scholarly journals Length of stay, hospitalization cost, and in-hospital mortality in US adult inpatients with immune thrombocytopenic purpura, 2006–2012

2017 ◽  
Vol Volume 13 ◽  
pp. 15-21 ◽  
Author(s):  
Ruopeng An ◽  
Peizhong Wang
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Immune Thrombocytopenic Purpura ◽  
Thrombocytopenic Purpura ◽  
Hospitalization Cost

Abstract 4353: Economic Burden of Prolonged Hyponatremia in Patients Admitted with Congestive Hear Failure (CHF) and Hyponatremia

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ying P Tabak ◽  
Marya Zilberberg ◽  
James Spalding ◽  
Xiaowu Sun ◽  
Yan Liu ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Economic Burden ◽  
Excess Cost ◽  
Electrolyte Abnormality ◽  
Hospitalization Cost ◽  
Hospital Survival ◽  
Significant Difference ◽  
Multivariable Regression ◽  
Favorable Group

Introduction : Hyponatremia is a common electrolyte abnormality present in patients hospitalized with CHF. Hypothesis : We sought to evaluate that the rate of correction of hyponatremia impacts the length of stay (LOS) and associated hospitalization cost. Methods : We analyzed 9,427 hyponatremic (Na<135 mEq/L) CHF patients hospitalized in 2003–2006 across 72 hospitals. Based on evaluation of hospital survival, we found a lower mortality with a Na rate of rise in the first 48 hours of 1– 6 mEq/L (favorable group). We conducted multivariable regression to estimate the effect of Na management on LOS and cost, controlling for baseline Na, admission severity, mortality status, and interaction of severity and mortality. Hospitalization cost was calculated by hospital and calendar year using the Center for Medicare and Medicaid Services (CMS) cost/charge ratios. Findings : The overall in-hospital mortality was 5.7%. The rate of favorable Na management within 48 hours of hospitalization was 60% (n=5,647). About 38% (n=3,557) patients had hyponatremia status unchanged or further deteriorated from baseline (prolonged hyponatremia). Another 2% (n=218) had Na corrected more than 7.0 mEq/L. After adjusting for confounders, the prolonged hyponatremia group showed 0.71 day increase in the LOS (95% CI: 0.45, 0.97 days; p<.0001) and $1,324 excess cost (95% CI: $569, $2,079; p<.001). The overcorrection group did not show significant difference in LOS and cost from the favorable Na group. Conclusions : Only 60% CHF patients with admission hyponatremia are managed favorably in regards to the rate of serum Na correction. The adjusted mean marginal excess LOS of prolonged hyponatremia is about 1 day and the excess cost is over $1,300. Recognition and institution of measures to insure an appropriate and predictable rate of Na correction are needed in order to improve economic outcomes among hyponatremic patients with CHF.

scholarly journals Epidemiology and Outcomes of Patients With Healthcare Facility–Onset Clostridioides difficile Infection

2021 ◽  
Author(s):  
Matthew D Eberly ◽  
Apryl Susi ◽  
Daniel J Adams ◽  
Christopher S Love ◽  
Cade M Nylund
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Costs ◽  
Healthcare Facility ◽  
Case Mix ◽  
Cross Sectional ◽  
Military Health ◽  
Hospitalization Cost ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

ABSTRACT Background Clostridioides difficile infection (CDI) has become a rising public health threat. Our study aims to characterize the epidemiology and measure the attributable cost, length of stay, and in-hospital mortality of healthcare facility–onset Clostridioides difficile infection (HO-CDI) among patients in the U.S. Military Health System (MHS). Methods We performed a case–control and cross-sectional inpatient study of HO-CDI using MHS database billing records. Cases included those who were at least 18 years of age admitted to a military treatment facility with a stool sample positive for C. difficile obtained &gt;3 days after admission. Risk factors in the preceding year were identified. Patient case-mix adjusted outcomes including in-hospital mortality, length of stay, and hospitalization cost were evaluated by high-dimensional propensity score adjusted logistic regression. Results Among 474,518 admissions within the MHS from 2008 to 2015, we identified 591 (0.12%) patients with HO-CDI and found a significant increase in the trend of HO-CDI over the 7-year study period (P &lt; .001). Patients with HO-CDI had significantly higher hospitalization cost (attributable difference $66,044, P &lt; .001), prolonged hospital stay (attributable difference 12.4 days, P &lt; 0.001), and increased odds of in-hospital mortality (case-mix adjusted odds ratio 1.98; 95% CI, 1.43-2.74). Conclusions Healthcare facility–onset Clostridioides difficile infection is rising in patients within the MHS and is associated with increased length of stay, hospital costs, and in-hospital mortality. We identified a significantly increased burden of hospitalization among patients admitted with HO-CDI, highlighting the importance of infection control and antimicrobial stewardship initiatives aimed at decreasing the spread of this pathogen.

scholarly journals Elective Splenectomy in Immune Thrombocytopenic Purpura: An Analysis of National Inpatient Sample (NIS) Database between Years 2006 and 2014

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4672-4672
Author(s):  
Sunny R K Singh ◽  
Sindhu Malapati ◽  
Rohit Kumar ◽  
Prasanth Lingamaneni ◽  
Leila Khaddour ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Immune Thrombocytopenic Purpura ◽  
Charlson Comorbidity Index ◽  
Geographic Region ◽  
Teaching Hospitals ◽  
Insurance Status ◽  
Inpatient Mortality ◽  
Thrombocytopenic Purpura ◽  
Comorbidity Index ◽  
Income Quartile

Background: Over the years, splenectomy has dropped out of favor as a treatment option for Immune Thrombocytopenic Purpura (ITP) and is now considered only for patients who have failed multiple lines of therapy. One of the major concerns is surgical morbidity. We aim to study in-hospital outcomes following elective splenectomy in this population Methods: This is a retrospective cohort analysis of NIS database (years 2006 to 2014). Patients ≥18 years of age, who had an elective admission associated with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) procedure code for splenectomy were included in the study. Our cohort of interest was patients with ITP who underwent elective splenectomy (ITP ES). ICD-9-CM diagnosis codes were used to identify patients with ITP. All other patients who underwent elective splenectomy were labeled as non-ITP ES. Utilization of intensive care services was identified by procedure codes associated with vasopressor use, cardiopulmonary resuscitation, mechanical ventilation and initiation of dialysis in the absence of pre-existing end stage renal disease. Primary outcome was inpatient mortality and secondary outcome was length of stay (LOS). Associated factors were analyzed using multivariate logistic regression analysis. A p-value <0.05 was considered significant. We used STATA for statistical analysis. Results: A total of 102,698 admissions for elective splenectomies (ES) in adults were identified between the years 2006 and 2014,of which 11.36% (n= 11,668) were ITP ES. Inpatient mortality and mean LOS for all patients undergoing ES was 2.53% and 8.51 days respectively. Inpatient mortality and mean LOS in the ITP ES cohort was 0.86% and 4.37 days respectively. In the entire cohort of ES, inpatient mortality was lower in those with ITP versus non-ITP (OR 0.36, p<0.001). Also females had lower mortality when compared to men (OR 0.50, p<0.001). Inpatient mortality was higher with increasing age (OR 1.03, p<0.001) and Charlson Comorbidity Index (CCI) ≥3 vs 0 (OR 1.54, p <0.001). Mean length of stay was lower in those with ITP vs non ITP by 3.3 days (p<0.001). Within the ITP-ES cohort, mortality was higher with increasing age (OR 1.12, p <0.001), CCI ≥3 vs 0 (OR 18.39, p< 0.0001) and CCI 2 vs 0 (OR 8.61, p 0.008). Inpatient mortality was lower in teaching hospitals compared to non-teaching hospitals with a trend towards significance (OR 0.35, p 0.05). Gender, insurance status, income quartile, geographic region and hospital size did not affect odds of inpatient mortality in this cohort. Length of stay (LOS) in ITP ES cohort had positive correlation with age (coefficient 0.038, p<0.001), income quartile 51-75th vs 0-25th percentile (coefficient 0.81, p 0.03), CCI ≥3 vs 0 (coefficient 3.29, p<0.001), CCI 2 vs 0 (coefficient 2.11, p<0.001), CCI 1 vs 0 (coefficient 0.86, p<0.001). There was no association of gender, insurance status and geographic region with LOS within this cohort. Conclusion: Inpatient mortality and length of stay in admissions for elective splenectomy was significantly lower in ITP patients compared to non ITP patients. Also, in ITP patients undergoing elective splenectomy, older age and a charlson comorbidity index of 2 or above were associated with higher odds of dying in the same admission.These findings from real world data have practical implications for clinicians and patients, as they weigh the pros and cons of splenectomy as a treatment option for ITP. Table Disclosures Donthireddy: Viracta: Other: PI for Clinical Trial.

scholarly journals Immune Thrombocytopenic Purpura (ITP) as an Uncommon Extraintestinal Complication of Crohn’s Disease: Case Vignette and Systematic Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Raisa Epistola ◽  
Tiffanie Do ◽  
Ritika Vankina ◽  
Daniel Wu ◽  
James Yeh ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Immune Thrombocytopenic Purpura ◽  
Case Reports ◽  
Case Vignette ◽  
Mucosal Permeability ◽  
Extraintestinal Manifestation ◽  
Thrombocytopenic Purpura ◽  
Disease Case ◽  
Inflammatory Bowel

While the association of immune thrombocytopenic purpura (ITP) and inflammatory bowel disease (IBD) has been described in a few case reports, management of ITP as an extraintestinal manifestation of Crohn’s disease (CD) is less studied. There are approximately a dozen cases describing the management of patients dually diagnosed with CD/ITP. Previous reports postulated that the mechanism of ITP in CD was through the presence of circulating immune complexes in the serum and antigenic mimicry due to increased mucosal permeability in active colitis, versus increased mucosal production of TH1-type proinflammatory cytokines during CD flares, which may account for remission of ITP with surgery for CD. We present a case of a 27-year-old man who presented with medically refractory CD and ITP who responded to surgical management with colectomy and splenectomy, along with a systematic review of the literature. These cases suggest that colectomy should be considered in the treatment of medically refractory ITP among patients with concomitant CD.

scholarly journals Experience with protein A-immunoadsorption in treatment-resistant adult immune thrombocytopenic purpura

Blood ◽  
1992 ◽  
Vol 79 (9) ◽  
pp. 2237-2245 ◽  
Author(s):  
HW Snyder ◽  
SK Cochran ◽  
JP Balint ◽  
JH Bertram ◽  
A Mittelman ◽  
...  
Keyword(s):  
Side Effects ◽  
Immune Thrombocytopenic Purpura ◽  
Protein A ◽  
Staphylococcal Protein A ◽  
Treatment Resistant ◽  
Thrombocytopenic Purpura ◽  
Specific Serum ◽  
Clinical Responses ◽  
Acute Increase

Abstract Extracorporeal immunoadsorption of plasma to remove IgG and circulating immune complexes (CIC) was evaluated as a therapy for adults with treatment-resistant immune thrombocytopenic purpura (ITP). Seventy-two patients with initial platelet counts less than 50,000/microL who had failed at least two other therapies were studied. They received an average of six treatments of 0.25 to 2.0 L plasma per procedure over a 2- to 3-week period using columns of staphylococcal protein A-silica (PROSORBA immunoadsorption treatment columns; IMRE Corp, Seattle, WA). The treatments caused an acute increase in the platelet count to greater than 100,000/microL in 18 patients and to 50,000 to 100,000/microL in 15 patients. The median time to response was 2 weeks. Responses were transient (less than 1 month duration) in seven of those patients (10%), but no additional relapses were reported over a follow- up period of up to 26 months (mean of 8 months). Clinical responses were associated with significant decreases in specific serum platelet autoantibodies (including anti-glycoprotein IIb/IIIa), platelet- associated Ig, and CIC. Thirty percent of treatments were associated with transient mild to moderate side effects usually presenting as a hypersensitivity-type reaction. Continued administration of failed therapies for ITP, which always included low-dose corticosteroids (less than or equal to 30 mg/d), had no demonstrable influence on the effectiveness of immunoadsorption treatment but did depress the incidence and severity of side effects. The degree of effectiveness of protein A immunoadsorption therapy in patients with treatment-resistant ITP is promising and further controlled studies in this patient population are warranted.

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