scholarly journals Association between Nafamostat Mesylate and In-Hospital Mortality in Patients with Coronavirus Disease 2019: A Multicenter Observational Study

2021 ◽  
Vol 11 (1) ◽  
pp. 116
Author(s):  
Ryota Inokuchi ◽  
Toshiki Kuno ◽  
Jun Komiyama ◽  
Kazuaki Uda ◽  
Yoshihisa Miyamoto ◽  
...  
Keyword(s):  
Propensity Score ◽  
Observational Study ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Smoking Status ◽  
Retrospective Observational Study ◽  
Sensitivity Analyses ◽  
Multiple Imputations ◽  
Nafamostat Mesylate

Nafamostat mesylate may be effective against coronavirus disease 2019 (COVID-19). However, it is not known whether its use is associated with reduced in-hospital mortality in clinical practice. We conducted a retrospective observational study to evaluate the effect of nafamostat mesylate in patients with COVID-19 using the Medical Data Vision Co. Ltd. hospital-based database in Japan. We compared patients with COVID-19 who were (n = 121) and were not (n = 15,738) administered nafamostat mesylate within 2 days of admission between January and December 2020. We conducted a 1:4 propensity score matching with multiple imputations for smoking status and body mass index and combined the 20 imputed propensity score-matched datasets to obtain the adjusted odds ratio for in-hospital mortality. Crude in-hospital mortality was 13.2% (16/121) and 5.0% (790/15,738), respectively. In the propensity score-matched analysis with multiple imputations, the adjusted odds ratio (use vs. no use of nafamostat mesylate) for in-hospital mortality was 1.27 (95% confidence interval: 0.61–2.64; p = 0.52). Sensitivity analyses showed similar results. The results of this retrospective observational study did not support an association between nafamostat mesylate and improved in-hospital outcomes in patients with COVID-19, although further studies with larger sample sizes are warranted to assess the generalizability of our findings.

scholarly journals Outcomes of Neutropenic Patients with Clostridium difficile Infection

2020 ◽  
Vol 41 (S1) ◽  
pp. s339-s340
Author(s):  
Roopali Sharma ◽  
Deepali Dixit ◽  
Sherin Pathickal ◽  
Jenny Park ◽  
Bernice Lee ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Treatment Failure ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
End Point ◽  
Neutropenic Patients

Background: Data from Clostridium difficile infection (CDI) in neutropenic patients are still scarce. Objective: To assess outcomes of CDI in patients with and without neutropenia. Methods: The study included a retrospective cohort of adult patients at 3 academic hospitals between January 2013 and December 2017. The 2 study arms were neutropenic patients (neutrophil count <500/mm3) and nonneutropenic patients with confirmed CDI episodes. The primary outcome evaluated the composite end point of all-cause in-hospital mortality, intensive care unit (ICU) admissions, and treatment failure at 7 days. The secondary outcome evaluated hospital length of stay. Results: Of 962 unique cases of CDI, 158 were neutropenic (59% men) and 804 were nonneutropenic (46% men). The median age was 57 years (IQR, 44–64) in the neutropenic group and 68 years (IQR, 56–79) in the nonneutropenic group. The median Charlson comorbidity score was 5 (IQR, 3–7.8) and 4 (IQR, 3–5) in the neutropenic and nonneutropenic groups, respectively. Regarding severity, 88.6% versus 48.9% were nonsevere, 8.2% versus 47% were severe, and 3.2% versus 4.1% were fulminant in the neutropenic and nonneutropenic groups, respectively. Also, 63% of patients (60.9% in nonneutropenic, 65.2% in neutropenic) were exposed to proton-pump inhibitors. A combination CDI treatment was required in 53.2% of neutropenic patients and 50.1% of nonneutropenic patients. The primary composite end point occurred in 27% of neutropenic patients versus 22% of nonneutropenic patients (P = .257), with an adjusted odds ratio of 1.30 (95% CI, 0.84–2.00). The median hospital length of stay after controlling for covariates was 21.3 days versus 14.2 days in the neutropenic and nonneutropenic groups, respectively (P < .001). Complications (defined as hypotension requiring vasopressors, ileus, or bowel perforation) were seen in 6.0% of the nonneutropenic group and 4.4% of the neutropenic group (P = .574), with an adjusted odds ratio of 0.61 (95% CI, 0.28–1.45). Conclusions: Neutropenic patients were younger and their cases were less severe; however, they had lower incidences of all-cause in-hospital mortality, ICU admissions, and treatment failure. Hospital length of stay was significantly shorter in the neutropenic group than in the nonneutropenic group.Funding: NoneDisclosures: None

scholarly journals Time to First Cigarette and Self-Reported Health Among US Adult Smokers

2019 ◽  
Vol 12 ◽  
pp. 1179173X1882526 ◽  
Author(s):  
Baksun Sung
Keyword(s):  
United States ◽  
Propensity Score ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Smoking Behavior ◽  
The United States ◽  
Elevated Risk ◽  
Poor Health ◽  
Increased Risk ◽  
Reported Health

Background: Numerous studies have reported that shorter time to first cigarette (TTFC) is linked to elevated risk for smoking-related morbidity. However, little is known about the influence of early TTFC on self-reported health among current smokers. Hence, the objective of this study was to examine the association between TTFC and self-reported health among US adult smokers. Methods: Data came from the 2012-2013 National Adult Tobacco Survey (NATS). Current smokers aged 18 years and older (N = 3323) were categorized into 2 groups based on TTFC: ≤ 5 minutes (n = 1066) and >5 minutes (n = 2257). Propensity score matching (PSM) was used to control selection bias. Results: After adjusting for sociodemographic and smoking behavior factors, current smokers with early TTFC had higher odds for poor health in comparison with current smokers with late TTFC in the prematching (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.31-2.08) and postmatching (AOR = 1.60; 95% CI = 1.22-2.09) samples. Conclusions: In conclusion, smokers with early TTFC were associated with increased risk of poor health in the United States. To reduce early TTFC, elaborate efforts are needed to educate people about harms of early TTFC and benefits of stopping early TTFC.

Pulmonary Arterial Enlargement in Well-Treated Persons With Human Immunodeficiency Virus

2020 ◽  
Vol 223 (1) ◽  
pp. 94-100
Author(s):  
Andreas D Knudsen ◽  
Andreas Ronit ◽  
Thomas Kristensen ◽  
Magda Teresa Thomsen ◽  
Anne-Mette Lebech ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Confidence Interval ◽  
Pulmonary Artery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Smoking Status ◽  
Main Pulmonary Artery ◽  
Related Factors ◽  
General Population Study ◽  
Immunodeficiency Virus

Abstract Background Pulmonary artery enlargement is a marker of pulmonary hypertension. We aimed to determine the proportion with pulmonary artery enlargement among well-treated persons with human immunodeficiency virus HIV (PWH) and uninfected controls. Methods PWH with a chest computed tomography were included from the ongoing Copenhagen Comorbidity in HIV Infection (COCOMO) study. Age and sex-matched uninfected controls were recruited from the Copenhagen General Population Study. Pulmonary artery enlargement was defined as a ratio of &gt;1 between the diameter of the main pulmonary artery (at the level of its bifurcation) and the diameter of the ascending aorta. Results In total, 900 PWH were included, and 44 (5%) had a pulmonary artery–aorta ratio (PA:A) &gt;1. After adjustment for age, sex, and body mass index, obesity (adjusted odds ratio, 4.33; 95% confidence interval, 1.76–10.65; P = .001) and injection drug use (IDU) (4.90; 1.00–18.46; P = .03) were associated with higher odds of having a PA:A &gt;1, and pulmonary indices and smoking status were not. HIV seropositivity was borderline associated with a PA:A &gt;1 (adjusted odds ratio, 1.89; 95% confidence interval, .92–3.85; P = .08). Conclusions A PA:A &gt;1 was common in PWH. Obesity and IDU were independently associated with this finding and HIV serostatus was borderline associated with it, but HIV-related factors were not. Increased awareness may be appropriate in obese PWH and those with IDU.

scholarly journals Ceftriaxone versus ampicillin/sulbactam for the treatment of aspiration-associated pneumonia in adults

2019 ◽  
Vol 8 (15) ◽  
pp. 1275-1284 ◽  
Author(s):  
Shinya Hasegawa ◽  
Atsushi Shiraishi ◽  
Makito Yaegashi ◽  
Naoto Hosokawa ◽  
Konosuke Morimoto ◽  
...  
Keyword(s):  
Risk Factor ◽  
Propensity Score ◽  
Observational Study ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Risk Difference ◽  
Study Cohort ◽  
Propensity Score Matching Analysis ◽  
Related Risk ◽  
Baseline Characteristics

Aim: To compare hospital mortality in patients with aspiration-associated pneumonia treated with ceftriaxone (CTRX) and in those treated with ampicillin/sulbactam (ABPC/SBT). Methods: From a Japanese multicentre observational study cohort of patients with pneumonia, those diagnosed with pneumonia and having at least one aspiration-related risk factor were selected. Propensity score-matching analysis was used to balance baseline characteristics of the participants and compare hospital mortality of patients treated with CTRX and those treated with ABPC/SBT. Results: Hospital mortality did not significantly differ between patients treated with CTRX and those treated with ABPC/SBT (6.6 vs 10.7%, risk difference -4.0, 95% CI [-9.4, 1.3]; p = 0.143). Conclusion: Further studies are needed to compare CTRX and ABPC/SBT treatments in patients with aspiration-associated pneumonia.

scholarly journals Predicting Smoking Status by Symptoms of Depression for U.S. Adolescents

1994 ◽  
Vol 75 (2) ◽  
pp. 911-914 ◽  
Author(s):  
Min Qi Wang ◽  
Eugene C. Fitzhugh ◽  
R. Carl Westerfield ◽  
James M. Eddy
Keyword(s):  
Logistic Regression ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Smoking Status ◽  
National Sample ◽  
Regression Analyses ◽  
Symptoms Of Depression ◽  
The Future ◽  
Predictive Relationships

This study examined the predictive relationships between adolescents' smoking and symptoms of depression. A national sample of 6,900 adolescents, ages 14 to 18 years, were selected for analysis. Variables of interest included measures for smoking status and symptoms of depression. Odds ratio and adjusted odds ratio from logistic regression analyses indicated that more of the 885 smokers than of the 6,015 nonsmokers reported feelings of unhappiness, sadness, or depression, hopelessness about the future, and having trouble going to sleep.

scholarly journals Initial experience with novel CGRP-receptor inhibitor therapy in Migraine in the United Arab Emirates: a retrospective observational study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bui Bao Khanh Dinh ◽  
Waseem Hamed Aziz ◽  
Alessandro Terruzzi ◽  
Derk Wolfgang Krieger
Keyword(s):  
Observational Study ◽  
Odds Ratio ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Real Life ◽  
Retrospective Observational Study ◽  
Lower Probability ◽  
P Value ◽  
Cgrp Receptor ◽  
Number Of Patients

Abstract Background Erenumab is a calcitonin gene-related peptide (CGRP)-receptor antibody inhibiting CGRP function. CGRP is prominently involved in the pathophysiology of migraine through nociceptive modulation in the trigeminovascular system. This study aims to explore the treatment effect of erenumab in a real-life setting. Methods In this retrospective observational study, we analyzed the data of 91 patients with migraine receiving at least three consecutive monthly injections of erenumab and followed up for 3–12 months. The primary objective was to describe the reduction in monthly migraine days throughout the follow-up period. To identify patients who responded to treatment, we analyzed the association between different patient characteristics and their treatment outcomes. Results Seventy-three patients (80.2%) responded to erenumab treatment, defined as ≥50% reduction of migraine days per month, across all migraine types. It was noted that ethnicity (p-value = 0.015) and older age (p-value = 0.035) were associated with clinically relevant improvement of symptoms. Middle Eastern ethnicity was related to less improvement of symptoms while Europeans were more likely to benefit from erenumab therapy (odds ratio: 12.788, p = 0.037). Patients aged from 31 to 40 and 41–65 years benefited most from erenumab treatment with a response rate of 77.8 and 89.9%, respectively, also confirmed by logistic regression (p = 0.047). Neither gender nor dose increase of erenumab showed association with the reported clinically relevant improvement of the symptoms. An association between clinically relevant improvement of headaches and the type of migraine was also noted. Around 87.9% of patients with episodic migraine responded to treatment, followed by 84.1% of chronic migraine patients and 50% of medication overuse headache patients. Medication overuse headache showed a lower probability of therapy success with erenumab (odds ratio: 0.126, p = 0.039). An improvement of headaches was eminent in patients who received 140 mg erenumab monthly (2 × 70 mg injections) and patients who had one injection every two weeks. Conclusions Erenumab is a novel preventive treatment for all migraine types. Clinically relevant improvement of headaches and reduction of monthly migraine days were demonstrated in patients that continued the treatment course. In real-life, a substantial number of patients suspended therapy early, reasons for which need further investigation.

scholarly journals The Burden of Hyperbilirubinemia in Critically Ill Patients with Hematological Malignancies: Post-hoc Analysis of a Prospective Multicenter Multinational Study

2020 ◽  
Author(s):  
Magali Bisbal ◽  
Michael Darmon ◽  
Colombe Saillard ◽  
Vincent Mallet ◽  
Charlotte Mouliade ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Cancer Progression ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hematological Malignancies ◽  
Severity Of Illness ◽  
Rank Test ◽  
Total Serum

Abstract BackgroundThe evidence on the clinical significance of hyperbilirubinemia (HB) in critically ill patients with hematological malignancies is scarce. We therefore studied its burden in a 2010-2011 Franco-Belgian multicenter prospective study designed to evaluate the prognosis of these patients.Patients and methodsThe cohort comprised 893 patients from 17 centers, 61% men, with a median (interquartile range) age of 60 (49 – 70) years, and preferentially with underlying non-Hodgkin lymphoma (32%) or acute myeloid leukemia (27%). HB was defined as a total serum bilirubin ≥ 33 µmol/L at intensive care unit (ICU) admission. Our main goal was to evaluate the relationship between HB and outcome of critically ill hematological patients. Causes and management of HB in the ICU were analyzed as secondary end points.ResultsHB concerned 185 (21%) patients. Cyclosporine and antimicrobial treatments, ascites and cirrhosis, acute kidney injury, neutropenia, and myeloma (adjusted odd ratio [aOR] 0.38, p=0.006) were risk factors. Hospital mortality was 56.3% and 36.3% in patients with and without HB, respectively (p<0.0001 with the log-rank test). Adjusted for severity of illness, the adjusted odds ratio (95% confidence interval) of HB for in-hospital mortality was 1.86 (1.28, 2.72). HB was overlooked by the ICU team for 92 (53%) patients. Overwise, liver workups for HB led to treatment modifications in 32 (40%) patients, including chemotherapy for cancer progression that was associated with reduced mortality with an adjusted odds ratio of 0.23, (p=0.02).ConclusionHB is associated with outcome of critically ill hematological adult patients and should be systematically explored and treated.

scholarly journals Clinical Relevance of Impaired Consciousness in Accidental Hypothermia: A Japanese Multicenter Retrospective Study

2020 ◽  
Author(s):  
Masahiro Fukuda ◽  
Masahiro NOZAWA ◽  
Yohei OKADA ◽  
Sachiko MORITA ◽  
Naoki EHARA ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Likelihood Ratio ◽  
Clinical Relevance ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Accidental Hypothermia ◽  
Impaired Consciousness ◽  
Severe Hypothermia ◽  
Level Of Consciousness ◽  
The Relationship

Abstract Background: Severe accidental hypothermia (AH) is a life-threatening condition, and early identification can enable transport to an appropriate medical facility. The Swiss staging model has been used to classify patients with AH, but little is known regarding the relationship between the degree of impaired consciousness and core body temperature (BT) in AH. This study aimed to clarify the relationship between the level of consciousness and core BT and determine whether the level of consciousness could be used to predict severe hypothermia and in-hospital mortality among patients with AH.Methods: We retrospectively investigated the clinical relevance of impaired consciousness in AH. We included adult patients with AH and excluded patients with out-of-hospital cardiac arrest. The patients were identified from the J-point registry, which contains information regarding patients treated for AH between April 1, 2011 and March 31, 2016 in any of the 12 participating institutions in Japan. The primary exposure of interest was the level of consciousness at hospital arrival. Odds ratios were calculated for severe hypothermia and in-hospital mortality.Results: Overall, 505 of the 572 patients in the registry were included. Compared to mildly impaired consciousness, the adjusted odds ratio for severe hypothermia was 3.3 (95% confidence interval [CI]: 1.7–6.3) for moderately impaired consciousness and 4.7 (95% CI: 2.4–9.1) for severely impaired consciousness. Severely impaired consciousness as a predictor severe hypothermia had a sensitivity of 0.44 (95% CI: 0.34–0.54), specificity of 0.78 (95% CI: 0.74–0.82), positive likelihood ratio of 2.04, and negative likelihood ratio of 0.71. Compared to mildly impaired consciousness, the adjusted odds ratio for in-hospital mortality was 1.7 (95% CI: 0.95–2.9) for moderately impaired consciousness and 2.1 (95% CI: 1.2–3.8) for severely impaired consciousness.Conclusions: Severely impaired consciousness was a reliable predictor of severe hypothermia and in-hospital mortality in patients with AH. Thus, in an urban out-of-hospital emergency setting, the level of impaired consciousness may be helpful for triaging patients to the appropriate hospital.

scholarly journals Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3713-3718 ◽  
Author(s):  
Gaultier Marnat ◽  
Bertrand Lapergue ◽  
Igor Sibon ◽  
Florent Gariel ◽  
Romain Bourcier ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Endovascular Therapy ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Favorable Outcome ◽  
Sensitivity Analyses ◽  
Carotid Dissection ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Tandem Occlusion

Background and Purpose: The efficacy of endovascular therapy in patients with acute ischemic stroke due to tandem occlusion is comparable to that for isolated intracranial occlusion in the anterior circulation. However, the optimal management of acute cervical internal carotid artery lesions is unknown, especially in the setting of carotid dissection, but emergency carotid artery stenting (CAS) is frequently considered. We investigated the safety and efficacy of emergency CAS for carotid dissection in patients with acute stroke with tandem occlusion in current clinical practice. Methods: We retrospectively analyzed a prospectively maintained database composed of 2 merged multicenter international observational real-world registries (Endovascular Treatment in Ischemic Stroke and Thrombectomy in Tandem Lesion). Data from endovascular therapy performed in the treatment of tandem occlusions related to acute cervical carotid dissection between January 2012 and January 2019 at 24 comprehensive stroke centers were analyzed. Results: The study assessed 136 patients with tandem occlusion due to dissection, including 65 (47.8%) treated with emergency CAS and 71 (52.2%) without. The overall rates of favorable outcome (90-day modified Rankin Scale score, 0–2) and successful reperfusion (modified Thrombolysis in Cerebral Infarction, 2b–3) were 58.0% (n=76 [95% CI, 49.6%–66.5%]) and 77.9% (n=106 [95% CI, 71.0%–85.0%]), respectively. In subgroup analyses, the rate of successful reperfusion (89.2% versus 67.6%; adjusted odds ratio, 2.24 [95% CI, 1.33–3.77]) was higher after CAS, whereas the 90-day favorable outcome (54.3% versus 61.4%; adjusted odds ratio, 0.84 [95% CI, 0.58–1.22]), symptomatic intracerebral hemorrhage (sICH; 10.8% versus 5.6%; adjusted odds ratio, 1.59 [95% CI, 0.79–3.17]), and 90-day mortality (8.0% versus 5.8%; adjusted odds ratio, 1.00 [95% CI, 0.48–2.09]) did not differ. In sensitivity analyses of patients with successful intracranial reperfusion, CAS was not associated with an improved clinical outcome. Conclusions: Emergency stenting of the dissected cervical carotid artery during endovascular therapy for tandem occlusions seems safe, whatever the quality of the intracranial reperfusion.

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