Effect of combined renin angiotensin aldosterone inhibitors and diuretic treatment among patients hospitalized with SARS-CoV-2 Infection COVID-19

Abstract Background: Antecedent use of renin angiotensin aldosterone inhibitors (RAASi) appears crucial to prevent clinical deterioration and protect against cardiovascular and/or thrombotic complications of Coronavirus Disease (COVID-19), for indicated patients. Doubts have been raised about continuing treatment throughout infection, and nothing is known regarding its effect with concomitant medications. Hence, the purpose of this paper is to evaluate the differential effect of RAASi continuation in patients hospitalized with COVID-19 according to diuretic use.Methods: We used the Coracle (epidemiology, clinical characteristics, and therapy in real life patients affected by Sars-Cov-2) multi-center registry, which contains data of hospitalized patients with COVID-19 from 4 regions of Italy. We performed analyses on adult (50+ years) records with admission on/after February 22, 2020 with a known mortality or discharge status as of April 1, 2020. We constructed a multivariable Firth logistic regression model to complete our objective.Results: There were 286 patients in this analysis. Overall, 100 (35.0%) patients continued RAASi and 186 (65%) discontinued. There were 98 patients who were treated with a diuretic; 51 (52%) of those continued RAASi. The in-hospital mortality rates among patients treated with a diuretic and continued vs. discontinued RAASi were 7.8% vs 25.5% (p = 0.0179). There were 188 patients who were not treated with a diuretic; 49 (26.1%) of those continued RAASi. The in-hospital mortality rates among patients who were not treated with a diuretic and continued vs. discontinued RAASi were 16.3% vs 9.4% (p = 0.1827). After accounting for age, congestive heart failure, and coronary heart disease/ischemic heart disease, continuing RAASi decreased the risk of mortality by approximately 72% (OR = 0.28, 95% CI = 0.08 – 0.94, p = 0.0391) for patients treated with diuretics, but did not alter the risk in patients who were not treated with diuretics.Conclusion: Diuretic use in hospitalized patients with COVID-19 who were on RAASi prior to admission was associated with increased risk of in-hospital mortality. Whether this combined therapy increases risk or is the reflection of a more severe presentation deserves further investigation. Continuing RAASi therapy in patients concomitantly treated with diuretics was associated with reduced in-hospital mortality.

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Procedural and remote outcome among patients undergoing urgent trans-catheter aortic valve implantation

European Heart Journal ◽

10.1093/ehjci/ehaa946.2586 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Berkovitch ◽

A Segev ◽

A Finkelstein ◽

R Kornowski ◽

H Danenberg ◽

...

Keyword(s):

Multivariate Analysis ◽

Hospital Mortality ◽

Mortality Rates ◽

P Value ◽

Complication Rates ◽

Increased Risk ◽

Procedural Complication ◽

Elective Procedure ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Severe aortic stenosis patients suffer frequent heart failure decompensations events often requiring hospitalization. In extreme situations patients can be found with pulmonary edema and cardiogenic shock, unresponsive to medical treatment. Urgent trans-catheter aortic valve implantation (TAVI) has emerged as a treatment option for these high-risk patients. Methods We investigated 3,599 patients undergoing TAVI. Subjects were divided into two groups based on procedure urgency: patients who were electively hospitalized for the procedure (N=3,448) and those who had an urgent TAVI (N=151). Peri-procedural complications were documented according to the VARC-2 criteria. In hospital and 1-year mortality rates were prospectively documented. Results Mean age of the study population was 82±7, of whom 52% were female. Peri-procedural complication rates was significantly higher among patients with an urgent indication for TAVI compared to those having an elective procedure: valve malposition 3.6% vs. 0.6% (p-value=0.023), valve migration 3.2% vs. 0.9% (p-value=0.016), post procedure myocardial infarction 3.7% vs. 0.3% (p-value=0.004), and stage 3 acute kidney injury 2.6% vs. 0.5%, (p-value=0.02). Univariate analysis found that patients with urgent indication for TAVI had significantly higher in hospital mortality (5.8% vs. 1.4%, p-value<0.001). similarly, multivariate analysis adjusted for age, gender and cardio-vascular risk factors found that patients with urgent indication had more than 5-folds increased risk of in-hospital mortality (OR 5.94, 95% CI 2.28–15.43, p-value<0.001). Kaplan-Meier's survival analysis showed that patients undergoing urgent TAVI had higher 1-year mortality rates compared to patients undergoing an elective TAVI procedure (p-value log-rank<0.001, Figure). Multivariate analysis found they had more than 2-folds increased risk of mortality at 1-year (HR 2.27, 95% CI 1.53–3.38, p<0.001 compared to those having an elective procedure. Conclusions Patients with urgent indication for TAVI have higher in-hospital mortality and higher peri-procedural complication rates. However, if these patients survive the index hospitalization, they enjoy good prognosis. Kaplan-Meier's survival analysis Funding Acknowledgement Type of funding source: None

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Impact of congenital heart disease on outcomes among pediatric patients hospitalized for influenza infection

BMC Pediatrics ◽

10.1186/s12887-020-02344-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Laxmi V. Ghimire ◽

Fu-Sheng Chou ◽

Anita J. Moon-Grady

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Respiratory Failure ◽

Hospital Mortality ◽

Congenital Heart ◽

Pediatric Patients ◽

Influenza Infection ◽

Ventilatory Support ◽

Personal Hygiene ◽

Increased Risk

Abstract Background Young children and those with chronic medical conditions are at risk for complications of influenza including cardiopulmonary compromise. Here we aim to examine risks of mortality, clinical complications in children with congenital heart disease (CHD) hospitalized for influenza. Methods We analyzed data from in-hospital pediatric patients from 2003, 2006, 2009, 2012 and 2016 using the nationally representative Kids Inpatient Database (KID). We included children 1 year and older and used weighted data to compare the incidence of in-hospital mortality and rates of complications such as respiratory failure, acute kidney injury, need for mechanical ventilation, arrhythmias and myocarditis. Results Data from the KID estimated 125,470 children who were admitted with a diagnosis of influenza infection. Out of those, 2174(1.73%) patients had discharge diagnosis of CHD. Children with CHD who required hospitalization for influenza had higher in-hospital mortality (2.0% vs 0.5%), with an adjusted OR (aOR) of 2.8 (95% CI: 1.7–4.5). Additionally, acute respiratory failure and acute kidney failure were more likely among patients with CHD, with aOR of 1.8 (95% CI: 1.5–2.2) and aOR of 2.2 (95% CI: 1.5–3.1), respectively. Similarly, the rate of mechanical ventilatory support was higher in patients with CHD compared to those without, 14.1% vs 5.6%, aOR of 1.9 (95% CI: 1.6–2.3). Median length of hospital stay in children with CHD was longer than those without CHD [4 (IQR: 2–8) days vs. 2 (IQR: 2–4) days]. Outcomes were similar between those with severe vs non-severe CHD. Conclusions Children with CHD who require hospital admission for influenza are at significantly increased risk for in-hospital mortality, morbidities, emphasizing the need to reinforce preventative measures (e.g. vaccination, personal hygiene) in this particularly vulnerable population.

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A simple index predicting mortality in acutely hospitalized patients

QJM ◽

10.1093/qjmed/hcaa293 ◽

2020 ◽

Author(s):

Paul Froom ◽

Zvi Shimoni ◽

Jochanan Benbassat ◽

Bernard Silke

Keyword(s):

Hospital Mortality ◽

Medical Condition ◽

External Validation ◽

Laboratory Data ◽

Age Groups ◽

Mortality Rates ◽

Hospitalized Patients ◽

Outcome Variable ◽

Simple Index ◽

C Statistic

Abstract Background Mortality rates used to evaluate and improve the quality of hospital care are adjusted for comorbidity and disease severity. Comorbidity measured by International Classification of Diseases codes do not reflect the severity of the medical condition that requires clinical assessments not available in electronic databases, and/or laboratory data with clinically relevant ranges to permit extrapolation from one setting to the next. Aim To propose a simple index predicting mortality in acutely hospitalized patients. Design Retrospective cohort study with internal and external validation. Methods The study populations were all acutely admitted patients in 2015-6, and in January - November, 2019 to internal medicine, cardiology and intensive care departments at the Laniado Hospital in Israel, and in 2002-19, at St James Hospital, Ireland. Predictor variables were age and admission laboratory tests. The outcome variable was in-hospital mortality. Using logistic regression of the data in the 2015-6 Israeli cohort, we derived an index that included age groups and significant laboratory data. Results In the Israeli 2015-6 cohort the index predicted mortality rates from 0.2 to 32.0% with a c-statistic (area under the ROC curve) of 0.86. In the Israeli 2019 validation cohort, the index predicted mortality rates from 0.3 to 38.9% with a c-statistic of 0.87. An abbreviated index performed similarly in the Irish 2002-19 cohort. Conclusions Hospital mortality can be predicted by age and selected admission laboratory data without acquiring information from the patient’s medical records. This permits an inexpensive comparison of performance of hospital departments.

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Impact of Comorbidities on Length of Stay and Mortality in Hospitalized Patients with Cancer and Febrile Neutropenia

Blood ◽

10.1182/blood.v124.21.2601.2601 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2601-2601 ◽

Cited By ~ 3

Author(s):

Eva Culakova ◽

Marek S. Poniewierski ◽

Jeffrey Crawford ◽

David C. Dale ◽

Gary H. Lyman

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Research Funding ◽

Infectious Complications ◽

Hospitalized Patients ◽

Cancer Type ◽

Patients With Cancer ◽

Time Period ◽

Increased Risk ◽

The Impact

Background: Hematologic toxicities are common side effects of cancer chemotherapy. Despite advances in supportive care, febrile neutropenia (FN) continues to represent a serious adverse event often requiring hospitalization and is associated with an increased risk of mortality. The purpose of this analysis was to investigate the impact of comorbidities and infectious complications on in-patient length of stay (LOS) and mortality in hospitalized patients with cancer and neutropenia over the past decade. Methods: Hospitalization data from the University Health Consortium database inclusive of the years 2004-2012 from 239 US medical centers were analyzed. Cancer type, presence of neutropenia, comorbidities, and infection type were based on ICD-9-CM codes recorded during hospitalization. This analysis includes adult patients with malignant disease and neutropenia. Patients undergoing bone marrow or stem cell transplantation were excluded. For patients with multiple hospitalizations, the first admission during the time period studied was utilized. Primary study outcomes included hospital length of stay (LOS≥10 days) and in-hospital mortality. Multivariate logistic regression analysis was utilized to study the impact of major comorbidities on the primary outcomes. Major comorbidities under consideration included heart, liver, lung, renal, cerebrovascular, peripheral-vascular disease, diabetes and venous thromboembolism. Results: Among 135,309 patients with cancer hospitalized with neutropenic events, one-third were age 65 years or older and 51% were male. Approximately one-quarter (24.5%) of patients experienced more than one admission with FN. The mean (median) length of stay increased progressively from 11.1 (6) days in 2004 to 12.8 (7) days in 2012. Patients with leukemia, lymphoma and central nervous system (CNS) malignancies experienced the longest mean LOS (21.4, 10.5, 10.2 days, respectively). Overall, 50,846 (37.6%) had a LOS≥10 days and 10,261 (7.6%) patients died during the hospitalization with no difference seen over the time period of observation. (P=.30). Greater rates of mortality were observed in patients with lung (11.2%) or CNS (9.3%) malignancies, and leukemia (9.3%). Infectious complications were documented in 59.5% of patients and their presence was associated with greater LOS≥10 days (48.2% vs. 22.0%) and higher mortality (11.2% vs. 2.3%). Greater LOS≥10 days (51.6% vs. 37.1%) and increased mortality (9.8% vs. 7.5%) were also observed among obese patients with cancer. Likewise, patients with multiple comorbid conditions had more prolonged hospitalizations and a greater risk of in-hospital mortality. (Table) Abstract 2601. Table Solid tumors Lymphoma LeukemiaNo. of comorbiditiesNo. of patients% died% with LOS≥10 daysNo. of patients% died% with LOS≥10 daysNo. of patients% died% with LOS≥10 days017,8580.911.28,1890.617.010,3950.853.5118,1723.417.97,7512.626.611,3803.463.2214,2508.927.25,3868.141.08,6039.769.937,49918.038.42,86118.455.25,04022.877.742,70525.151.41,06033.670.52,00438.183.1≥ 560235.262.327839.980.657749.087.0All patients*61,0867.022.625,5256.632.237,9999.265.4 LOS – length of stay; * 10,699 patients with other type or multiple tumors not included in the table The trend toward longer LOS and greater mortality with increased number of comorbidities persisted in multivariate analyses after adjusting for cancer type, age, gender, ethnicity and type of infection (odds ratio (OR) per +1 comorbidity increase: [mortality: OR =1.89; 95% CI: 1.85-1.92; P<.0001], [LOS: OR=1.56; 95% CI: 1.54-1.58; P<.0001]). Conclusions: Major medical comorbidities are common among hospitalized patients with cancer and neutropenia. Importantly, such comorbidities are associated with prolonged hospitalization and increased risk of in-hospital mortality with significantly worse outcomes in patients with lymphoma or leukemia. Greater awareness of risk factors associated with poor prognosis in cancer patients hospitalized with neutropenic complications as well as validated risk tools to better identify low risk as well high risk patients may guide more personalized cancer care, potentially improving clinical outcomes and lowering the cost of care. Disclosures Crawford: Amgen: Consultancy. Dale:Amgen: Consultancy, Honoraria, Research Funding. Lyman:Amgen: Research Funding.

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Effects of seasonal and climate variations on in-hospital mortality and length of stay in patients with type A aortic dissection

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01639-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zeng-Rong Luo ◽

Zhi-Qin Lin ◽

Liang-wan Chen ◽

Han-Fan Qiu

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Length Of Stay ◽

Aortic Dissection ◽

Hospital Mortality ◽

Type A ◽

Descending Aorta ◽

Type A Aortic Dissection ◽

Medical Quality ◽

Increased Risk

Abstract Objective To investigate the effects of seasonal and climatic changes on postoperative in-hospital mortality and length of stay (LOS) in patients with type A acute aortic dissection (AAD). Methods Patients undergoing implantation of the modified triple-branched stent graft to replace the descending aorta in addition to aortic root reconstruction for type A AAD in our hospital from January 2016 to December 2019 were included. Relevant data were retrospectively collected and analyzed. Results A total of 404 patients were included in our analyses. The multivariate unconditional logistic regression analysis showed that patients admitted in autumn (OR 4.027, 95% CI 1.023–17.301, P = 0.039) or with coronary heart disease (OR 8.938, 95% CI 1.991–29.560, P = 0.049) were independently associated with an increased risk of postoperative in-hospital mortality. Furthermore, patients admitted in autumn (OR 5.956, 95% CI 2.719–7.921, P = 0.041) or with hypertension (OR 3.486, 95% CI 1.192–5.106, P = 0.035) were independently associated with an increased risk of longer LOS. Conclusion Patients admitted in autumn or with coronary heart disease are at higher risk of in-hospital mortality following surgery for type A AAD. Also, patients admitted in autumn or with hypertension have a longer hospital LOS. In the autumn of the temperature transition, we may need to strengthen the management of medical quality after surgery for type A AAD.

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The triglyceride-glucose index played an important role in prognosis in critically ill patients with heart disease

10.21203/rs.3.rs-819706/v1 ◽

2021 ◽

Author(s):

Guangyao Zhai ◽

Biyang Zhang ◽

Jianlong Wang ◽

Yuyang Liu ◽

Yujie Zhou

Keyword(s):

Heart Disease ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Binary Logistic Regression ◽

Independent Effect ◽

Binary Logistic Regression Analysis ◽

Triglyceride Glucose Index ◽

Increased Risk ◽

Patients With Diabetes

Abstract Background As an alternative method to evaluate insulin resistance (IR), triglyceride-glucose index (TyG) was shown to be related to the severity and prognosis of cardiovascular diseases. The main objective of this study was to explore the association between TyG and in-hospital mortality in critically ill patients with heart disease Method: TyG was calculated as previously reported: ln [fasting TGs (mg/dL) * FBG (mg/dL)/2]. All patients were divided into four different categories based on TyG quartiles. Primary outcome was in-hospital mortality. Binary logistic regression analysis was performed to determine the independent effect of TyG. Result 4839 critically ill patients with heart disease were included. In-hospital mortality increased as TyG quartiles increased (Quartile 4 vs Quartile 1: 12.1 vs 5.3, P < 0.001). Even after adjusting for confounding variables, TyG was still independently associated with the increased risk of in-hospital mortality in critically ill patients with heart disease (Quartile 4 vs Quartile 1: OR, 95% CI: 2,43, 1.79–3.31, P < 0.001, P for trend < 0.001). However, we did not observe the association between increased TyG and the risk of mortality in patients with diabetes. Furthermore, as TyG quartiles increased, the length of intensive care unit (ICU) stay was prolonged (Quartile 4 vs Quartile 1: 2.3, 1.3–4.9 vs 2.1, 1.3–3.8, P = 0.007). And the significant interactions were not found in most subgroups. Conclusion TyG was independently correlated with in-hospital mortality in critically ill patients with heart disease.

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Catheter ablation of ventricular arrhythmias and in-hospital mortality: insights from the German-wide Helios hospital network of 5052 cases

EP Europace ◽

10.1093/europace/euz260 ◽

2019 ◽

Cited By ~ 1

Author(s):

Sebastian König ◽

Laura Ueberham ◽

René Müller-Röthing ◽

Michael Wiedemann ◽

Michael Ulbrich ◽

...

Keyword(s):

Heart Disease ◽

Catheter Ablation ◽

Hospital Mortality ◽

Ventricular Arrhythmias ◽

Emergency Admission ◽

Structural Heart Disease ◽

Mortality Rates ◽

Hospital Death ◽

Premature Ventricular Contractions ◽

Hospital Transfer

Abstract Aims Catheter ablation (CA) of ventricular arrhythmias is one of the most challenging electrophysiological interventions with an increasing use over the last years. Several benefits must be weighed against the risk of potentially life-threatening complications which necessitates a steady reevaluation of safety endpoints. Therefore, the aims of this study were (i) to investigate overall in-hospital mortality in patients undergoing such procedures and (ii) to identify variables associated with in-hospital mortality in a German-wide hospital network. Methods and results Between January 2010 and September 2018, administrative data provided by 85 Helios hospitals were screened for patients with main or secondary discharge diagnosis of ventricular tachycardia (VT) or premature ventricular contractions (PVCs) in combination with an arrhythmia-related CA using ICD- and OPS codes. In 5052 cases (mean age 60.9 ± 14.3 years, 30.1% female) of 30 different hospitals, in-hospital mortality was 1.27% with a higher mortality in patients ablated for VT (1.99%, n = 2, 955) compared to PVC (0.24%, n = 2, 097, P < 0.01). Mortality rates were 2.06% in patients with ischaemic heart disease (IHD, n = 2, 137), 1.47% in patients with non-ischaemic structural heart disease (NIHD, n = 1, 224), and 0.12% in patients without structural heart disease (NSHD, n = 1, 691). Considering different types of hospital admission, mortality rates were 0.35% after elective (n = 2, 825), 1.60% after emergency admission/hospital transfer <24 h (n = 1, 314) and 3.72% following delayed hospital transfer >24 h after initial admission (n = 861, P < 0.01 vs. elective admission and emergency admission/hospital transfer <24 h). In multivariable analysis, a delayed hospital transfer >24 h [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.59–3.28, P < 0.01], the occurrence of procedure-related major adverse events (OR 6.81, 95% CI 2.90–16.0, P < 0.01), Charlson Comorbidity Index (CCI, OR 2.39, 95% CI 1.56–3.66, P < 0.01) and its components congestive heart failure (OR 8.04, 95% CI 1.71–37.8, P < 0.01), and diabetes mellitus (OR 1.59, 95% CI 1.13–2.22, P < 0.01) were significantly associated with in-hospital death. Conclusions We reported in-hospital mortality rates after CA of ventricular arrhythmias in the largest multicentre, administrative dataset in Germany which can be implemented in quality management programs. Aside from comorbidities, a delayed hospital transfer to a CA performing centre is associated with an increased in-hospital mortality. This deserves further studies to determine the optimal management strategy.

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

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa517 ◽

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 < .001). Patients with hypopituitarism had higher ICU admissions (OR 1.50 [95% CI, 1.30-1.74], P < .001), and faced a 2.4-day prolonged length of hospitalization (95% CI, 1.94–2.95, P < .001) compared to matched controls. Risk of 30-day (OR 1.31 [95% CI, 1.13-1.51], P < .001) and 1-year readmission (OR 1.29 [95% CI, 1.17-1.42], P < .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.

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Venous Thromboembolism in Hospitalized Patients with Multiple Myeloma: A Nationwide Analysis

Blood ◽

10.1182/blood-2018-99-116101 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3596-3596

Author(s):

Kahee A Mohammed ◽

Kristen M Sanfilippo

Keyword(s):

Multiple Myeloma ◽

Venous Thromboembolism ◽

Hospital Mortality ◽

Hospitalized Patients ◽

Major Surgery ◽

Hospital Level ◽

Prolonged Hospitalization ◽

Increased Risk ◽

The Impact ◽

Hospital Characteristics

Abstract Background: The burden of multiple myeloma has increased in last 30 years, both in US and globally. Patients with multiple myeloma are at increased risk of developing venous thromboembolism (VTE) resulting in significant morbidity and mortality. This study aimed to (1) determine patient and hospital characteristics associated with VTE, (2) assess the impact of VTE on in-hospital mortality and prolonged hospitalization, and (3) examine trends in the rates of VTE and VTE-associated in-hospital mortality and prolonged hospitalization in patients with multiple myeloma. Methods: A retrospective analysis of Nationwide Inpatient Sample, 2008 - 2014, was conducted. International Classification of Diseases-9-Clinical Modification codes were used to identify hospitalized patients (aged ≥ 18 years) with multiple myeloma. Trends in the prevalence of VTE and VTE-associated in-hospital mortality and prolonged hospitalization rates were assessed using the Cochrane-Armitage test. Weighted, multilevel hierarchical logistic regression using generalized linear mixed models with generalized estimated equations were used to examine the association between patient and hospital characteristics and study outcomes Results: Among 136,652 hospitalized patients with multiple myeloma, 4.2% were diagnosed with VTE. Although statistically insignificant, a slight increase in VTE rates were observed from 2008 to 2014 (3.9% to 4.4%) (p 0.18). In adjusted multilevel hierarchical regression, we found higher odds of VTE in male gender (odds ratio [OR] = 1.08, 95% Confidence Interval [CI] = 1.02 - 1.14), Black race (OR = 1.11, 95% CI = 1.03 - 1.19), those who had a major surgery (OR = 1.73, 95% CI = 1.62 - 1.85), and higher Elixhauser comorbidity index (OR = 3.73, 95% CI = 2.66 - 5.23). Hospital level correlates of VTE included: admission to teaching vs. non-teaching (OR = 1.07, 95% CI = 1.01 - 1.13), and admission to medium vs. small sized hospitals (OR = 1.11, 95% CI = 1.01 - 1.23), while lower odds of VTE were noted among patients admitted to hospitals located in Northeast (OR = 0.91, 95% CI = 0.84 - 0.98) vs. South. Patients diagnosed with vs. without VTE had higher odds of in-hospital mortality (OR = 1.36, 95% CI = 1.22 - 1.51) and prolonged hospital stay (OR = 1.65, 95% CI = 1.55 - 1.75). A statistically significant trend for decreasing VTE associated mortality (10.0% to 5.3%) (p <.001) and prolonged hospitalization (32.1% to 28.2%) (p <.001) rates were observed across study years. Conclusions: During the study period, there has been an increase in rate of VTE among patients with multiple myeloma. Patients with multiple myeloma and VTE had a high risk of in-hospital mortality compared to those without VTE; however, rates of VTE-associated in-hospital mortality and prolongation of hospitalization have decreased over time. Hospital level characteristics were significantly associated with VTE. These findings might reflect changing detection guidelines and better management of VTE in cancer patients. Lastly, patient level characteristics independently predict the occurrence of VTE. Given the higher in-hospital mortality associated with patients with VTE and multiple myeloma, there is a need for prospective studies to identify effective strategies to prevent VTE in this patient population and improve outcomes. Disclosures Sanfilippo: Bristol-Myers Squibb: Speakers Bureau.

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Mortality among Hospitalized Dengue Patients with Comorbidities in Mexico, Brazil, and Colombia

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.20-1163 ◽

2021 ◽

Author(s):

Alejandro E. Macias ◽

Guilherme L. Werneck ◽

Raúl Castro ◽

Cesar Mascareñas ◽

Laurent Coudeville ◽

...

Keyword(s):

Heart Disease ◽

Relative Risk ◽

Hospital Mortality ◽

Case Fatality ◽

Cross Sectional Study ◽

Severe Dengue ◽

Sectional Study ◽

Cross Sectional ◽

Risk Of Death ◽

Increased Risk

Dengue patients with comorbidities may be at higher risk of death. In this cross-sectional study, healthcare databases from Mexico (2008–2014), Brazil (2008–2015), and Colombia (2009–2017) were used to identify hospitalized dengue cases and their comorbidities. Case fatality rates (CFRs), relative risk, and odds ratios (OR) for in-hospital mortality were determined. Overall, 678,836 hospitalized dengue cases were identified: 68,194 from Mexico, 532,821 from Brazil, and 77,821 from Colombia. Of these, 35%, 5%, and 18% were severe dengue, respectively. Severe dengue and age ≥ 46 years were associated with increased risk of in-hospital mortality. Comorbidities were identified in 8%, 1%, and 4% of cases in Mexico, Brazil, and Colombia, respectively. Comorbidities increased hospitalized dengue CFRs 3- to 17-fold; CFRs were higher with comorbidities regardless of dengue severity or age. The odds of in-hospital mortality were significantly higher in those with pulmonary disorders (11.6 [95% CI 7.4–18.2], 12.7 [95% CI 9.3–17.5], and 8.0 [95% CI 4.9–13.1] in Mexico, Brazil, and Colombia, respectively), ischemic heart disease (23.0 [95% CI 6.6–79.6], 5.9 [95% CI 1.4–24.6], and 7.0 [95% CI 1.9–25.5]), and renal disease/failure (8.3 [95% CI 4.8–14.2], 8.0 [95% CI 4.5–14.4], and 9.3 [95% CI 3.1–28.0]) across the three countries; the odds of in-hospital mortality from dengue with comorbidities was at least equivalent or higher than severe dengue alone (4.5 [95% CI 3.4–6.1], 9.6 [95% CI 8.6–10.6], and 9.0 [95% CI 6.8–12.0). In conclusion, the risk of death because of dengue increases with comorbidities independently of age and/or disease severity.

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