality and 30-day hospital readmission. Secondary outcomes were intensive care unit (ICU) admission, intubation rate, length-of-hospital stay (LOS), and patient disposition after discharge. Results After matching, 94 352 patients were included in the cohort. Among 47 176 patients with hyponatremia, 8383 (17.8%) reached the primary outcome compared with 7994 (17.0%) in the matched control group (odds ratio [OR] 1.06 [95% CI, 1.02-1.10], P = .001). Hyponatremic patients were more likely to be admitted to the ICU (OR 1.43 [95% CI, 1.37-1.50], P < .001), faced a 56% increase in prolonged LOS (95% CI, 1.52-1.60, P < .001), and were admitted more often to a postacute care facility (OR 1.38 [95% CI 1.34-1.42, P < .001). Of note, patients with the syndrome of inappropriate antidiuresis (SIAD) had lower in-hospital mortality (OR 0.67 [95% CI, 0.56-0.80], P < .001) as compared with matched normonatremic controls. Conclusion In this study, hyponatremia was associated with increased risk of short-term adverse events, primarily driven by higher readmission rates, which was consistent among all outcomes except for decreased in-hospital mortality in SIAD patients.

scholarly journals Associations between concussion and risk of diagnosis of psychological and neurological disorders: a retrospective population-based cohort study

2020 ◽  
Vol 8 (3) ◽  
pp. e000390
Author(s):  
Marc P Morissette ◽  
Heather J Prior ◽  
Robert B Tate ◽  
John Wade ◽  
Jeff R S Leiter
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Geographical Location ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Control Group ◽  
Increased Risk

ObjectiveTo investigate associations between concussion and the risk of follow-up diagnoses of attention-deficit hyperactivity disorder (ADHD), mood and anxiety disorders (MADs), dementia and Parkinson’s disease.DesignA retrospective population-based cohort study.SettingAdministrative health data for the Province of Manitoba between 1990–1991 and 2014–2015.ParticipantsA total of 47 483 individuals were diagnosed with a concussion using International Classification of Diseases (ICD) codes (ICD-9-CM: 850; ICD-10-CA: S06.0). All concussed subjects were matched with healthy controls at a 3:1 ratio based on age, sex and geographical location. Associations between concussion and conditions of interest diagnosed later in life were assessed using a stratified Cox proportional hazards regression model, with adjustments for socioeconomic status and pre-existing medical conditions.Results28 021 men (mean age ±SD, 25±18 years) and 19 462 women (30±21 years) were included in the concussion group, while 81 871 men (25±18 years) and 57 159 women (30±21 years) were included in the matched control group. Concussion was associated with adjusted hazard ratios of 1.39 (95% CI 1.32 to 1.46, p<0.001) for ADHD, 1.72 (95% CI 1.69 to 1.76; p<0.001) for MADs, 1.72 (95% CI 1.61 to 1.84; p<0.001) for dementia and 1.57 (95% CI 1.41 to 1.75; p<0.001) for Parkinson’s disease.ConclusionConcussion was associated with an increased risk of diagnosis for all four conditions of interest later in life.

Excess Mortality Among Hospitalized Patients With Hypopituitarism—A Population-Based, Matched-Cohort Study

2020 ◽  
Vol 105 (11) ◽  
Author(s):  
Fahim Ebrahimi ◽  
Alexander Kutz ◽  
Ulrich Wagner ◽  
Ben Illigens ◽  
Timo Siepmann ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Excess Mortality ◽  
Population Based ◽  
Hospitalized Patients ◽  
Matched Cohort ◽  
Prolonged Length ◽  
Matched Cohort Study ◽  
Increased Risk

Abstract Context Patients with hypopituitarism face excess mortality in the long-term outpatient setting. However, associations of pituitary dysfunction with outcomes in acutely hospitalized patients are lacking. Objective The objective of this work is to assess clinical outcomes of hospitalized patients with hypopituitarism with or without diabetes insipidus (DI). Design, Setting, and Patients In this population-based, matched-cohort study from 2012 to 2017, hospitalized adult patients with a history of hypopituitarism were 1:1 propensity score–matched with a general medical inpatient cohort. Main Outcome Measures The primary outcome was in-hospital mortality. Secondary outcomes included all-cause readmission rates within 30 days and 1 year, intensive care unit (ICU) admission rates, and length of hospital stay. Results After matching, 6764 cases were included in the study. In total, 3382 patients had hypopituitarism and of those 807 (24%) suffered from DI. All-cause in-hospital mortality occurred in 198 (5.9%) of patients with hypopituitarism and in 164 (4.9%) of matched controls (odds ratio [OR] 1.32, [95% CI, 1.06-1.65], P = .013). Increased mortality was primarily observed in patients with DI (OR 3.69 [95% CI, 2.44-5.58], P &lt; .001). Patients with hypopituitarism had higher ICU admissions (OR 1.50 [95% CI, 1.30-1.74], P &lt; .001), and faced a 2.4-day prolonged length of hospitalization (95% CI, 1.94–2.95, P &lt; .001) compared to matched controls. Risk of 30-day (OR 1.31 [95% CI, 1.13-1.51], P &lt; .001) and 1-year readmission (OR 1.29 [95% CI, 1.17-1.42], P &lt; .001) was higher among patients with hypopituitarism as compared with medical controls. Conclusions Patients with hypopituitarism are highly vulnerable once hospitalized for acute medical conditions with increased risk of mortality and adverse clinical outcomes. This was most pronounced among those with DI.

scholarly journals Risk of New Primary Cancer in Patients with Posterior Uveal Melanoma: A National Cohort Study

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 284
Author(s):  
Mette Bagger ◽  
Vanna Albieri ◽  
Tine Gadegaard Hindso ◽  
Karin Wadt ◽  
Steffen Heegaard ◽  
...  
Keyword(s):  
Cohort Study ◽  
Uveal Melanoma ◽  
Population Based ◽  
Control Group ◽  
Cancer Type ◽  
Primary Cancer ◽  
Increased Risk ◽  
Specific Cancer ◽  
National Cohort ◽  
Cancer Types

Background: Studies on the risk of new primary cancer in patients with posterior uveal melanoma (UM) have produced conflicting results, and the role of socioeconomic status (SES) is unknown. The purpose of this population-based matched cohort study was to determine the risk of new primary cancer following the diagnosis of posterior UM. Methods: 2179 patients with posterior UM 1968–2016 and 22,717 matched controls without cancer were included. Incidence and time-dependent hazard ratio (HR) of new primary cancer were described, and the effect of SES was emphasized in a sub-cohort. Results: The incidence of new primary cancer was increased in patients with posterior UM, rate ratio (RR) 1.21 (95% CI: 1.08; 1.35), but the specific cancer types did not differ compared to the controls. The rate of new primary cancer following the diagnosis of posterior UM was significantly increased 2–5 years (HR 1.49 (95% CI: 1.23; 1.80)) and 11–15 years (HR: 1.49 (95% CI: 1.12; 1.99)), and adjusting for SES did not change the rate (HR 1.35 (95% CI:1.20; 1.55)). Conclusions: Patients with posterior UM have an increased risk of new primary cancer independent of SES. No difference in incidence of specific cancer type was observed compared to the control group.

Risk of Stroke with Antivenom Usage after Venomous Snakebite in Taiwan: A Population-Based Cohort Study

QJM ◽  
2021 ◽  
Author(s):  
Wei-Hsin Hung ◽  
Jie Sung ◽  
Wen-Yee Chen ◽  
Lu-Ting Chiu ◽  
Hei-Tung Yip ◽  
...  
Keyword(s):  
Cohort Study ◽  
Acute Stroke ◽  
Hemorrhagic Stroke ◽  
Risk Model ◽  
Rare Complication ◽  
Underlying Mechanism ◽  
Population Based ◽  
Control Group ◽  
Research Database ◽  
Increased Risk

Abstract Background and Purpose Stroke is a rare complication of snakebites, but may lead to serious sequelae. We aimed to explore the relationship between venomous snakebite and the risk for acute stroke, in a nationwide population-based cohort study. Methods This retrospective cohort study used claims data between January 1, 2000 and December 31, 2012, from the Taiwan National Health Insurance Research Database. The study included data of patients aged 18 years or older with venomous snakebite (N = 535), matched for propensity score with controls without venomous snakebite (N = 2140). The follow-up period was the duration from the initial diagnosis of venomous snakebite and administration of antivenom to the date of an acute stroke, or until December 31, 2013. The competing risk model was used to estimate the hazard ratio (HR) and 95% confidence intervals (CIs) of stroke, ischemic stroke, and hemorrhagic stroke, after adjusting for demographic and other possible stroke risk factors. Result The adjusted HR for the venomous snakebite group compared with the control group was 2.72 for hemorrhagic stroke (95% CI: 1.41, 5.26). Stratified analysis showed that the older age group (&gt;65 years old) had a higher risk of hemorrhagic stroke. A 2.68-fold significant increase in the risk for hemorrhagic stroke was observed following venomous snakebite with antivenom usage (95% CI = 1.46, 26.63). Conclusion Venomous snakebite is associated with an increased risk of hemorrhagic stroke after the use of an antivenom. Further study of the underlying mechanism is warranted.

scholarly journals Risk of adverse events associated with upper and lower endoscopic ultrasound: a population-based cohort study

2021 ◽  
Vol 09 (09) ◽  
pp. E1427-E1434
Author(s):  
Roshan Razik ◽  
Paul D. James ◽  
Rishad Khan ◽  
Courtney Maxwell ◽  
Yibing Ruan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Hospital Admissions ◽  
Multivariable Analysis ◽  
Needle Aspiration ◽  
Population Based ◽  
Emergency Department Visits ◽  
Therapeutic Interventions ◽  
Increased Risk

Abstract Background and study aim Endoscopic ultrasound (EUS) enables diagnostic evaluation and therapeutic interventions but is associated with adverse events. We conducted a population-based cohort study to determine the risk of adverse events for upper and lower EUS with and without fine-needle aspiration (FNA). Patients and methods All adults who underwent EUS and resided in Calgary in 2007–2013 were included. Endoscopy and provincial databases were used to identify EUS procedures, unplanned emergency department visits, and hospital admissions within 30 days of the procedures, which were then characterized through formal chart review. Adverse events were defined a priori and classified as definitely, possibly, or not related to EUS. The primary outcome was 30-day risk of adverse events classified as definitely or possibly related to EUS. Univariable and multivariable analyses were conducted with risk factors known to be associated with EUS adverse events. Results 2895 patients underwent 3552 EUS procedures: 3034 (85 %) upper EUS, of which 710 (23 %) included FNA, and 518 (15 %) lower EUS, of which 23 (4 %) involved FNA. Overall, 69 procedures (2 %) involved an adverse event that was either definitely or possibly related to EUS, with 33 (1 %) requiring hospitalization. None of the adverse events required intensive care or resulted in death. On multivariable analysis, only FNA was associated with increased risk of adverse events (odds ratio 6.43, 95 % confidence interval 3.92–10.55; P < 0.001). Conclusion Upper and lower EUS were generally safe but FNA substantially increased the risk of adverse events. EUS-related complications requiring hospitalization were rare.

scholarly journals Association between de Quervain syndrome and herpes zoster: a population-based cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e046891
Author(s):  
Chao-Yu Hsu ◽  
Der-Shin Ke ◽  
Cheng-Li Lin ◽  
Chia-Hung Kao
Keyword(s):  
Cohort Study ◽  
Health Insurance ◽  
Herpes Zoster ◽  
National Health Insurance ◽  
National Health ◽  
Population Based ◽  
Control Group ◽  
Research Database ◽  
Increased Risk ◽  
De Quervain

ObjectiveBoth physical diseases such as infection and chronic pain and psychological disorders such as depression have been associated with herpes zoster (HZ) reactivation. However, the relationship between de Quervain syndrome (DQS), a painful tenosynovitis and HZ remains unclear. We investigated whether DQS increases the risk of HZ reactivation.DesignA retrospective population-based cohort study.SettingTaiwan.ParticipantsWe used a subset of Taiwan’s National Health Insurance Research Database, the Longitudinal Health Insurance Database which contains the registration files and original claims data of 1 million randomly selected individuals from the National Health Insurance programme. The case group in this study comprised patients newly diagnosed with DQS between 2000 and 2012. Individuals without DQS comprised the control group. Cases and controls were 1:1 matched by age, sex and index year (defined as the year of DQS diagnosis).ResultsApproximately 55% of the participants were ≤49 years. Most participants were women (77%). The incidence rate of HZ in the DQS group was 8.39 per 1000 person years. After adjustments for age, sex and comorbidities, patients with DQS had a 1.30 times higher risk of HZ reactivation than the control group. Stratification analysis revealed taht DQS increases the HZ risk in individuals ≤64 years, women, and patients without comorbidities.ConclusionDQS is associated with an increased risk of HZ. Clinicians should be aware of this risk when dealing with patients with DQS, particularly in young adults.

scholarly journals Increased risk of bisphosphonate-related osteonecrosis of the jaw in patients with Sjögren’s syndrome: nationwide population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024655 ◽  
Author(s):  
Min-Tser Liao ◽  
Wu-Chien Chien ◽  
Jen-Chun Wang ◽  
Chi-Hsiang Chung ◽  
Shi-Jye Chu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Tooth Extraction ◽  
Cox Regression ◽  
Sjogren’S Syndrome ◽  
Population Based ◽  
Osteonecrosis Of The Jaw ◽  
Sjogren's Syndrome ◽  
Control Group ◽  
Increased Risk

ObjectiveThe aim of this study was to explore whether patients with Sjögren’s syndrome (SS) were susceptible to bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) after tooth extraction in the entire population of Taiwan.DesignA nationwide population-based retrospective cohort study.SettingData were extracted from Taiwan’s National Health Insurance Research Database (NHIRD).MethodologyMedical conditions for both the study and control group were categorised using the International Classification of Diseases, 9th Revision. ORs and 95% CIs for associations between SS and osteonecrosis of the jaw (ONJ) were estimated using Cox regression.ResultsOverall, 13 398 patients diagnosed with SS were identified from the NHIRD. An additional 53 592 matched patients formed the control group. At the 3-year follow-up, patients with SS started to exhibit a significantly increased cumulative risk of developing BRONJ compared with that of patients without SS (log rank test <0.001). At the end of the follow-up period, patients with SS exhibited a significantly increased incidence of ONJ compared with that of the controls (0.08%vs0.03%, p=0.017). The Cox regression model showed that patients with SS also exhibited a significantly increased risk of developing BRONJ compared with that of the patients without SS (adjusted HR=7.869, 95% CI 3.235 to 19.141, p<0.001).ConclusionPatients with SS exhibit an increased risk of developing BRONJ after tooth extraction. BPs should be used with caution in patients with SS.

scholarly journals ASSOCIATION OF HYPERGLYCEMIA WITH HOSPITAL MORTALITY IN NONDIABETIC COVID-19 PATIENTS: A COHORT STUDY

2020 ◽  
Author(s):  
Manju Mamtani ◽  
Ambarish M. Athavale ◽  
Mohan Abraham ◽  
Jane Vernik ◽  
Amatur R Amarah ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Reference Group ◽  
Prior History ◽  
Increased Risk ◽  
History Of ◽  
Observational Cohort ◽  
Design And Methods

ABSTRACTObjectiveDiabetes is a known risk factor for mortality in Coronavirus disease 2019 (COVID-19) patients. Our objective was to identify prevalence of hyperglycemia in COVID-19 patients with and without prior diabetes and quantify its association with COVID-19 disease course.Research Design and MethodsThis observational cohort study included all consecutive COVID-19 patients admitted to John H Stroger Jr. Hospital, Chicago, IL from March 15, 2020 to May 15, 2020. The primary outcome was hospital mortality and the studied predictor was hyperglycemia (any blood glucose ≥7.78 mmol/L during hospitalization).ResultsOf 403 COVID-19 patients studied, 51 (12.7%) died. Hyperglycemia occurred in 228 (57%) patients; 83 of these hyperglycemic patients (36%) had no prior history of diabetes. Compared to the reference group no-diabetes/no-hyperglycemia patients the no-diabetes/hyperglycemia patients showed higher mortality [1.8% versus 20.5%, adjusted odds ratio 21.94 (95% confidence interval 4.04-119.0), p < 0.001]; improved prediction of death (p=0.0162) and faster progression to death (p=0.0051). Hyperglycemia within the first 24 and 48 hours was also significantly associated with mortality (odds ratio 2.15 and 3.31, respectively). Further, compared to the same reference group, the no-diabetes/hyperglycemia patients had higher likelihood of ICU admission (p<0.001), acute respiratory distress syndrome (p<0.001), mechanical ventilation (p<0.001), and a longer hospital stay in survivors (p<0.001).ConclusionsHyperglycemia without prior diabetes was common (21% of hospitalized COVID-19 patients) and was associated with an increased risk of and faster progression to death. Development of hyperglycemia in COVID-19 patients who do not have diabetes is an early indicator of progressive disease.

scholarly journals The association between psoriatic arthritis and venous thromboembolism: a population-based cohort study

2022 ◽  
Vol 24 (1) ◽  
Author(s):  
Tal Gazitt ◽  
Jacob Pesachov ◽  
Idit Lavi ◽  
Muna Elias ◽  
Amir Haddad ◽  
...  
Keyword(s):  
Cohort Study ◽  
Psoriatic Arthritis ◽  
Large Population ◽  
Multivariable Analysis ◽  
Previous History ◽  
Population Based ◽  
Janus Kinase ◽  
Control Group ◽  
Increased Risk ◽  
History Of

Abstract Background Although the risk of cardiovascular disease has been discussed extensively in both psoriasis (PsO) and psoriatic arthritis (PsA), very few studies have addressed the occurrence of venous thromboembolic (VTE) events among PsO patients, and even fewer in PsA. Thus, our goal was to assess the association between PsA and VTE events using a large population-based database. Methods This retrospective cohort study includes all 5,275 patients with newly diagnosed PsA from the largest health care provider in Israel between January 2003 and December 2018. Identified PsA patients were matched by age, sex, ethnicity, and index date with 21,011 controls without PsA from the same database. Both groups were followed through June 30, 2019 for the occurrence of VTE event. Cox proportional hazard regression models were used to assess the association between PsA and VTE. Results PsA cohort consisted of 53.2% females with mean age of 51.7±15.4 Sixty-two patients (1.2%) were diagnosed with VTE in the PsA group and 176 patients (0.8%) in the control group (p=0.023, HR=1.40, 95% CI 1.05-1.87). However, there was no increased risk of VTE among PsA patients on multivariable analysis (p=0.16, HR=1.27, 95% CI 0.91-1.80). Within the PsA group, patients with VTE were more often of older age and with history of VTE. Conclusions This study suggests that the increased risk of VTE in PsA patients appears to be related to the underlying comorbidities and not independently associated with PsA. Age and previous history of VTE were the only risk factors associated with increased risk of VTE in patients with PsA. Addressing VTE risk is recommended especially in the era of Janus kinase inhibitors.

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