scholarly journals Association of Smoking Status with Outcomes in Hospitalized COVID-19 Patients

2020 ◽  
Author(s):  
Muhammad Adrish ◽  
Sridhar Chilimuri ◽  
Nikhitha Mantri ◽  
Haozhe Sun ◽  
Maleeha Zahid ◽  
...  
Keyword(s):  
Critical Illness ◽  
Cox Model ◽  
Smoking Status ◽  
Severity Of Illness ◽  
Systemic Steroid ◽  
Risk Of Death ◽  
Artery Disease ◽  
Never Smokers ◽  
Stage Renal Disease ◽  
End Stage

Abstract Introduction: Smoking causes inflammation of the lung epithelium by releasing cytokines and impairing muco-ciliary clearance. Some studies have linked smoking with severity of illness of COVID-19 whereas others have found no such association.Methods: This was a retrospective analysis of all adults hospitalized with COVID-19 from March 09 to May 18, 2020. Results: 1173 patients met the study criteria. 837 patients never smoked and 336 patients were either current smokers or past smoker and were grouped together in smokers group. Patients in smokers group were more likely to be male and had higher incidence of underlying COPD (19% vs. 6%, p<0.001), human immunodeficiency virus infection (11% vs. 5%,p<0.001), cancer (11% vs. 6%, p=0.005), congestive heart failure (15% vs. 8%, p<0.001), coronary artery disease (15% vs. 9%, p=0.027), chronic kidney disease (11% vs. 8%, p=0.037), and end-stage renal disease (10% vs. 6%, p=0.009) compared to non-smokers. Smokers were more likely to develop critical illness requiring mechanical ventilation (47% vs. 37% p=0.005). Univariate Cox model for survival analysis by smoking status showed that smokers only current smokers had higher risk of death compared to never-smokers (HR 1.61, 95% confidence interval 1.22–2.12, p<0.001). In the multivariate approach Cox model for the survival, female sex, age, LDH and systemic steroid use were associated with overall survival.Conclusion: In our large single center retrospective database of patients hospitalized with COVID-19, smoking was associated with development of critical illness and higher likelihood of death

scholarly journals Association of smoking status with outcomes in hospitalised patients with COVID-19

2020 ◽  
Vol 7 (1) ◽  
pp. e000716 ◽  
Author(s):  
Muhammad Adrish ◽  
Sridhar Chilimuri ◽  
Nikhitha Mantri ◽  
Haozhe Sun ◽  
Maleeha Zahid ◽  
...  
Keyword(s):  
Critical Illness ◽  
Cox Model ◽  
Smoking Status ◽  
Serum Lactate ◽  
Outcome Analysis ◽  
Serum Lactate Dehydrogenase ◽  
Chronic Obstructive ◽  
Systemic Steroid ◽  
Risk Of Death ◽  
Hospitalised Patients

IntroductionSmoking causes inflammation of the lung epithelium by releasing cytokines and impairing mucociliary clearance. Some studies have linked smoking with severity of illness of COVID-19 whereas others have found no such association.MethodsThis was a retrospective analysis of all adults hospitalised with COVID-19 from 9 March to 18 May 2020.Results1173 patients met the study criteria. 837 patients never smoked whereas 336 patients were either current smokers or past smoker and were grouped together in smokers group. Patients in smokers group were more likely to be male and had higher incidence of underlying chronic obstructive pulmonary disease (19% vs 6%, p<0.001), HIV infection (11% vs 5%,p<0.001), cancer (11% vs 6%, p=0.005), congestive heart failure (15% vs 8%, p<0.001), coronary artery disease (15% vs 9%, p=0.3), chronic kidney disease (11% vs 8%, p=0.037) and end-stage renal disease (10% vs 6%, p=0.009) compared with non-smokers. Outcome analysis showed that smokers were more likely to develop critical illness requiring mechanical ventilation (47% vs 37% p=0.005). Univariate Cox model for survival analysis by smoking status showed that among smokers only current smokers had higher risk of death compared with never smokers (HR 1.61, 95% CI 1.22 to 2.12, p<0.001). In the multivariate approach, Cox model for the survival, female sex, young age, low serum lactate dehydrogenase and systemic steroid use were associated with overall improved survival.ConclusionIn our large single-centre retrospective database of patients hospitalised with COVID-19, smoking was associated with development of critical illness and higher likelihood of death.

scholarly journals Investigation of the Impact of Endodontic Therapy on Survival among Dialysis Patients in Taiwan: A Nationwide Population-Based Cohort Study

2021 ◽  
Vol 18 (1) ◽  
pp. 326
Author(s):  
Chih-Chien Chiu ◽  
Ya-Chieh Chang ◽  
Ren-Yeong Huang ◽  
Jenq-Shyong Chan ◽  
Chi-Hsiang Chung ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Root Canal ◽  
Dialysis Patients ◽  
Root Canal Therapy ◽  
Risk Of Death ◽  
Stage Renal Disease ◽  
End Stage

Objectives Dental problems occur widely in patients with chronic kidney disease (CKD) and may increase comorbidities. Root canal therapy (RCT) is a common procedure for advanced decayed caries with pulp inflammation and root canals. However, end-stage renal disease (ESRD) patients are considered to have a higher risk of potentially life-threatening infections after treatment and might fail to receive satisfactory dental care such as RCT. We investigated whether appropriate intervention for dental problems had a potential impact among dialysis patients. Design Men and women who began maintenance dialysis (hemodialysis or peritoneal dialysis) between January 1, 2000, and December 31, 2015, in Taiwan (total 12,454 patients) were enrolled in this study. Participants were followed up from the first reported dialysis date to the date of death or end of dialysis by December 31, 2015. Setting Data collection was conducted in Taiwan. Results A total of 2633 and 9821 patients were classified into the RCT and non-RCT groups, respectively. From the data of Taiwan’s National Health Insurance, a total of 5,092,734 teeth received RCT from 2000 to 2015. Then, a total of 12,454 patients were followed within the 16 years, and 4030 patients passed away. The results showed that members of the non-RCT group (34.93%) had a higher mortality rate than those of the RCT group (22.79%; p = 0.001). The multivariate-adjusted hazard ratio for the risk of death was 0.69 (RCT vs. non-RCT; p = 0.001). Conclusions This study suggested that patients who had received RCT had a relatively lower risk of death among dialysis patients. Infectious diseases had a significant role in mortality among dialysis patients with non-RCT. Appropriate interventions for dental problems may increase survival among dialysis patients. Abbreviations: CKD = chronic kidney disease, ESRD = end-stage renal disease, RCT = root canal therapy.

scholarly journals Prediction of All-Cause Mortality Using an Echocardiography-Based Risk Score in Hemodialysis Patients

2020 ◽  
pp. 1-11
Author(s):  
Jing Zhu ◽  
Chao Tang ◽  
Han Ouyang ◽  
Huaying Shen ◽  
Tao You ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Model ◽  
Prognostic Score ◽  
Basic Model ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Cardiac Valve Regurgitation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

<b><i>Aim:</i></b> To derive an echocardiography-based prognostic score for a 3-year risk of mortality in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). <b><i>Methods:</i></b> 173 ESRD patients hospitalized in the second affiliated hospital of Soochow University from January 1, 2010, to July 31, 2016, were enrolled and followed up for 3 years. All subjects began to receive HD from recruitment. Baseline clinical and echocardiographic parameters were collected and screened for risk factors using univariate and multivariate analysis. The prognostic value of echocardiographic indexes was determined by concordance indexes and reclassification assay. Restricted cubic spline models (RCS) and forest plots were employed to visualize the association between risk factors and all-cause mortality. A multivariate nomogram including the identified factors was developed to estimate the prognosis. <b><i>Results:</i></b> After multivariate adjustment for advanced age, hypertension, diabetes, and decreased hemoglobin (Hb), echocardiographic indexes including left atrial diameter index (LADI), cardiac valvular calcification, and moderate to severe cardiac valve regurgitation were independently associated with the risk of 3-year mortality in HD patients. RCS showed that age, Hb, and LADI were positively associated with the risk of mortality. Adding multiple echocardiographic indexes to a basic model containing age, hypertension, diabetes, and Hb increased the concordance index and improved reclassification. A multivariate Cox model-derived nomogram showed the association between each factor and mortality by the end of follow-up. <b><i>Conclusions:</i></b> Echocardiographic indexes showed independent predictive power for mortality in ESRD patients and may constitute a promising prognostic tool in this population.

Abstract P259: Smoking Increases Risks of Death and Stroke in Both Men and Women. Absolute Risk Difference of Stroke is Likely to be Larger in Women

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Masaki Ohsawa ◽  
Kuniaki Ogasawara ◽  
Shinichi Omama ◽  
Kozo Tanno ◽  
Kazuyoshi Itai ◽  
...  
Keyword(s):  
Smoking Status ◽  
Absolute Risk ◽  
Incidence Rates ◽  
Risk Difference ◽  
Current Smoker ◽  
Men And Women ◽  
Risk Of Death ◽  
Adjusted Rate ◽  
Never Smokers ◽  
Rate Ratios

Background: Smoking is an important risk factor for cardiovascular disease, however, to what extent smoking increases excessive deaths and strokes in a general population has not been sufficiently examined especially in women. Methods: A total of 10,382 female and male participants aged 65 years or older were divided into two groups according to smoking status (current smoker; never smoker). Past smokers were excluded. Main outcomes were all-cause death and incident stroke. Age-adjusted mortality and incidence rates were estimated in the groups using Poisson’s regression analysis. Age-adjusted rate ratios (RR) and excess events (EE per 1000 person-years) attributable to smoking were determined using the rate in never smokers as a reference. Results: There were 1410 deaths and 735 strokes during the 9.0-year observation period (90,099 person-years). Smoking contributed to a 2.3-fold higher risk of death in women and 1.8-fold higher risk in men. It contributed to 12 excess deaths per 1000 person-years in both men and women. The rate ratio and excessive events of stroke were likely to be higher in women than those in men (RR: 2.6 vs. 1.6; EE: 9.3 vs 5.0, see table). Conclusion: Smoking significantly increases risks of death and stroke not only in men but also in women. Absolute risk difference of stroke attributable to smoking is likely to be larger in women than in men.

scholarly journals Circulatory microRNA expression profile for coronary artery calcification in chronic kidney disease patients

2021 ◽  
Vol 21 (2) ◽  
pp. 728-734
Author(s):  
Bhooma Vijayaraghavan ◽  
Sridharan Jeyamohan ◽  
Giri Padmanabhan ◽  
Antony Joseph Velangann ◽  
Kumaresan Ramanathan
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Microrna Expression ◽  
Calcium Scoring ◽  
Serum Samples ◽  
High Calcium ◽  
Significant Difference ◽  
Artery Disease ◽  
Stage Renal Disease ◽  
End Stage

Background & Aim: Coronary artery disease (CAD) is the primary cause of mortality in patients with end stage renal disease (ESRD). MicroRNA profiling is proven as a powerful tool in the diagnosis of any disease at the molecular level. Hence, the present study aimed to profile the microRNA expression for CAD especially coronary artery calcification in CKD patients. Materials and Methods: Two hundread patients with CKD stages 3 to 5 without dialysis and healthy controls were includ- ed in this study. All two hundred patients underwent 1024 multi sliceardiac computed tomography (CT) scan for calcium scoring. The calcium scoring more than 100 have been included in the study. We performed miRNA microarray analysis from serum samples of seven high calcium scored with CKD patients and one control patients. Results: Seven patients have observed circulating miRNAs has significantly upregulated and downregulated when compared with control patients. mir21, mir 67, mir 390, mir 56, mir 250, mir 65 and mir 13 were up regulated and mir235, mir256, mir226, mir207, mir255, mir193 were downregulated. There was no significant difference in left ventricle function. Conclusion: 13 microRNAs play a potential role in coronary artery calcification in CKD patients. Keywords: CKD; CAD; microRNA; coronary artery calcification.

Abstract P112: Coronary RevascularizationProcedure Mortality in Coronary Artery Disease Patients With End-Stage Renal Disease: Do Racial Disparities Matter?

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Alexander V Sergeev
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Racial Disparities ◽  
End Stage Renal Disease ◽  
Post Procedure ◽  
Artery Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Studies have demonstrated that chronic kidney disease (CKD), especially its last stage - end-stage renal disease (ESRD) - is not only an independent risk factor for coronary artery disease (CAD), but it also worsens survival prognosis in CAD patients. It remains unclear whether racial disparities affect the outcomes of coronary revascularization procedures - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - in CAD patients with ESRD (CAD-ESRD). Study Objectives: (1) to investigate comparative effectiveness of CABG and PCI on in-hospital mortality outcomes in CAD-ESRD patients and (2) to investigate racial disparities in the utilization and in-hospital mortality outcomes of CABG and PCI in CAD-ESRD patients. Methods: We conducted a retrospective cohort study of in-hospital mortality in 23,519 CAD-ESRD patients [mean + SD age: 65.4 + 11.6 years; 62.2% (14,626 of 23,519) males] after CABG and PCI during 2007-2011. Patient race was defined as white, black, Asian, or Native American. In-hospital patient death was a binary outcome of interest. Adjusted odds ratios were obtained from multivariable logistic regression (MLR), adjusted for known clinical, demographic, and socio-economic covariates. Results: In the covariate-adjusted MLR analysis, post-PCI in-hospital mortality in CAD-ESRD patients was significantly lower than post-CABG mortality (adjusted OR = 0.47, 95% CI: 0.41-0.53, p<0.001). Post-procedure mortality was associated with emergency room (ER) admission (adjusted OR 1.62, 95% CI: 1.44-1.83, p<0.001), older age (3.2% increase for each year, 95% CI: 2.6-3.8%, p<0.001), and higher severity of co-existing conditions other than ESRD measured by the Elixhauser Comorbidity Index (8.5% increase for each point increase in the modified Elixhauser-Walraven score, 95% CI: 7.5-9.5%, p<0.001). Blacks were more likely to undergo an ER admission (48.4%) than Asians (46.0%), Native Americans (43.2%) or whites (42.4%, p<0.05, with multiple comparison correction). In the adjusted MLR analysis, race was not a statistically significant independent predictor of post-procedure mortality. C-statistic for the MLR was 0.729. Conclusions: Our results suggest that in-hospital post-PCI mortality in CAD-ESRD patients is lower than post-CABG mortality. Racial disparities in ER admissions - a demonstrated predictor of post-procedure mortality in these patients - may reflect the underlying racial disparities in access to and utilization of primary care. Further studies investigating disparities in CAD-ESRD mortality are warranted.

scholarly journals P1541HEMODIALYSIS IN END-STAGE RENAL DISEASE PATIENTS OVER 75 YEARS OLD

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Tasnim Mesbahi ◽  
Barbouch Samia ◽  
Fattoum Safa ◽  
Najjar Mariem ◽  
Jebali Hela ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Older Patients ◽  
Cox Model ◽  
Dialysis Initiation ◽  
First Year ◽  
Younger Patients ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Over the last decade, the age of dialysis patients has been increasing steadily worldwide. The benefits of dialysis in older people with end stage renal disease (ESRD) are not clear. We will try to evaluate whether dialysis in older has survival advantage compared to younger people. Method It is a prospective descriptive and analytic study including 229 patients who initiated chronic hemodialysis during the period between January and June 2017. Patients were classified into two groups by age at dialysis initiation. Patients above 75 years of age were considered old (old group OG). Patients aged less then 75 years old were considered young (young group YG). Primary outcome was old patient’s survival during the first 3 and 12 months from the dialysis initiation. Results Among a total of 229 new patients who began dialysis treatment, 41 (17,9%) ESRD were above 75 years of age.The sex ratio was 0,95 and 1,54 in respectively in OG and YG (p = 0,167). Diabetes was present in 56% of the elderly and in 59% of the younger group (p = 0,72) and was more frequently the cause of ESRD in the two groups. The average of modified Charlson Comorbidity Index was 6,7 ± 2,3 and 3,9 ± 2,6 respectively in OG and YG(p = 10-3). Younger patients had been referred earlier to nephrologists than the older ones. In fact, glomerular filtration rate at the beginning of the follow up was 18,7 ± 8,9 ml/min/1,73 in OG and 25,4 ± 16,2 in YG (p = 0,004). There was no statically significant difference between the two groups in the frequency of the use of temporary catheters at dialysis initiation (p = 0,778) and the urgent or planned initiation of dialysis (p = 0,298). Younger patients required hospitalization to organize dialysis initiation more than older patients (51,6% VS 26,8%; p = 0,005). Compared with the group of younger patients, Cox model showed an incremental increase in mortality associated with older patients’ group during the first year of HD (p = 0,036). However, there was no difference between OG and YG in the mortality rate during the first 3 months of HD (p = 0,102). Conclusion We may conclude that life expectancy of patients who began dialysis above 75 years is significantly shorter than younger patients in the first year of HD. In the other hand, the difference between the 2 groups wasn’t significant regarding the conditions of dialysis initiation.

Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

2020 ◽  
Vol 51 (6) ◽  
pp. 424-432 ◽  
Author(s):  
Salina P. Waddy ◽  
Adan Z. Becerra ◽  
Julia B. Ward ◽  
Kevin E. Chan ◽  
Chyng-Wen Fwu ◽  
...  
Keyword(s):  
The United States ◽  
Future Research ◽  
Dialysis Patients ◽  
Mortality And Morbidity ◽  
Medication Prescription ◽  
Risk Of Death ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Dialysis Discontinuation

Background: The opioid epidemic is a public health emergency and appropriate medication prescription for pain remains challenging. Physicians have increasingly prescribed gabapentinoids for pain despite limited evidence supporting their use. We determined the prevalence of concomitant gabapentinoid and opioid prescriptions and evaluated their associations with outcomes among dialysis patients. Methods: We used the United States Renal Data System to identify patients treated with dialysis with Part A, B, and D coverage for all of 2010. Patients were grouped into 4 categories of drugs exposure status in 2010: (1) no prescriptions of either an opioid or gabapentinoid, (2) ≥1 prescription of an opioid and no prescriptions of gabapentinoids, (3) no prescriptions of an opioid and ≥1 prescription of gabapenbtinoids, (4) ≥1 prescription of both an opioid and gabapentinoid. Outcomes included 2-year all-cause death, dialysis discontinuation, and hospitalizations assessed in 2011 and 2012. Results: The study population included 153,758 dialysis patients. Concomitant prescription of an opioid and gabapentin (15%) was more common than concomitant prescription of an opioid and pregabalin (4%). In adjusted analyses, concomitant prescription of an opioid and gabapentin compared to no prescription of either was associated with increased risk of death (hazard ratio [HR] 1.16, 95% CI 1.12–1.19), dialysis discontinuation (HR 1.14, 95% CI 1.03–1.27), and hospitalization (HR 1.33, 95% CI 1.31–1.36). Concomitant prescription of an opioid and pregabalin compared to no prescription of either was associated with increased mortality (HR 1.22, 95% CI 1.16–1.28) and hospitalization (HR 1.37, 95% CI 1.33–1.41), but not dialysis discontinuation (HR 1.13, 95% CI 0.95–1.35). Prescription of opioids and gabepentinoids compared to only being prescribed opioids was associated with higher risk of hospitalizations, but not mortality, or dialysis discontinuation. Conclusions: Concomitant prescription of opioids and gabapentinoids among US dialysis patients is common, and both drugs have independent effects on outcomes. Future research should prospectively investigate the potential harms of such drugs and identify safer alternatives for treatment of pain in end-stage renal disease patients.

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