Liver Failure in Pregnancy: A Retrospective Study of 62 Cases

Abstract Background: Liver failure in pregnancy is a rare but potentially severe disease with a high rate of short-term morbidity and mortality, while there is still a lack of accurate diagnosis, effective treatments and prognostic indicators for liver failure in pregnancy. This study aims to retrospectively investigate the clinical characteristics of liver failure in pregnancy caused by AFLP and hepatitis B, and to explore the potential prognostic indicators. Methods: Sixty-two pregnant women with symptoms and signs of hepatic dysfunction, admitting to the Third Affiliated Hospital of Sun Yat-sen University between January 1, 2010 and December 31, 2019 were retrospectively recruited. The baseline clinical characteristics, in-hospital mortality and changes of important laboratory examination parameters during hospitalization were determined.Results: The in-hospital mortality rate of liver failure in pregnancy was 27.4% and most of the deaths were recorded in the first 7 days after admission. Patients suffered in-hospital death had a significant lower gestational age, a higher incidence rate of hepatorenal syndrome and were more likely to receive hysterectomy but less likely to receive intrauterine balloon tamponade. The baseline aspartate aminotransferase, total bilirubin, indirect bilirubin and platelet levels were significantly higher, while cholinesterase, prothrombin activity and creatinine levels were significantly lower in patients with in-hospital death than that in patients discharged alive. The change tendencies of total bilirubin level and prothrombin activity were greatly different between patients with in-hospital deaths and patients discharged alive. Some differences in baseline clinical characteristics between different underlying etiologies of pregnant patients with liver failure were also detected.Conclusions: The mortality rate of liver failure in pregnancy is high especially within 7 days after admission. The change tendencies of total bilirubin and prothrombin activity were greatly different between dead and survived patients with liver failure during hospitalization, which suggested that these parameters might be important prognostic factors of liver failure in pregnancy and their alterations should be carefully tracked.

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Predictors of In-Hospital Mortality for Road Traffic Accident-Related Severe Traumatic Brain Injury

Journal of Personalized Medicine ◽

10.3390/jpm11121339 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1339

Author(s):

Chien-Hung Chen ◽

Yu-Wei Hsieh ◽

Jen-Fu Huang ◽

Chih-Po Hsu ◽

Chia-Ying Chung ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mortality Rate ◽

Hospital Mortality ◽

Prothrombin Time ◽

High Mortality ◽

Clinical Characteristics ◽

Road Traffic ◽

Road User ◽

Severe Tbi

(1) Background: Road traffic accidents (RTAs) are the leading cause of pediatric traumatic brain injury (TBI) and are associated with high mortality. Few studies have focused on RTA-related pediatric TBI. We conducted this study to analyze the clinical characteristics of RTA-related TBI in children and to identify early predictors of in-hospital mortality in children with severe TBI. (2) Methods: In this 15-year observational cohort study, a total of 618 children with RTA-related TBI were enrolled. We collected the patients’ clinical characteristics at the initial presentations in the emergency department (ED), including gender, age, types of road user, the motor components of the Glasgow Coma Scale (mGCS) score, body temperature, blood pressure, blood glucose level, initial prothrombin time, and the intracranial computed tomography (CT) Rotterdam score, as potential mortality predictors. (3) Results: Compared with children exhibiting mild/moderate RTA-related TBI, those with severe RTA-related TBI were older and had a higher mortality rate (p < 0.001). The in-hospital mortality rate for severe RTA-related TBI children was 15.6%. Compared to children who survived, those who died in hospital had a higher incidence of presenting with hypothermia (p = 0.011), a lower mGCS score (p < 0.001), a longer initial prothrombin time (p < 0.013), hyperglycemia (p = 0.017), and a higher Rotterdam CT score (p < 0.001). Multivariate analyses showed that the mGCS score (adjusted odds ratio (OR): 2.00, 95% CI: 1.28–3.14, p = 0.002) and the Rotterdam CT score (adjusted OR: 2.58, 95% CI: 1.31–5.06, p = 0.006) were independent predictors of in-hospital mortality. (4) Conclusions: Children with RTA-related severe TBI had a high mortality rate. Patients who initially presented with hypothermia, a lower mGCS score, a prolonged prothrombin time, hyperglycemia, and a higher Rotterdam CT score in brain CT analyses were associated with in-hospital mortality. The mGCS and the Rotterdam CT scores were predictive of in-hospital mortality independently.

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Predictive determinants of overall survival among re-infected COVID-19 patients using the elastic-net regularized Cox proportional hazards model: a machine-learning algorithm

BMC Public Health ◽

10.1186/s12889-021-12383-3 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Vahid Ebrahimi ◽

Mehrdad Sharifi ◽

Razieh Sadat Mousavi-Roknabadi ◽

Robab Sadegh ◽

Mohammad Hossein Khademian ◽

...

Keyword(s):

Machine Learning ◽

Overall Survival ◽

Mortality Rate ◽

Serum Creatinine ◽

Hospital Mortality ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Elastic Net ◽

Hospital Death ◽

Wbc Count

Abstract Background Narrowing a large set of features to a smaller one can improve our understanding of the main risk factors for in-hospital mortality in patients with COVID-19. This study aimed to derive a parsimonious model for predicting overall survival (OS) among re-infected COVID-19 patients using machine-learning algorithms. Methods The retrospective data of 283 re-infected COVID-19 patients admitted to twenty-six medical centers (affiliated with Shiraz University of Medical Sciences) from 10 June to 26 December 2020 were reviewed and analyzed. An elastic-net regularized Cox proportional hazards (PH) regression and model approximation via backward elimination were utilized to optimize a predictive model of time to in-hospital death. The model was further reduced to its core features to maximize simplicity and generalizability. Results The empirical in-hospital mortality rate among the re-infected COVID-19 patients was 9.5%. In addition, the mortality rate among the intubated patients was 83.5%. Using the Kaplan-Meier approach, the OS (95% CI) rates for days 7, 14, and 21 were 87.5% (81.6-91.6%), 78.3% (65.0-87.0%), and 52.2% (20.3-76.7%), respectively. The elastic-net Cox PH regression retained 8 out of 35 candidate features of death. Transfer by Emergency Medical Services (EMS) (HR=3.90, 95% CI: 1.63-9.48), SpO2≤85% (HR=8.10, 95% CI: 2.97-22.00), increased serum creatinine (HR=1.85, 95% CI: 1.48-2.30), and increased white blood cells (WBC) count (HR=1.10, 95% CI: 1.03-1.15) were associated with higher in-hospital mortality rates in the re-infected COVID-19 patients. Conclusion The results of the machine-learning analysis demonstrated that transfer by EMS, profound hypoxemia (SpO2≤85%), increased serum creatinine (more than 1.6 mg/dL), and increased WBC count (more than 8.5 (×109 cells/L)) reduced the OS of the re-infected COVID-19 patients. We recommend that future machine-learning studies should further investigate these relationships and the associated factors in these patients for a better prediction of OS.

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Abstract P161: Drug-Eluting Stent Utilization and Post-Coronary Revascularization Procedure Mortality: Do Racial Disparities Matter?

Circulation ◽

10.1161/circ.129.suppl_1.p161 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Alexander V Sergeev

Keyword(s):

Native American ◽

Hospital Mortality ◽

Racial Disparities ◽

Coronary Revascularization ◽

Multivariable Analysis ◽

Drug Eluting Stents ◽

Drug Eluting Stent ◽

Hospital Death ◽

Drug Eluting ◽

To Receive

Background: Besides being a major risk factor for coronary artery disease (CAD), diabetes mellitus (DM) also worsens CAD patients’ prognosis. Percutaneous coronary intervention (PCI) with stenting is an effective treatment procedure for certain categories of CAD patients with DM (CAD-DM). Newer drug-eluting stents (DES) were developed to minimize the occurrence of restenosis known to hinder PCI with older non-drug-eluting stents (non-DES). We hypothesized that disparities in DES utilization and post-procedure mortality would exist in CAD-DM patients. Methods: We conducted a retrospective cohort study of in-hospital mortality in 132,934 CAD-DM patients [mean+SD age: 65.3+11.4 years; 62.7% (83,409 of 132,934) males] after PCI with DES and non-DES in the years 2007,2009. Patient race was classified as white, black, or other Asian, Pacific Islander, Native American). Due to short length of stay, in-hospital death was defined as a binary variable (discharged alive vs. deceased). Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for in-hospital death after DES and non-DES PCI in relation to patients’ race, adjusting for confounders: age, gender, comorbidities, number of stents inserted, number of vessels treated, socio-economic status, emergency department (ED) admission, rural/urban area status. Results: Blacks were less likely to receive newer DES stent than any other racial group: 75.7% blacks, 76.9% whites, 79.0% other (p<0.04). Blacks were more likely to undergo an emergency rather than planned procedure: 45.7% blacks, 39.8% whites, and 42.7% other were ED-admitted (p<0.01). In adjusted multivariable analysis, controlling for the type of stent and confounding factors, post-PCI mortality in blacks was similar to whites (adjusted OR 0.824, 95% CI: 0.672-1.010, p=0.06), but in other was higher than in whites (adjusted OR 1.284, 95% CI: 1.151-1.434, p<0.001). Conclusions: Racial disparities exist in DES utilization by CAD-DM patients and in post-PCI in-hospital mortality: blacks are least likely to receive DES, but patients of other racial groups are more likely to die after PCI. Further studies investigating the mechanisms responsible for these disparities are warranted.

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Ischemic Stroke with Troponin Elevation: Patient Characteristics, Resource Utilization, and In-Hospital Outcomes

Cerebrovascular Diseases ◽

10.1159/000445526 ◽

2016 ◽

Vol 42 (3-4) ◽

pp. 213-223 ◽

Cited By ~ 5

Author(s):

Krishi Peddada ◽

Salvador Cruz-Flores ◽

Larry B. Goldstein ◽

Eliahu Feen ◽

Kevin F. Kennedy ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Clinical Characteristics ◽

Causes Of Death ◽

Mortality Rates ◽

Hospital Death ◽

Stroke Patients ◽

Troponin Elevation ◽

Changes Over Time ◽

Over Time

Background: Among patients hospitalized for acute ischemic stroke, abnormal serum troponins are associated with higher risk of short-term mortality. However, most findings have been reported from European hospitals. Whether troponin elevation after stroke is independently associated with death among a more heterogeneous US population remains unclear. Furthermore, only a few studies have evaluated the association between the magnitude of troponin elevation and subsequent mortality, patterns of dynamic troponin changes over time, or whether troponin elevation is related to specific causes of death. Methods: Using data collected in the American Heart Association's ‘Get With The Guidelines' stroke registry between 2008 and 2012 at a tertiary care US hospital, we used logistic regression to evaluate the independent relationship between troponin elevation and mortality after adjusting for demographic and clinical characteristics. We then assessed whether the magnitude of troponin elevation was related to in-hospital mortality by calculating mortality rates according to tertiles of peak troponin levels. Dynamic troponin changes over time were evaluated as well. To better understand whether troponin elevation identified patients most likely to die due to a specific cause of death, investigators blinded from troponin values reviewed all in-hospital deaths, and the association between troponin elevation and mortality was evaluated among patients with cardiac, neurologic, or other causes of death. Results: Of 1,145 ischemic stroke patients, 199 (17%) had elevated troponin levels. Troponin-positive patients had more cardiovascular risk factors, more intensive medical therapy, and greater use of cardiac procedures. These individuals had higher in-hospital mortality rates than troponin-negative patients (27 vs. 8%, p < 0.001), and this association persisted after adjustment for 13 clinical and management variables (OR 4.28, 95% CI 2.40-7.63). Any troponin elevation was associated with higher mortality, even at very low peak troponin levels (mortality rates 24-29% across tertiles of troponin). Patients with persistently rising troponin levels had fewer anticoagulant and antiatherosclerotic therapies, with markedly worse outcomes. Furthermore, troponin-positive patients had higher rates of all categories of death: neurologic (17 vs. 7%), cardiac (5 vs. <1%), and other causes of death (5 vs. <1%; p < 0.001 for all comparisons). Conclusions: Ischemic stroke patients with abnormal troponin levels are at higher risk of in-hospital death, even after accounting for demographic and clinical characteristics, and any degree of troponin elevation identifies this higher level of risk. Troponins that continue to rise during the hospitalization identify stroke patients at markedly higher risk of mortality, and both neurologic and non-neurologically mediated mortality rates are higher when troponin is elevated.

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Epidemiology, disease spectrum and economic burden of non-typhoidal Salmonella infections in Taiwan, 2006–2008

Epidemiology and Infection ◽

10.1017/s0950268812000088 ◽

2012 ◽

Vol 140 (12) ◽

pp. 2256-2263 ◽

Cited By ~ 15

Author(s):

P. L. CHEN ◽

C. Y. LI ◽

T. H. HSIEH ◽

C. M. CHANG ◽

H. C. LEE ◽

...

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Economic Burden ◽

Clinical Characteristics ◽

The Elderly ◽

Hospital Data ◽

Disease Spectrum ◽

Salmonella Infections ◽

High Incidence ◽

Taiwan National Health Insurance

SUMMARYThe purpose of this study was to understand the seasonal, geographical and clinical characteristics of Taiwanese patients hospitalized for non-typhoidal Salmonella (NTS) infections and their economic burden. Hospital data obtained from the Taiwan National Health Insurance (NHI) database between 2006 and 2008 were analysed. Infants had the highest annual incidence of 525 cases/100 000 person-years. Elderly patients aged >70 years had the highest in-hospital mortality rate (2·6%). Most (82·6%) gastroenteritis occurred in children aged <10 years. Septicaemia, pneumonia, arthritis and osteomyelitis occurred mainly in patients aged >50 years. A median medical cost for NTS-associated hospitalizations was higher for patients with septicaemia than for those with gastroenteritis. Seasonal variation of NTS-associated hospitalizations was correlated with temperature in different areas of Taiwan. In summary, infants had a high incidence of NTS-associated hospitalizations. However, the elderly had a higher in-hospital mortality rate and more invasive NTS infections than children.

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Predictive determinants of overall survival among re-infected COVID-19 patients using the elastic-net regularized Cox proportional hazards model: a machine-learning algorithm

10.21203/rs.3.rs-371941/v1 ◽

2021 ◽

Author(s):

Vahid Ebrahimi ◽

Mehrdad Sharifi ◽

Razieh Sadat Mousavi-Roknabadi ◽

Robab Sadegh ◽

Mohammad Hossein Khademian ◽

...

Keyword(s):

Machine Learning ◽

Overall Survival ◽

Mortality Rate ◽

Serum Creatinine ◽

Hospital Mortality ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Elastic Net ◽

Hospital Death ◽

Wbc Count

Abstract Background: Narrowing a large set of features to a smaller one can improve our understanding of the main risk factors for in-hospital mortality in patients with COVID-19. This study aimed to derive a parsimonious model for predicting overall survival (OS) among re-infected COVID-19 patients using machine-learning (ML) algorithms.Methods: The retrospective data of 283 re-infected COVID-19 patients admitted to twenty-six medical centers (affiliated with Shiraz University of Medical Sciences) from 10 June to 26 December 2020 were reviewed and analyzed. An elastic-net regularized Cox proportional hazards (PH) regression and model approximation via backward elimination were utilized to optimize a predictive model of time to in-hospital death. Then, the model was reduced to its core features to maximize simplicity and generalizability.Results: The empirical in-hospital mortality rate among the re-infected COVID-19 patients was obtained as 9.5%. In addition, the mortality rate among the intubated patients was 83.5%. Using the Kaplan-Meier approach, the OS (95% CI) rates for days 7, 14, and 21 were 87.5% (81.6-91.6%), 78.3% (65.0-87.0%), and 52.2% (20.3-76.7%), respectively. The elastic-net Cox PH regression retained 8 out of 35 candidate features of death. Transfer by Emergency Medical Services (EMS) (HR=3.90, 95% CI: 1.63-9.48), SpO2≤85% (HR=8.10, 95% CI: 2.97-22.00), increased serum creatinine (HR=1.85, 95% CI: 1.48-2.30), and increased white blood cells (WBC) count (HR=1.10, 95% CI: 1.03-1.15) were associated with higher in-hospital mortality rates in the re-infected COVID-19 patients.Conclusion: The results of the ML analysis demonstrated that transfer by EMS, profound hypoxemia (SpO2≤85%), increased serum creatinine (more than 1.6 mg/dL), and increased WBC count (more than 8.5 (×109 cells/L)) reduced the OS of the re-infected COVID-19 patients.

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Does Risk Calculator by Nationwide Survey Match The Postoperative Outcome in Patients Who Underwent Major Hepatectomy?

10.21203/rs.3.rs-76187/v1 ◽

2020 ◽

Author(s):

Atsushi Nanashima ◽

Naoya Imamura ◽

Masahide Hiyoshi ◽

Koichi Yano ◽

Takeomi Hamada ◽

...

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

High Mortality ◽

Major Hepatectomy ◽

Nationwide Survey ◽

Hospital Death ◽

Risk Calculator ◽

Biliary Malignancy ◽

Co Morbidity ◽

Hepatobiliary Diseases

Abstract Background: To clarify significance of the present National Clinical Database risk calculator (NCD-RC) for hepatectomy in Japan, relationship between perioperative parameters or outcomes in major hepatectomy and the mortality rate by NCD-RC was examined. Methods: Patient demographics, co-morbidity, surgical records, postoperative morbidity or mortality were examined and compared to the 30 days- or in-hospital-mortality rate among 55 patients with hepatobiliary diseases who underwent hemi- or more-extended hepatectomy and central (segment 458) hepatectomy. The cut-off percent for high risk mortality before hepatectomy was set at 5% in this period. Results: In-hospital morbidity over CD III was 17 (28%), The 30-day mortality and in-hospital mortality was nil and two (3%), respectively. Male patient showed significantly higher in-hospital mortality rate (p<0.01). In the 37 patients (group woML), mean age was 67.8±8.7 years old ranging 45 and 84. Others included A) with severe complications or mortality in whom low mortality rate (group wML, n=13), B) without severe complications neither mortality in whom high mortality rate (group woMH, n=7), and C) with severe complications or mortality in whom high mortality rate (group wMH, n=4 (6.5%)). Age, distribution of elderly patients, gender, the hepatobiliary diseases and the prevalence of preoperative co-morbidity were not significantly different between groups. In the group wML, the bile leakage was dominant and, however, the in-hospital death was not observed. In the group wMH, all operations were right hepatectomy with bile duct resection (RH-BDR) for biliary malignancy and two died of hepatic failure and, however, the prevalence of RH-BDR was not significantly higher in comparison with other groups. Conclusions: Predictive mortality rate by risk calculator under nationwide survey did not always match with patient outcomes in the actual clinical setting and further improvement will be required. In case of RH-BDR for biliary malignancy with high predictive rate, the careful perioperative managements is important under the present nationwide database.

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The Attributable Mortality of Sepsis for Acute Kidney Injury: A Propensity Score Matched Study

10.21203/rs.3.rs-699907/v1 ◽

2021 ◽

Author(s):

Huimiao Jia ◽

Yijia Jiang ◽

Xi Zheng ◽

Wen Li ◽

Meiping Wang ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Mortality Rate ◽

Propensity Score ◽

Hospital Mortality ◽

Excess Mortality ◽

Kidney Injury ◽

Attributable Mortality ◽

Hospital Death ◽

Significant Difference

Abstract Background: Both sepsis and AKI are diseases of major concern in intensive care unit (ICU). This study aimed to evaluate the excess mortality attributable to sepsis for acute kidney injury (AKI).Methods: A propensity score-matched analysis of a prospective cohort study about sepsis epidemiology in 18 Chinese ICUs (January 2014-August 2015) was performed (registration number: ChiCTR-ECH-13003934). Propensity score model was sequentially conducted to match AKI patients with and without sepsis on day 1, day 2, and day 3-5. The primary outcome was hospital death of AKI patients. Propensity score-matched analyses were conducted to estimate the excess mortality attributable to sepsis for AKI. Results: A total of 2008 AKI patients (40.9%) were eligible for the study. Of the 1010 AKI patients with sepsis, 619 (61.3%) were matched to 619 AKI patients in whom sepsis did not develop during the screening period of the study. The hospital mortality rate of matched AKI patients with sepsis was 205 of 619 (33.1%) compared with 150 of 619 (24.0%) for their matched AKI controls without sepsis (p = 0.001). The attributable mortality of total sepsis for AKI patients was 9.1% (95% CI 4.8-13.3%). Matched AKI patients with and without sepsis were subgrouped according to the severity of sepsis (sepsis, septic shock). Of the matched patients with sepsis, 328 (53.0%) diagnosed septic shock. The mortality rate showed remarkably higher in matched AKI patients with septic shock (43.9%) than their controls of patients without sepsis (27.7%). The attributable mortality of septic shock for AKI was 16.2% (95% CI 11.3-20.8%, p < 0.001). Further, the attributable mortality of sepsis for AKI was 1.4% (95% CI 4.1-5.9%, p = 0.825), although there was no significant difference of mortality rate observed between matched AKI patients with and without sepsis (21.0% vs. 19.6%).Conclusions: The attributable hospital mortality of total sepsis for AKI were 9.1%. Septic shock contributes to major excess mortality rate for AKI than sepsis.

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Abstract 208: Racial Disparities Affect In-hospital Mortality Rates Following Coronary Artery Bypass Grafting Among Patients With End-stage Renal Disease

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.208 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Alexander V Sergeev

Keyword(s):

Coronary Artery ◽

Mortality Rate ◽

Hospital Mortality ◽

Racial Disparities ◽

Artery Bypass ◽

Mortality Rates ◽

Hospital Death ◽

Asian Patients ◽

Stage Renal Disease ◽

Esrd Patients

Background: Coronary artery disease (CAD) is the leading cause of death among patients with end-stage renal disease (ESRD). ESRD patients are at a higher risk of coronary artery bypass grafting (CABG) perioperative mortality than their non-ESRD counterparts. The extent and the mechanisms of racial disparities in post-CABG outcomes among ESRD patients remain unclear. Hypothesis: We hypothesized that post-CABG in-hospital mortality in ESRD patients is affected by patients’ race. Methods: We conducted a retrospective cohort study of post-CABG in-hospital mortality among 6,590 CAD patients with ESRD during the period of 2007-2011 [mean±SD age: 64.8±11.13 years; 67.8% (4,468 of 6,590) males]. Most of the patients were white (66.0%; 4,347 of 6,590), 21.7% (1,432 of 6,590) were black, 11.0% (725 of 6,590) were Asian, and 1.3% (86 of 6,590) were American Indian. In-hospital death was defined as a binary outcome (discharged alive or deceased) due to a relatively short length of stay. Adjusted odds ratios (OR) for in-hospital death after CABG in relation to patients’ race, adjusting for major clinical and demographic covariates, were obtained with multivariable logistic regression. Results: Unadjusted (crude) post-CABG in-hospital mortality rate in ESRD patients was 8.8% (579 of 6,590). Mortality rate was higher among patients admitted through emergency department (ED) than non-ED admitted patients: mortality rates 10.2% (221 of 2,169 ED admitted) and 8.1% (358 of 4,421 non-ED admitted), respectively ( P =0.0048). Deceased patients had more severe comorbidities and higher Elixhauser-Walraven comorbidity scores (12.6±6.7 points among deceased and 9.2±6.0 points among discharged alive; P <0.001). Blacks were more likely to experience an ED admission [with 39.2% (561 of 1,432) of blacks being ED admitted] than Asians (34.6%; 251 of 725 were ED admitted), whites (30.6%; 1,331 of 4,347 were ED admitted) or American Indians (30.2%; 26 of 86 were ED admitted). In the adjusted multivariable analysis, black patients had statistically significantly higher odds of post-CABG death than Asian patients (adjusted OR, 1.58; 95% CI, 1.09-2.30; P =0.0169). However, neither white patients (adjusted OR, 1.35; 95% CI, 0.96-1.89; P =0.0860) nor American Indian patients (adjusted OR, 2.16; 95% CI, 0.95-4.94; P =0.0676) had a statistically significantly higher risk of post-CABG death compared to Asian patients. Conclusions: Our findings indicate that racial disparities affect post-CABG in-hospital mortality rates in CAD patients with ESRD. Post-CABG mortality rate disparities may be attributed, at least partially, to racial disparities in severity of comorbidity and the type of admittance. Further studies investigating more detailed mechanisms responsible for these disparities are warranted.

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Abstract 18891: Racial Differences in End-of-life Care Associated With Heart Failure Hospitalizations in the United States: A Population-based Analysis From 2011-2012

Circulation ◽

10.1161/circ.132.suppl_3.18891 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Nilay Kumar ◽

Rohan Khera ◽

Neetika Garg

Keyword(s):

Parenteral Nutrition ◽

Hospital Mortality ◽

End Of Life ◽

Racial Differences ◽

The United States ◽

Hospital Death ◽

The Us ◽

Eol Care ◽

To Receive ◽

Racial Ethnic

Background and objectives: Racial disparities in healthcare delivery constitute a major public health problem in the US. There are few studies evaluating the effect of race on utilization of end-of-life (EOL) procedures in HF hospitalizations in the US. Hypothesis: Utilization of EOL procedures differs significantly between racial-ethnic groups independent of socioeconomic status (SES) or probability of in-hospital death. Methods: We used the 2011-2012 Nationwide/National Inpatient Sample to identify primary HF hospitalizations. EOL procedures of interest were intubation, tracheostomy and prolonged mechanical ventilation, hemodialysis, cardiopulmonary resuscitation, gastrostomy, enteral or parenteral nutrition. Relevant ICD-9 codes were used. We used residential ZIP code as a proxy for SES. Multivariate logistic models were used to evaluate racial differences in EOL care while adjusting for SES and probability of in-hospital mortality. Results: 375,740 hospitalizations representing 1.8 million hospitalizations nationwide were included in the study. Mean age was 72.6 (SD 14.6) years and 50.1% were women. Overall 7.81% were intubated, 0.69% underwent tracheostomy, and 6.55% underwent hemodialysis, 0.55% underwent CPR, 0.22% had a gastrostomy and 0.45% received enteral or parenteral nutrition. Blacks, Hispanics, Asians or Pacific Islanders and Other races were more likely to receive EOL procedures compared to Whites after adjusting for SES and probability of in-hospital death. (Fig) Use of any EOL procedure was associated with higher age and sex adjusted odds of in-hospital mortality (OR 6.54, 6.09 - 7.04; p<0.001) and average charges ($76,917 vs. 35,841, p<0.001). Conclusions: Racial-ethnic minorities hospitalized for HF are significantly more likely to receive aggressive EOL care compared to Whites. The reasons for racial differences in utilization of EOL care in HF should be investigated in future studies.

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