scholarly journals AKI in Hospitalized Patients with COVID-19

2020 ◽  
Vol 32 (1) ◽  
pp. 151-160 ◽  
Author(s):  
Lili Chan ◽  
Kumardeep Chaudhary ◽  
Aparna Saha ◽  
Kinsuk Chauhan ◽  
Akhil Vaid ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care ◽  
Observational Study ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Kidney Function ◽  
The United States ◽  
Hospitalized Patients ◽  
Health Records

BackgroundEarly reports indicate that AKI is common among patients with coronavirus disease 2019 (COVID-19) and associated with worse outcomes. However, AKI among hospitalized patients with COVID-19 in the United States is not well described.MethodsThis retrospective, observational study involved a review of data from electronic health records of patients aged ≥18 years with laboratory-confirmed COVID-19 admitted to the Mount Sinai Health System from February 27 to May 30, 2020. We describe the frequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aORs) with mortality.ResultsOf 3993 hospitalized patients with COVID-19, AKI occurred in 1835 (46%) patients; 347 (19%) of the patients with AKI required dialysis. The proportions with stages 1, 2, or 3 AKI were 39%, 19%, and 42%, respectively. A total of 976 (24%) patients were admitted to intensive care, and 745 (76%) experienced AKI. Of the 435 patients with AKI and urine studies, 84% had proteinuria, 81% had hematuria, and 60% had leukocyturia. Independent predictors of severe AKI were CKD, men, and higher serum potassium at admission. In-hospital mortality was 50% among patients with AKI versus 8% among those without AKI (aOR, 9.2; 95% confidence interval, 7.5 to 11.3). Of survivors with AKI who were discharged, 35% had not recovered to baseline kidney function by the time of discharge. An additional 28 of 77 (36%) patients who had not recovered kidney function at discharge did so on posthospital follow-up.ConclusionsAKI is common among patients hospitalized with COVID-19 and is associated with high mortality. Of all patients with AKI, only 30% survived with recovery of kidney function by the time of discharge.

scholarly journals Hemorrhage in patients with polycythemia vera receiving aspirin with an anticoagulant: a prospective, observational study

Haematologica ◽  
2021 ◽  
Author(s):  
Jeffrey I. Zwicker ◽  
Dilan Paranagama ◽  
David S. Lessen ◽  
Philomena M. Colucci ◽  
Michael R. Grunwald
Keyword(s):  
United States ◽  
Observational Study ◽  
Confidence Interval ◽  
Polycythemia Vera ◽  
Prospective Observational Study ◽  
The United States ◽  
Increased Risk ◽  
Adjusted Rate ◽  
Risk Of Hemorrhage

Polycythemia vera (PV) is associated with increased risk of thrombosis and hemorrhage. Aspirin, recommended for primary thromboprophylaxis, is often combined with anticoagulants during management of acute thrombotic events. The safety of dual antiplatelet and anticoagulant therapy is not established in PV. In a prospective, observational study, 2510 patients with PV were enrolled at 227 sites in the United States. Patients were monitored for the development of hemorrhage and thrombosis after enrollment. A total of 1602 patients with PV received aspirin with median (range) follow-up of 2.4 (0-3.6) years. The exposure-adjusted rate of all hemorrhages in patients receiving aspirin alone was 1.40 per 100 patient-years (95% confidence interval [CI]: 0.99-1.82). The combination of aspirin plus anticoagulant was associated with an incidence of hemorrhage of 6.75 per 100 patient-years (95% CI: 3.04-10.46). The risk of hemorrhage was significantly greater in patients receiving the combination of aspirin and anticoagulant compared with aspirin alone (total hemorrhages, hazard ratio [HR]: 5.83; 95% CI: 3.36-10.11; P

CHARACTERISTICS OF NONTRAUMATIC SUBARACHNOID HEMORRHAGE IN THE UNITED STATES IN 2003

Neurosurgery ◽  
2007 ◽  
Vol 61 (6) ◽  
pp. 1131-1138 ◽  
Author(s):  
Alisa M. Shea ◽  
Shelby D. Reed ◽  
Lesley H. Curtis ◽  
Michael J. Alexander ◽  
John J. Villani ◽  
...  
Keyword(s):  
United States ◽  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
The United States ◽  
National Database ◽  
Endovascular Coiling ◽  
Hospital Outcomes

Abstract OBJECTIVE Substantial progress has been made in the diagnosis and treatment of subarachnoid hemorrhage (SAH). However, studies of SAH in the United States do not include information more recent than 2001, precluding analysis of shifts in treatment methods. We examined the epidemiology and in-hospital outcomes of nontraumatic SAH in the United States. METHODS We analyzed nationally representative data from the 2003 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project to determine demographic and hospital characteristics, treatments, and in-hospital outcomes of patients with nontraumatic SAH. RESULTS In 2003, there were an estimated 31,476 discharges for nontraumatic SAH among patients aged 17 years or older, or 14.5 discharges per 100,000 adults. The in-hospital mortality rate was 25.3%. Microvascular clipping was performed in 7513 discharges, or 23.9% of inpatients with nontraumatic SAH; endovascular coiling was performed in 2849 discharges (9.1%). Adjusted odds of treatment with either procedure were significantly higher in urban teaching hospitals compared with urban nonteaching hospitals (odds ratio, 1.62; 95% confidence interval, 1.00–2.62) or rural hospitals (odds ratio, 3.08; 95% confidence interval, 1.93–4.91). CONCLUSION The in-hospital mortality rate associated with nontraumatic SAH continues to exceed 25%. Although it is unclear how many patients with nontraumatic SAH were actually diagnosed with a cerebral aneurysm, this study suggests that less than one-third of patients hospitalized for SAH receive surgical or endovascular treatment. Prospective studies are needed to elucidate either what systematic coding error is occurring in the national database or why patients may not receive treatment to secure a ruptured aneurysm.

scholarly journals The Epidemiology of Admissions of Nontraumatic Subarachnoid Hemorrhage in the United States

Neurosurgery ◽  
2013 ◽  
Vol 73 (2) ◽  
pp. 217-223 ◽  
Author(s):  
Fred Rincon ◽  
Robert H. Rossenwasser ◽  
Aaron Dumont
Keyword(s):  
United States ◽  
Subarachnoid Hemorrhage ◽  
Relative Risk ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Incidence Rate ◽  
Hospital Discharge ◽  
The United States ◽  
Term Care ◽  
Incidence And Mortality

Abstract BACKGROUND: Subarachnoid hemorrhage (SAH) is the cause of 5% to 10% of strokes annually in the United States. OBJECTIVE: To study the incidence and mortality trends of admissions of SAH from 1979 to 2008 using a nationally representative sample of all nonfederal acute-care hospitals in the United States: The National Hospital Discharge Survey. METHODS: The sample was obtained from the hospital discharge records according to the International Classification of Disease, 9th Revision, Clinical Modification code 430. RESULTS: We reviewed data on approximately 1 billion hospitalizations in the United States over a 30-year study period and identified 612 500 cases of SAH, which was more common in women (relative risk 1.71, 95% confidence interval 1.7-1.72) and nonwhite persons than white persons (relative risk 1.46, 95% confidence interval 1.4-1.5). The estimated incidence rate of admission after SAH was 7.2 to 9.0 per 100 000/year and did not significantly change over the study period. Overall, in-hospital mortality after SAH fell from 30% during the period from 1979 to 1983 to 20% during the subperiod from 2004 to 2008 (P = .03) and was lower in larger treating hospitals. The average days of care for SAH hospitalizations decreased, but the rate of discharge to long-term care facilities increased. CONCLUSION: The incidence rate of admission after SAH has remained stable over the past 30 years. Total deaths and in-hospital mortality after SAH have decreased significantly. In-hospital mortality after SAH is lower in larger treating hospitals.

scholarly journals Clinical Characteristics of Hospitalized Covid-19 Patients in New York City

2020 ◽  
Author(s):  
Ishan Paranjpe ◽  
Adam J Russak ◽  
Jessica K De Freitas ◽  
Anuradha Lala ◽  
Riccardo Miotto ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care ◽  
Case Series ◽  
The United States ◽  
Hospitalized Patients ◽  
Global Public Health ◽  
C Reactive Protein ◽  
Health Crisis ◽  
Reactive Protein ◽  
D Dimer

ABSTRACTBackgroundThe coronavirus 2019 (Covid-19) pandemic is a global public health crisis, with over 1.6 million cases and 95,000 deaths worldwide. Data are needed regarding the clinical course of hospitalized patients, particularly in the United States.MethodsDemographic, clinical, and outcomes data for patients admitted to five Mount Sinai Health System hospitals with confirmed Covid-19 between February 27 and April 2, 2020 were identified through institutional electronic health records. We conducted a descriptive study of patients who had in-hospital mortality or were discharged alive.ResultsA total of 2,199 patients with Covid-19 were hospitalized during the study period. As of April 2nd, 1,121 (51%) patients remained hospitalized, and 1,078 (49%) completed their hospital course. Of the latter, the overall mortality was 29%, and 36% required intensive care. The median age was 65 years overall and 75 years in those who died. Pre-existing conditions were present in 65% of those who died and 46% of those discharged. In those who died, the admission median lymphocyte percentage was 11.7%, D-dimer was 2.4 ug/ml, C-reactive protein was 162 mg/L, and procalcitonin was 0.44 ng/mL. In those discharged, the admission median lymphocyte percentage was 16.6%, D-dimer was 0.93 ug/ml, C-reactive protein was 79 mg/L, and procalcitonin was 0.09 ng/mL.ConclusionsThis is the largest and most diverse case series of hospitalized patients with Covid-19 in the United States to date. Requirement of intensive care and mortality were high. Patients who died typically had pre-existing conditions and severe perturbations in inflammatory markers.

scholarly journals Medical Abortion Care During a Pandemic

2020 ◽  
Vol 7 (3) ◽  
pp. 291-292
Author(s):  
I. Cori Baill
Keyword(s):  
United States ◽  
Intensive Care ◽  
Medical Abortion ◽  
The United States ◽  
Staff Nurses ◽  
Women Nurses ◽  
Emergency Rooms ◽  
Patient Exposure ◽  
Abortion Care

In keeping with federal policy, our state’s laws do not permit medical abortion via telemedicine, not even during the coronavirus disease 2019 (COVID-19) outbreak, a decision that endangers the lives of women, clinical staff, nurses, and doctors. It also ties dedicated professionals to the clinic instead of being available to emergency rooms, bedsides, and intensive care units, knowing if their clinic doors close vulnerable women may be driven to desperate acts. Instead of 6 feet we could have been 3000 miles apart. Nearly 39% of abortions in the United States are medical abortions. Instructions, medication prescriptions, and routine follow-up can all be safely done remotely. When an examination or ultrasound are necessary, it can be accomplished with minimal staff and patient exposure. Instead, I am caught in a Kafkaesque moment in an already surreal time. Making medical abortion part of telemedicine during the COVID-19 pandemic could save the lives of women, nurses, staff, and doctors. Maybe yours, maybe even mine.

In-hospital mortality among adults with autism spectrum disorder in the United States: A retrospective analysis of US hospital discharge data

Autism ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 177-189 ◽  
Author(s):  
Ilhom Akobirshoev ◽  
Monika Mitra ◽  
Robbie Dembo ◽  
Emily Lauer
Keyword(s):  
United States ◽  
Autism Spectrum Disorders ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
The United States ◽  
Autism Spectrum ◽  
Adults With Autism ◽  
Inpatient Hospital ◽  
Spectrum Disorders

A retrospective data analysis using 2004–2014 Healthcare Cost and Utilization Project Nationwide Inpatient Sample was conducted to examine in-hospital mortality among adults with autism spectrum disorders in the United States compared to individuals in the general population. We modeled logistic regressions to compare inpatient hospital mortality between adults with autism spectrum disorders (n = 34,237) and age-matched and sex-matched controls (n = 102,711) in a 1:3 ratio. Adults with autism spectrum disorders had higher odds for inpatient hospital mortality than controls (odds ratio = 1.44, 95% confidence interval: 1.29–1.61, p < 0.001). This risk remained high even after adjustment for age, sex, race/ethnicity, income, number of comorbidities, epilepsy and psychiatric comorbidities, hospital bed size, hospital region, and hospitalization year (odds ratio = 1.51, 95% confidence interval: 1.33–1.72, p < 0.001). Adults with autism spectrum disorders who experienced in-hospital mortality had a higher risk for having 10 out of 27 observed Elixhauser-based medical comorbidities at the time of death, including psychoses, other neurological disorders, diabetes, hypothyroidism, rheumatoid arthritis collagen vascular disease, obesity, weight loss, fluid and electrolyte disorders, deficiency anemias, and paralysis. The results from the interaction of sex and autism spectrum disorders status suggest that women with autism spectrum disorders have almost two times higher odds for in-hospital mortality (odds ratio = 1.95, p < 0.001) than men with autism spectrum disorders. The results from the stratified analysis also showed that women with autism spectrum disorders had 3.17 times higher odds (95% confidence interval: 2.50–4.01, p < 0.001) of in-hospital mortality compared to women from the non–autism spectrum disorders matched control group; this difference persisted even after adjusting for socioeconomic, clinical, and hospital characteristics (odds ratio = 2.75, 95% confidence interval: 2.09–3.64, p < 0.001). Our findings underscore the need for more research to develop better strategies for healthcare and service delivery to people with autism spectrum disorders.

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