Liver Cirrhosis Mortality Worldwide: in Hospital Factors Associated?

Intro: Thrombosis risk is increased during pregnancy and puerperium. There are no recent data on nationwide trends in thrombotic events during the delivery period. Objective: To determine risk factors for thrombotic events in women hospitalized for deliveries. Methods: Data from the Nationwide Inpatient Sample (2000-2010) were used to identify deliveries. Weighted proportion of pregnancy hospitalizations with comorbid thrombotic events, including TIA, ischemic stroke, hemorrhagic stroke, acute MI, and venous thromboembolism, was determined. Poisson regression was used to identify risk factors for thrombotic events. The first multivariable model adjusted for sociodemographic and hospital factors. The second model in addition adjusted for comorbid conditions. Results: There were 4,305,561 women hospitalized for delivery (21.5 million US deliveries), of which 7,242 (0.17%) had thrombotic events in the peripartum period. From 2000-2010, there was an increase in deliveries with associated thrombotic events observed from 7.46/10K to 34.8/10K. Compared to 2000, deliveries with thromboses was 8-fold more likely in 2010 (RR 7.94, 95% CI 1.98-31.93). There was no significant difference in rates from 2000 to 2010 after adjustment for sociodemographic and hospital factors. From 2000-2010, pregnant women with thrombotic events were older, more likely to be White, to smoke, to lack insurance, to be admitted to rural hospitals, and to be admitted in the South or Midwest. After multivariable adjustment for sociodemographics, hospital factors, and comorbidities, admissions in the South (RR 1.26, 95% CI 1.02-1.55) or Midwest (1.33, 95% CI 1.05-1.68), atrial fibrillation (1.28, 95% CI 1.01-1.62), pre-/eclampsia (5.78, 95% CI 4.37-7.66), dyslipidemia (1.72, 95% CI 1.42-2.09), atrial septal defect (14.38, 95% CI 6.76-30.58), and valvular heart disease (1.67, 95% CI 1.25-2.24) were independently associated with higher risk of thrombotic events. Conclusions: From 2000-2010, there was a sizeable increase in deliveries with associated thrombosis. Identification of factors associated with thrombotic events for women hospitalized for normal pregnancies will aid in targeted interventions to screen for, prevent and treat thrombosis related to pregnancy.

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MO785CAUSES OF THE DELAY IN CREATING PERMANENT VASCULAR ACCESS IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab103.0023 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Abdulla Al-Sayyari

Keyword(s):

Vascular Access ◽

Venous Catheter ◽

Cross Sectional ◽

Factors Associated ◽

Practical Concern ◽

Significant Difference ◽

Patient Noncompliance ◽

Hospital Factors ◽

Patient Factor ◽

Main Factor

Abstract Background and Aims Many patients start HD with central venous catheter (CVC) which has multiple complications This study aims at identifying the physicians’ perspectives regarding the reasons of delayed AVF creation Method This is a cross-sectional questionnaires-based survey designed at discovering the physicians' opinions and perception about the reasons for the delay in the creation of permanent vascular access and patient’s factors, physicians factors, and hospital factors leading to this delay, Results There was a total of 212 participants, of whom 131 (61.8%) were of consultant level. The three most important factors associated with delay in AVF creation were “denial of kidney disease or the need of AVF” (76.4%), “dialysis fears and practical concern” (75.9%) and “the patient refusing to undergo AVF surgery” (73.1%). Significantly fewer consultants (42.7%) than below consultants (45.7%) pointed out that “patient noncompliance with nephrology appointments” was a significant factor (p=0.046). The most important physicians & hospital factors was “insufficient conduction of pre-dialysis care and education about AVF initiation to the patient (63.7%) The respondents were asked to choose one of four possible factors that they felt was the main factor in delaying AVF creation. Over two thirds (68.4%) chose the patient factor as the main factor There was no significant difference in this response whether the respondents were consultants or below consultants (p=0.8)) Conclusion The most agreed on factors associated with AVF creation delay are the denial of the need for dialysis, fear of dialysis and practical concern, insufficient conduction of pre-dialysis care and education about AVF initiation to the patient, and late referral to a nephrologist. a validated approach to patients' selection and referral to vascular access creation that could be applied on different types of patient in different regions is required .

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Abstract 106: Determinants of Fluoroscopy time in Veterans Undergoing Cardiac Catheterization Procedures: Insights from the National VA Clinical Assessment, Reporting and Tracking (CART) Program

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a106 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Thomas T Tsai ◽

Lauren Pointer ◽

Michael P Ho ◽

Reza Fazel ◽

Brahmajee K Nallamothu ◽

...

Keyword(s):

Radiation Exposure ◽

Cardiac Catheterization ◽

Bypass Graft ◽

Arterial Disease ◽

National Registry ◽

Fluoroscopy Time ◽

Factors Associated ◽

Improvement Programs ◽

Hospital Factors ◽

Peripheral Arterial

Background: Radiation exposure to Veterans from invasive cardiac procedures is high and accounts for a substantial proportion of their overall exposure from medical imaging. The patient, provider and hospital factors associated with increased fluoroscopy time are unclear. Methods: From the National VA CART program database of catheterization laboratories, we evaluated the distribution of fluoroscopy time in patients undergoing coronary angiography (CA), bypass graft angiography (BGA) and/or PCI. Using multivariable logistic regression, we evaluated the patient, provider and hospital factors associated with the highest quartile of fluoroscopy time. Results: We examined 87,658 CA, BGA and PCI procedures performed by 362 operators at 58 VA facilities from 2007 through 2010. There is wide variation in fluoroscopy time by operator regardless of procedure performed (Table 1). Multiple patient, provider and hospital factors were associated with fluoroscopy times in the highest quartile. Patient factors included age and a history of peripheral arterial disease; provider factors included operator volume and experience; and hospital factors included whether or not they were associated with a teaching program. Conclusion: In a large VA national registry of all cardiac catheterization procedures, fluoroscopy time is highly variable and dependent on multiple factors, many of which may be modifiable. Quality improvement programs targeted at modifiable behaviors may lead to decreased fluoroscopy times and thus radiation exposure for our veterans.

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Factors associated with renal dysfunction in hepatitis C-related cirrhosis and its correlation with Child-Pugh score

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2019-000286 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000286 ◽

Cited By ~ 1

Author(s):

Hamza Waqar Bhatti ◽

Umama Tahir ◽

Noman Ahmed Chaudhary ◽

Sania Bhatti ◽

Muhammad Hafeez ◽

...

Keyword(s):

Liver Cirrhosis ◽

Hepatitis C ◽

Serum Creatinine ◽

Renal Dysfunction ◽

Cross Sectional Study ◽

Military Hospital ◽

Cross Sectional ◽

Disease Epidemiology ◽

Factors Associated ◽

Level Of Significance

ObjectivesTo assess factors associated with renal dysfunction (RD) in hepatitis C virus (HCV) cirrhosis, correlate renal parameters with Child-Pugh score (CPS) and find a cut-off value of CPS to determine RD.Materials and methodsIt was a cross-sectional study that included 70 cases of liver cirrhosis secondary to HCV from a period of 6 months at Combined Military Hospital, Multan. Diagnosis of HCV was confirmed by serological assay and liver cirrhosis by ultrasonography. CPS was determined and lab reports were taken. Patients were divided into two groups as not having RD (serum creatinine≤1.5 mg/dL) and having RD (serum creatinine≥1.5 mg/dL). Estimated glomerular filtration rate (eGFR) was calculated by chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Data were analyzed using SPSS V.23.0. χ2, Kruskal-Wallis test and Pearson coefficient of correlation were applied. ROC curve was drawn to evaluate cut-off value of CPS for the presence of RD. Level of significance was set at p<0.05.ResultsPatients with CP grade B or C develop RD as compared to patients with CP grade A (p=0.000). Mean age, urea, creatinine and eGFR varies significantly among patients who develop RD and patients who do not (p=0.02, p=0.000, p=0.000 and p=0.000, respectively). eGFR negatively correlates with CPS (r=−0.359, p=0.002). Creatinine, urea and ALBI score positively correlates with CPS (r=+0.417, p=0.000; r=+0.757, p=0.000; r=+0.362, p=0.002, respectively).ConclusionAscites and encephalopathy are associated with RD in HCV cirrhosis.

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