scholarly journals Comparison of survivors and nonsurvivors of diffuse alveolar hemorrhage: risk factors for in-hospital death

2021 ◽  
Vol 9 (12) ◽  
pp. 3541
Author(s):  
Swathi Sangli ◽  
Misbah Baqir ◽  
Jay Ryu
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Distress Syndrome ◽  
Multivariate Analyses ◽  
Clinical Course ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Hospital Death ◽  
Steroid Use ◽  
Hemorrhage Risk

Background: The objective of this study was to identify the predictors of in-hospital mortality among patients with diffuse alveolar hemorrhage (DAH).Methods: We conducted a retrospective review of 89 patients hospitalized for DAH at our institution. 49 patients who died during hospitalization and 40 patients who survived were compared. We reviewed their clinical course, radiologic and pathologic findings, along with medical management. We then performed univariate and multivariate analyses to identify the risk factors associated with in-hospital mortality.Results: We identified 12 factors to be associated with mortality when comparing survivor versus non-survivor cohorts: smoking (67 versus 42%, p=0.02), malignancy (17 versus 49%, p=0.002), interstitial lung disease (0 versus 14%, p=0.01), liver failure (2 versus 28%, p=0.001), autoimmune diseases (40 versus 8%, p=0.0006), thrombocytopenia (7 versus 71%, p<0.0001), ICU admission (57 versus 85%, p=0.004), mean ICU stay (p=0.4), steroid use (90 versus 63%, p=0.003), plasma exchange (15 versus 0 %, p=0.005), mechanical ventilation (37 versus 75%, p=0.0007) and acute respiratory distress syndrome (22 versus 77%, p<0.0001). On multivariate analysis, thrombocytopenia (p<0.0001) and ARDS (p=0.0013) were associated with higher odds of mortality in DAH while steroid use (p=0.0004) was associated with a lower risk of in-hospital mortality in patients with DAH.Conclusions: In DAH, thrombocytopenia and ARDS were predictors of in-hospital mortality whereas the use of steroid was associated with a more favorable prognosis. 

scholarly journals Comparison of Survivors and Nonsurvivors of Diffuse Alveolar Hemorrhage: Risk Factors for In-hospital Death

2021 ◽  
Author(s):  
Swathi Sangli ◽  
Misbah Baqir ◽  
Jay Ryu
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Distress Syndrome ◽  
Signs And Symptoms ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Hospital Death ◽  
P Value ◽  
Steroid Use ◽  
Hemorrhage Risk

Abstract ObjectiveThe objective of this study was to identify the predictors of in-hospital mortality among patients with diffuse alveolar hemorrhage (DAH).Patients and MethodsWe conducted a retrospective review of 89 patients hospitalized for DAH at our institution between 2001 and 2017: 49 patients who died during hospitalization and 40 patients who survived were compared. We reviewed their presenting signs and symptoms, clinical course, radiologic and pathologic findings, along with medical management. We then performed univariate and multivariate analyses to identify the risk factors associated with in-hospital mortality.ResultsWe identified 12 factors to be associated with mortality when comparing survivor vs non-survivor cohorts: smoking (27 [67%] vs 21 [42%], p = 0.02), malignancy (7 [17%] vs 24 [49%], p = 0.002), interstitial lung disease (0 vs 7 [14%], p = 0.01), liver failure (1 [2%] vs 14 [28%], p = 0.001), autoimmune diseases (16 [40%] vs 4 [8%], p =0.0006), thrombocytopenia (3 [7%] vs 35 [71%], p <0.0001), ICU admission (23 [57%] vs 40 [85%], p=0.004), mean duration of ICU stay (3.5 days [± 6.7] vs 5.5 days [± 5.5], p = 0.4), steroid use (36 [90%] vs 31 [63%], p = 0.003), use of plasma exchange (6 [15%] vs 0, p = 0.005), use of mechanical ventilation (15 [37%] vs 36 [75%], p value = 0.0007) and development of acute respiratory distress syndrome (ARDS) (9 [22%] vs 37 [77%], p <0.0001), respectively. On multivariate analysis, thrombocytopenia (OR 52.08: 95% CI, 8.59-315.71; p <0.0001) and ARDS (OR 11.71: 95% CI, 2.60-52.67; p = 0.0013) were associated with higher odds of mortality in DAH while steroid use (OR 0.05: 95% CI, 0.007-0.39; p = 0.0004) was associated with a lower risk of in-hospital mortality in patients with DAH.ConclusionIn DAH, thrombocytopenia and ARDS were predictors of in-hospital mortality whereas the use of steroid was associated with a more favorable prognosis.

scholarly journals High neutrophils and low lymphocytes percentages in bronchoalveolar lavage fluid are prognostic factors of higher in-hospital mortality in diffuse alveolar hemorrhage

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kensuke Kanaoka ◽  
Seigo Minami ◽  
Shoichi Ihara ◽  
Kiyoshi Komuta
Keyword(s):  
Prognostic Factors ◽  
Hospital Mortality ◽  
Bronchoalveolar Lavage ◽  
Poor Prognosis ◽  
Lavage Fluid ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Hospital Death ◽  
Logistic Regressions ◽  
Balf Cell

Abstract Background Diffuse alveolar hemorrhage (DAH) is a syndrome resulting from bleeding in the microcirculation of the lung, with a poor prognosis. The study aim was to identify prognostic factors of DAH, especially bronchoalveolar lavage fluids (BALF) cell pattern. Methods We conducted a single-center retrospective cohort study of patients diagnosed as having DAH and hospitalized at our hospital between October 2008 and July 2020. We performed univariate logistic regressions to identify variables associated with in-hospital death. Results Sixty-eight patients were included in our analysis. In-hospital mortality was 26.5%. Variables associated with in-hospital death were neutrophils percentage in BALF ≥ 44.5% [Odds Ratio (OR) 16.0, 95% confidence interval (CI) 4.33–58.9)], lymphocytes percentage in BALF < 14% (OR 7.44, 95% CI 2.11–26.2), idiopathic DAH (OR 0.31, 95% CI 0.10–0.95), oxygen flow ≥ 4L/min (OR 3.90, 95% CI 1.20–12.6), and estimated glomerular filtration rate < 60 mL/min (OR 5.00, 95%CI 1.29–19.4). Conclusions High neutrophils and low lymphocytes percentages in BALF were associated with poor prognosis.

scholarly journals Hospital mortality in hematogenous vertebral osteomyelitis

2021 ◽  
Vol 18 (3) ◽  
pp. 86-93
Author(s):  
A. Yu. Bazarov ◽  
K. S. Sergeyev ◽  
A. O. Faryon ◽  
R. V. Paskov ◽  
I. A. Lebedev
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Hospital Mortality ◽  
Medical Records ◽  
Vertebral Osteomyelitis ◽  
Hospital Death ◽  
Factors Affecting ◽  
Comorbidity Index ◽  
Probability Of Death ◽  
Type C

Objective. To analyze lethal outcomes in patients with hematogenous vertebral osteomyelitis.Material and Methods. Study design: retrospective analysis of medical records. A total of 209 medical records of inpatients who underwent treatment for hematogenous vertebral osteomyelitis in 2006–2017 were analyzed. Out of them 68 patients (32.5 %) were treated conservatively, and 141 (67.5 %) – surgically. The risk factors for lethal outcomes were studied for various methods of treatment, and a statistical analysis was performed.Results. Hospital mortality (n = 9) was 4.3 %. In patients who died in hospital, average time for diagnosis making was 4 times less (p = 0.092). The main factors affecting mortality were diabetes mellitus (p = 0.033), type C lesion according to the Pola classification (p = 0.014) and age over 70 years (p = 0.006). To assess the relationship between hospital mortality and the revealed differences between the groups, a regression analysis was performed, which showed that factors associated with mortality were Pola type C.4 lesions (OR 9.73; 95 % CI 1.75–54.20), diabetes mellitus (OR 5.86; 95 % CI 1.14–30.15) and age over 70 years (OR 12.58; 95 % CI 2.50–63.34). The combination of these factors increased the likelihood of hospital mortality (p = 0.001). Sensitivity (77.8 %) and specificity (84.2 %) were calculated using the ROC curve. In the group with mortality, the comorbidity index (CCI) was significantly higher (≥4) than in the group without mortality (p = 0.002). With a CCI of 4 or more, the probability of hospital death increases significantly (OR 10.23; 95 % CI 2.06–50.82), p = 0.005. Long-term mortality was 4.3 % (n = 9), in 77.8 % of cases the cause was acute cardiovascular pathology, and no recurrence of vertebral osteomyelitis was detected.Conclusion. Hospital mortality was 4.3 %, and there was no mortality among patients treated conservatively. The main risk factors were diabetes mellitus, type C lesion according to Pola and age over 70 years. There was a significant mutual burdening of these factors (p = 0.001). With CCI ≥4, the probability of death is higher (p = 0.005).

Long term veno-venous extracorporeal life support without intravenous anticoagulation for diffuse alveolar hemorrhage

Perfusion ◽  
2019 ◽  
Vol 34 (6) ◽  
pp. 523-525 ◽  
Author(s):  
Samuel M Galvagno ◽  
Nirav G Shah ◽  
Christopher R Cornachione ◽  
Kristopher B Deatrick ◽  
Michael A Mazzeffi ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Systemic Anticoagulation

Introduction: Diffuse alveolar damage is the histologic hallmark for the acute phase of acute respiratory distress syndrome and can occasionally present as diffuse alveolar hemorrhage. Case report: We report a patient with diffuse alveolar hemorrhage and acute respiratory distress syndrome requiring veno-venous extracorporeal life support for 210 days, who was successfully treated for a period of 130 consecutive days without intravenous anticoagulation. Discussion: Although there are a few brief reports detailing long extracorporeal life support runs, the literature is largely devoid of data regarding long-term extracorporeal life support without full systemic anticoagulation. Regular inspection of the extracorporeal membrane oxygenation circuit is critical because externally visible thrombi may predict internal thrombus generation with the potential for systemic embolization or abrupt oxygenator failure. In our case, multiple circuit and oxygenators changes were required. Conclusion: We have demonstrated that a patient with a contraindication for systemic anticoagulation can safely have veno-venous extracorporeal life support for prolonged periods without catastrophic thrombotic complications.

scholarly journals Dynamics in Anemia Development and Dysregulation of Iron Homeostasis in Hospitalized Patients with COVID-19

Metabolites ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 653
Author(s):  
Lukas Lanser ◽  
Francesco Robert Burkert ◽  
Rosa Bellmann-Weiler ◽  
Andrea Schroll ◽  
Sophie Wildner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Iron Homeostasis ◽  
Clinical Course ◽  
Severe Disease ◽  
University Hospital ◽  
Hospital Death ◽  
Icu Admission ◽  
Increased Risk ◽  
Discharge From Hospital ◽  
New Onset

Anemia and disturbances of iron metabolism are frequently encountered in patients with COVID-19 and associated with an adverse clinical course. We retrospectively analyzed 645 consecutive COVID-19 patients hospitalized at the Innsbruck University Hospital. Pre-existing anemia was associated with increased risk for in-hospital death. We further found that the decline in hemoglobin levels during hospital stay is more pronounced in patients with signs of hyperinflammation upon admission, the latter being associated with a nearly two-fold higher risk for new onset anemia within one week. Anemia prevalence increased from 44.3% upon admission to 87.8% in patients who were still hospitalized after two weeks. A more distinct decrease in hemoglobin levels was observed in subjects with severe disease, and new-onset anemia was associated with a higher risk for ICU admission. Transferrin levels decreased within the first week of hospitalization in all patients, however, a continuous decline was observed in subjects who died. Hemoglobin, ferritin, and transferrin levels normalized in a median of 122 days after discharge from hospital. This study uncovers pre-existing anemia as well as low transferrin concentrations as risk factors for mortality in hospitalized COVID-19 patients, whereas new-onset anemia during hospitalization is a risk factor for ICU admission. Anemia and iron disturbances are mainly driven by COVID-19 associated inflammation, and cure from infection results in resolution of anemia and normalization of dysregulated iron homeostasis.

scholarly journals Systemic Anticoagulation is Associated With Decreased Mortality in COVID-19 Patients: A Propensity Score-Matched Cohort Study

2021 ◽  
Author(s):  
Yi Bian ◽  
Yue Le ◽  
Ping Zhang ◽  
Zhigang He ◽  
Ye Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Major Bleeding ◽  
Distress Syndrome ◽  
Hospital Death ◽  
Lower Probability ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Systemic Anticoagulation

Abstract Background: Accumulating evidence has revealed that coagulopathy and widespread thrombosis in the lung are common in patients with Coronavirus Disease 2019 (COVID-19). This raises questions about the efficacy and safety of systemic anticoagulation (AC) in COVID-19 patients. Method: This single-center, retrospective, cohort study unselectively reviewed 2272 patients with COVID-19 admitted to the Tongji Hospital between Jan 25 and Mar 23, 2020. Propensity score-matching between patients adjusted for potential covariates was carried out with the patients divided into two groups depending on whether or not they had received AC treatment (AC group, ³7 days of treatment; non-AC group, no treatment). This yielded 164 patients in each group. Result: In-hospital mortality of the AC group was significantly lower than that of the non-AC group (14.0% vs. 28.7%, P =0.001). Treatment with AC was associated with a significantly lower probability of in-hospital death (adjusted HR=0.273, 95% CI, 0.154 to 0.484, P<0.001). The incidence of major bleeding and thrombocytopenia in the two groups was not significantly different. Subgroup analysis showed the following factors were associated with a significantly lower in-hospital mortality in patients who had received AC treatment; severe cases (13.2% vs. 24.6%, P=0.018), critical cases (20.0% vs 82.4%, P=0.003), patients with a D-dimer level ≥0.5 μg/mL (14.8% vs. 33.8, P<0.001), and moderate (16.7% vs. 60.0%, P=0.003) or severe acute respiratory distress syndrome (ARDS) cases at admission (33.3% vs. 86.7%, P=0.004). During the hospital stay, critical cases (38.3% vs. 76.7%, P<0.001) and severe ARDS cases (36.5% vs. 76.3%, P<0.001) who received AC treatment had significantly lower in-hospital mortality. Conclusions: AC treatment decreases the risk of in-hospital mortality, especially in critically ill patients, with no additional significant, major bleeding events or thrombocytopenia being observed.Trials registration - ChiCTR2000039855

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