Circulatory Shock among Hospitalized Patients for Salicylate Intoxication

Background: This study aimed to evaluate the risk factors for circulatory shock and its impact on outcomes in patients hospitalized for salicylate intoxication. Methods: We used the National Inpatient Sample to identify patients hospitalized primarily for salicylate intoxication from 2003–2014. Circulatory shock was identified based on hospital diagnosis code for any type of shock or hypotension. We compared clinical characteristics, in-hospital treatments, outcomes, and resource use between patients with and without circulatory shock associated with salicylate intoxication. Results: Of 13,805 hospital admissions for salicylate intoxication, circulatory shock developed in 484 (4%) admissions. Risk factors for development of circulatory shock included older age, female sex, concurrent psychotropic medication overdose, anemia, congestive heart failure, volume depletion, rhabdomyolysis, seizure, gastrointestinal bleeding, and sepsis. Circulatory shock was significantly associated with increased odds of any organ failure and in-hospital mortality. Length of hospital stay and hospitalization cost was significantly higher in patients with circulatory shock. Conclusion: Approximately 4% of patients admitted for salicylate intoxication developed circulatory shock. Circulatory shock was associated with worse clinical outcomes and increased resource use.

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Impact of Acute Kidney Injury on Outcomes of Hospitalizations for Heat Stroke in the United States

Diseases ◽

10.3390/diseases8030028 ◽

2020 ◽

Vol 8 (3) ◽

pp. 28

Author(s):

Charat Thongprayoon ◽

Fawad Qureshi ◽

Tananchai Petnak ◽

Wisit Cheungpasitporn ◽

Api Chewcharat ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Resource Utilization ◽

Hospital Admissions ◽

Heat Stroke ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

The United States

This study aims to evaluate the risk factors and the association of acute kidney injury with treatments, complications, outcomes, and resource utilization in patients hospitalized for heat stroke in the United States. Hospitalized patients from years 2003 to 2014 with a primary diagnosis of heat stroke were identified in the National Inpatient Sample dataset. End stage kidney disease patients were excluded. The occurrence of acute kidney injury during hospitalization was identified using the hospital diagnosis code. The associations between acute kidney injury and clinical characteristics, in-hospital treatments, outcomes, and resource utilization were assessed using multivariable analyses. A total of 3346 hospital admissions were included in the analysis. Acute kidney injury occurred in 1206 (36%) admissions, of which 49 (1.5%) required dialysis. The risk factors for acute kidney injury included age 20–39 years, African American race, obesity, chronic kidney disease, congestive heart failure, and rhabdomyolysis, whereas age <20 or ≥60 years were associated with lower risk of acute kidney injury. The need for mechanical ventilation and blood transfusion was higher when acute kidney injury occurred. Acute kidney injury was associated with electrolyte and acid-base derangements, sepsis, acute myocardial infarction, ventricular arrhythmia or cardiac arrest, respiratory, circulatory, liver, neurological, hematological failure, and in-hospital mortality. Length of hospital stay and hospitalization cost were higher in acute kidney injury patients. Approximately one third of heat stroke patients developed acute kidney injury during hospitalization. Acute kidney injury was associated with several complications, and higher mortality and resource utilization.

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Rhabdomyolysis among hospitalized patients for salicylate intoxication in the United States: Nationwide inpatient sample 2003–2014

PLoS ONE ◽

10.1371/journal.pone.0248242 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248242

Author(s):

Wisit Kaewput ◽

Charat Thongprayoon ◽

Tananchai Petnak ◽

Wisit Cheungpasitporn ◽

Fawad Qureshi ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Hospital Stay ◽

Resource Utilization ◽

Clinical Characteristics ◽

The United States ◽

Hospitalized Patients ◽

Hospital Treatment ◽

Organ Systems ◽

Salicylate Intoxication

Introduction This study aimed to assess the risk factors and impact of rhabdomyolysis on treatments, outcomes, and resource utilization in hospitalized patients for salicylate intoxication in the United States. Materials and methods The National Inpatient Sample was utilized to identify hospitalized patients with a primary diagnosis of salicylate intoxication from 2003–2014. Rhabdomyolysis was identified using hospital diagnosis code. We compared the clinical characteristics, in-hospital treatment, outcomes, and resource utilization between patients with and without rhabdomyolysis. Results A total of 13,805 hospital admissions for salicylate intoxication were studied. Of these, rhabdomyolysis developed in 258 (1.9%) admissions. The risk factors for rhabdomyolysis were age>20 years, male sex, volume depletion, hypokalemia, sepsis, and seizure. After adjustment for baseline clinical characteristics, salicylate intoxication patients with rhabdomyolysis required more invasive mechanical ventilation, and renal replacement therapy. Rhabdomyolysis was significantly associated with higher risk of failure of any organ systems, and in-hospital mortality. Length of hospital stay and hospitalization cost were higher when rhabdomyolysis occurred during hospital stay. Conclusions Rhabdomyolysis was not common in hospitalized patients for salicylate intoxication but it was associated with increased morbidity, mortality, and resource utilization.

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Gastrointestinal Bleeding among Hospitalizations for Salicylate Poisoning in the United States

QJM ◽

10.1093/qjmed/hcab034 ◽

2021 ◽

Author(s):

Charat Thongprayoon ◽

Kamolyut Lapumnuaypol ◽

Wisit Kaewput ◽

Tananchai Petnak ◽

Fawad Qureshi ◽

...

Keyword(s):

Risk Factors ◽

Gastrointestinal Bleeding ◽

Resource Use ◽

Hospital Admissions ◽

Invasive Mechanical Ventilation ◽

Gastric Lavage ◽

The United States ◽

Red Blood Cell Transfusion ◽

Increased Risk ◽

Salicylate Poisoning

Abstract Background This study aimed to determine the incidence, as well as evaluate risk factors, and impact of gastrointestinal bleeding on outcomes and resource use in patients admitted for salicylate poisoning. Methods We used the National Inpatient Sample to construct a cohort of patients hospitalized primarily for salicylate poisoning from 2003-2014. We compared clinical characteristics, in-hospital treatments, outcomes, and resource use between salicylate poisoning patients with and without gastrointestinal bleeding. Results Of 13,805 hospital admissions for salicylate poisoning, gastrointestinal bleeding occurred in 482 (3.5%) admissions. The risk factors for gastrointestinal bleeding included older age, history of atrial fibrillation, and cirrhosis. After adjusting for difference in baseline characteristics, patients with gastrointestinal bleeding required more gastric lavage, gastrointestinal endoscopy, invasive mechanical ventilation, red blood cell transfusion. Gastrointestinal bleeding was significantly associated with increased risk of anemia, circulatory, liver, and hematological failure but was not significantly associated with increased in-hospital mortality. The length of hospital stay and hospitalization cost was significantly higher in patients with gastrointestinal bleeding. Conclusion Gastrointestinal bleeding occurred in about 4% of patients admitted for salicylate poisoning. Gastrointestinal bleeding was associated with higher morbidity and resource use but not mortality.

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Rhabdomyolysis-associated acute kidney injury: clinical characteristics and intensive care unit transfer analysis

10.21203/rs.3.rs-40084/v1 ◽

2020 ◽

Author(s):

Decai Zhu ◽

Wenyan Li ◽

Jiawen Zhang ◽

Junsheng Tong ◽

Wenyuan Xie ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Renal Function ◽

Intensive Care ◽

Clinical Characteristics ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

Icu Transfer ◽

Icu Treatment

Abstract Background: Rhabdomyolysis (RM) associated acute kidney injury (AKI) is the most common systemic complication of RM. The present study aimed to assess the clinical characteristics and risk factors for intensive care unit (ICU) transfer for patients with RM-associated AKI.Methods: We included all patients who were age ≥ 18 years old with a diagnosis of RM from September 2012 to October 2018 and divided them into RM-associated AKI group and RM without AKI group. The primary outcome was transferring to ICU treatment. Regression analysis was performed to identify factors associated with ICU treatment and recovery of renal function.Results: Among the 149 patients with RM, 68 (45.6%) developed AKI. The percentage of patients with AKI who transferred to ICU was higher than patients without AKI (33.8% versus 12.3%, P < 0.002). Additionally, patients with AKI had higher percentage of undergoing dialysis (19.1% versus 2.5%, P < 0.01), all-cause mortality (13.2% versus 1.2%, P < 0.01), cost of hospitalization [10.8 1,000 yuan, IQR (5.5, 3.5) versus 5.9 1,000 yuan, IQR 5.9 (3.6, 9.9), P = 0.03], as well as longer length of hospital stay [8.0 (5.0, 14.0)] versus [6.0 (4.0, 11.0)], P = 0.02). Moreover, most patients with AKI achieved complete recovery (77.9%) at discharge. After adjusting for potential risk factors, RM-associated AKI remained an independent risk factor for ICU transfer (OR = 3.0, 95% CI, 1.11–8.3, P = 0.03). However, ICU transfer was not associated with recovery of renal function (OR = 0.88, 95% CI, 0.22–3.57, P = 0.856).Conclusion: RM leaded to AKI in most patients. RM-associated AKI could cause worse clinical outcome and predict ICU transfer for patients with RM.

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Clinical characteristics and risk factors of preventable hospital readmissions within 30 days

Scientific Reports ◽

10.1038/s41598-021-99250-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Elsemieke A. I. M. Meurs ◽

Carl E. H. Siegert ◽

Elien Uitvlugt ◽

Najla El Morabet ◽

Ruth J. Stoffels ◽

...

Keyword(s):

Risk Factors ◽

Clinical Characteristics ◽

Hospital Admissions ◽

Outpatient Visit ◽

Economic Status ◽

Hospital Readmissions ◽

Medical Specialty ◽

Single Type ◽

Factors Associated ◽

Multidisciplinary Meetings

AbstractKnowledge regarding preventable hospital readmissions is scarce. Our aim was to compare the clinical characteristics of potentially preventable readmissions (PPRs) with non-PPRs. Additionally, we aimed to identify risk factors for PPRs. Our study included readmissions within 30 days after discharge from 1 of 7 hospital departments. Preventability was assessed by multidisciplinary meetings. Characteristics of the readmissions were collected and 23 risk factors were analyzed. Of the 1120 readmissions, 125 (11%) were PPRs. PPRs occurred equally among different departments (p = 0.21). 29.6% of PPRs were readmitted by a practitioner of a different medical specialty than the initial admission (IA) specialist. The PPR group had more readmissions within 7 days (PPR 54% vs. non-PPR 44%, p = 0.03). The median LOS was 1 day longer for PPRs (p = 0.16). Factors associated with PPR were higher age (p = 0.004), higher socio-economic status (p = 0.049), fewer prior hospital admissions (p = 0.004), and no outpatient visit prior to readmission (p = 0.025). This study found that PPRs can occur at any department in the hospital. There is not a single type of patient that can easily be pinpointed to be at risk of a PPR, probably due to the multifactorial nature of PPRs.

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The Clinical Characteristics of ARDS in Children With Hematological Neoplasms

Frontiers in Pediatrics ◽

10.3389/fped.2021.696594 ◽

2021 ◽

Vol 9 ◽

Author(s):

Qiao Zhang ◽

Wen-ting Hu ◽

Fan Yin ◽

Han Qian ◽

Ying Wang ◽

...

Keyword(s):

Risk Factors ◽

Hospital Stay ◽

Clinical Characteristics ◽

Length Of Hospital Stay ◽

Fluid Volume ◽

Survival Group ◽

Total Length ◽

Hematological Neoplasms ◽

Independent Risk Factors ◽

Overall Mortality

In order to explore the clinical characteristics of pediatric patients admitted to the pediatric intensive care unit (PICU) who suffered from hematological neoplasms complicated with acute respiratory distress syndrome (ARDS), we retrospectively analyzed 45 ARDS children with hematological neoplasms who were admitted to the PICU of Shanghai Children's Medical Center from January 1, 2014, to December 31, 2020. The 45 children were divided into a survival group and a non-survival group, a pulmonary ARDS group and an exogenous pulmonary ARDS group, and an agranulocytosis group and a non-agranulocytosis group, for statistical analysis. The main clinical manifestations were fever, cough, progressive dyspnea, and hypoxemia; 55.6% (25/45) of the children had multiple organ dysfunction syndrome (MODS). The overall mortality rate was 55.6% (25/45). The vasoactive inotropic score (VIS), pediatric critical illness scoring (PCIS), average fluid volume in the first 3 days and the first 7 days, and the incidence of MODS in the non-survival group were all significantly higher than those in the survival group (P < 0.05). However, total length of mechanical ventilation and length of hospital stay and PICU days in the non-survival group were significantly lower than those in the survival group (P < 0.05). The PCIS (OR = 0.832, P = 0.004) and the average fluid volume in the first 3 days (OR = 1.092, P = 0.025) were independent risk factors for predicting death. Children with exogenous pulmonary ARDS were more likely to have MODS than pulmonary ARDS (P < 0.05). The mean values of VIS, C-reactive protein (CRP), and procalcitonin (PCT) in children with exogenous pulmonary ARDS were also higher (P < 0.05). After multivariate analysis, PCT was independently related to exogenous pulmonary ARDS. The total length of hospital stay, peak inspiratory pressure (PIP), VIS, CRP, and PCT in the agranulocytosis group were significantly higher than those in the non-agranulocytosis group (P < 0.05). Last, CRP and PIP were independently related to agranulocytosis. In conclusion, children with hematological neoplasms complicated with ARDS had a high overall mortality and poor prognosis. Children complicated with MODS, positive fluid balance, and high VIS and PCIS scores were positively correlated with mortality. In particular, PCIS score and average fluid volume in the first 3 days were independent risk factors for predicting death. Children with exogenous pulmonary ARDS and children with agranulocytosis were in a severely infected status and more critically ill.

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What Lies Beneath: Clinical and Resource-use Characteristics of Institutionalized Older People. A Retrospective, Population-based Cohort Study in Catalonia

10.21203/rs.2.22586/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jordi Amblàs-Novellas ◽

Sebastià J. Santaeugènia Gonzàlez ◽

Emili Vela ◽

Montse Clèries ◽

Joan C. Contel

Keyword(s):

Health Care ◽

Older People ◽

Resource Use ◽

Clinical Characteristics ◽

Length Of Hospital Stay ◽

Administrative Database ◽

North East ◽

Use Of Resources ◽

Institutionalized Older People ◽

Annual Mortality

Abstract BackgroundPlanning population care in a specific health care setting requires deep knowledge of the clinical characteristics of the target care recipients, which tend to be country specific. Our area virtually lacks any descriptive, far-reaching publications about institutionalized older people (IOP). We aimed to investigate the demographic and clinical characteristics of institutionalized older people (IOP) ≥65 years old and compare them with those of the rest of the population of the same age.MethodsRetrospective analysis (total cohort approach) of clinical and resource-use characteristics of IOP and non-IOP older than 65 years in Catalonia (North-East Spain). Variables analysed included age and sex, diagnoses, morbidity burden—using Adjusted Morbidity Groups (GMA)—, mortality, use of resources, and medications taken. All data were obtained from the administrative database of the local healthcare system.ResultsThis study included 93,038, 78,458, 68,545 and 67,456 IOP from 2011, 2013, 2015 and 2017, respectively. In this interval, an increase in mean age (82.02 vs. 85.95 years), in women (68.64% vs. 72.11%) and in annual mortality (11.74% vs. 20.46%) was observed. Compared with non-IOP (p<0.001 in all comparisons), IOP showed a higher annual mortality (20.46% vs. 3.13%), a larger number of chronic diseases (specially dementia: 46.47% vs. 4.58%), higher multimorbidity (15.2% vs. 4.2% with GMA of maximum complexity), and annual admissions to acute care (47.6% vs. 27.7%) and skilled nursing facilities (27.8% vs. 7.4%), mean length of hospital stay (10.0 vs. 7.2 days) and mean of medications taken (11.7 vs. 8.0). ConclusionsThere is a growing gap between the clinical and demographic characteristics of age-matched IOP and non-IOP, which overlaps with a higher mortality rate of IOP. The profile of resources utilization of IOP compared with non-IOP strongly suggests a deficiency of preventive actions and stresses the need to rethink the care model for IOP from a social and health care perspective.

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What Lies Beneath: Clinical and Resource-use Characteristics of Institutionalized Older People. A Retrospective, Population-based Cohort Study in Catalonia

10.21203/rs.2.22586/v2 ◽

2020 ◽

Author(s):

Jordi Amblàs-Novellas ◽

Sebastià J. Santaeugènia Gonzàlez ◽

Emili Vela ◽

Montse Clèries ◽

Joan C. Contel

Keyword(s):

Health Care ◽

Older People ◽

Resource Use ◽

Clinical Characteristics ◽

Length Of Hospital Stay ◽

Administrative Database ◽

North East ◽

Use Of Resources ◽

Institutionalized Older People ◽

Annual Mortality

Abstract Background Planning population care in a specific health care setting requires deep knowledge of the clinical characteristics of the target care recipients, which tend to be country specific. Our area virtually lacks any descriptive, far-reaching publications about institutionalized older people (IOP). We aimed to investigate the demographic and clinical characteristics of institutionalized older people (IOP) ≥65 years old and compare them with those of the rest of the population of the same age.Methods Retrospective analysis (total cohort approach) of clinical and resource-use characteristics of IOP and non-IOP older than 65 years in Catalonia (North-East Spain). Variables analysed included age and sex, diagnoses, morbidity burden—using Adjusted Morbidity Groups (GMA, Grupos de Morbilidad Ajustada)—, mortality, use of resources, and medications taken. All data were obtained from the administrative database of the local healthcare system.Results This study included 93,038, 78,458, 68,545 and 67,456 IOP from 2011, 2013, 2015 and 2017, respectively. In this interval, an increase in median age (83 vs. 87 years), in women (68.64% vs. 72.11%) and in annual mortality (11.74% vs. 20.46%) was observed. Compared with non-IOP (p<0.001 in all comparisons), IOP showed a higher annual mortality (20.46% vs. 3.13%), a larger number of chronic diseases (specially dementia: 46.47% vs. 4.58%), higher multimorbidity (15.2% vs. 4.2% with GMA of maximum complexity), and annual admissions to acute care (47.6% vs. 27.7%) and skilled nursing facilities (27.8% vs. 7.4%), mean length of hospital stay (10.0 vs. 7.2 days) and mean of medications taken (11.7 vs. 8.0). Conclusions There is a growing gap between the clinical and demographic characteristics of age-matched IOP and non-IOP, which overlaps with a higher mortality rate of IOP. The profile of resources utilization of IOP compared with non-IOP strongly suggests a deficiency of preventive actions and stresses the need to rethink the care model for IOP from a social and health care perspective.

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Indications and practice of enteral nutrition

Orvosi Hetilap ◽

10.1556/oh.2014.30066 ◽

2014 ◽

Vol 155 (51) ◽

pp. 2028-2033 ◽

Cited By ~ 1

Author(s):

Judit Hallay ◽

Dániel Nagy ◽

Béla Fülesdi

Keyword(s):

Risk Factors ◽

Treatment Outcome ◽

Enteral Nutrition ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Nutrition Therapy ◽

Present Review ◽

Hospitalised Patients ◽

Impact On Treatment ◽

Efficacy Of Treatment

Malnutrition in hospitalised patients has a significant and disadvantageous impact on treatment outcome. If possible, enteral nutrition with an energy/protein-balanced nutrient should be preferred depending on the patient’s condition, type of illness and risk factors. The aim of the nutrition therapy is to increase the efficacy of treatment and shorten the length of hospital stay in order to ensure rapid rehabilitation. In the present review the authors summarize the most important clinical and practical aspects of enteral nutrition therapy. Orv. Hetil., 2014, 155(51), 2028–2033.

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