scholarly journals Risk scoring systems to predict in-hospital mortality in patients with acute variceal bleeding due to HCV-induced liver cirrhosis

2018 ◽  
Vol 9 (1) ◽  
Author(s):  
Moataz Hassanien ◽  
Maged El-Ghannam ◽  
Mohamed Darwish El-Talkawy ◽  
Yosry Abdelrahman ◽  
Gamal El Attar ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Variceal Bleeding ◽  
Scoring Systems ◽  
Prognostic Scores ◽  
Acute Variceal Bleeding ◽  
Significant Difference ◽  
History Of ◽  
Risk Scoring

Background: this study was designed to validate and to compare accuracy of the prognostic scores; mainly Child Turcotte Pugh (CTP), creatinine-modified Child Turcotte Pugh (CTP-Cr), MELD, albumin bilirubin score (ALBI), and AIMS65, for the predicting clinical outcomes in cirrhotic Egyptian patients presenting with acute variceal bleeding (AVB). Methods: Retrospective single center study involving 725 patients presenting with AVB due to liver cirrhosis and HCV infection either alone or mixed with HBV infection. In hospital mortality prognostic scores were calculated; mainly CTP, modified CTP-Cr, MELD, ALBI, AIMS65. The endpoint is either patient improvement or death. Results: 725 patients were included over 1-year period. 547 (75%) survived and 178 (25%) died. Patients presented with hematemesis (515/71%), melena (120/16.5%) or hematemesis and melena (90/12.5%). Those with hematemesis for the first time were 241 (33%) and recurrent attacks were 484 (66.8%). The non-survivors had significantly more incidence of shock on presentation, more blood transfused units, history of NSAIDS intake, more ICU admission days and were more likely to be Childs C. Child, modified CTP-Cr, MELD, ALBI and ALMS65 scoring systems showed significant difference between survivors and non-survivors. Conclusion: Liver specific scores (Child, MELD) and gastrointestinal bleeding scoring systems (ALBI, AIMS65) are useful in predicting clinical outcomes of AVB in cirrhotic patients. CTP-Cr score had the highest prognostic capability of in hospital mortality. Presence of active bleeding at time of endoscopy, more complications, old age, shock and higher CPT-Cr score are additional independent predictors of in hospital mortality.

Abstract 1122‐000196: First‐Line Direct Contact Aspiration Versus Stent‐Retriever Technique: Real‐World Comparative Outcomes for Successful Mechanical Thrombectomy

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Ashutosh Mahapatra ◽  
Yasaman Moazeni ◽  
Thomas Patterson ◽  
Ramez Abdalla ◽  
Jenny Tsai ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Real World ◽  
Direct Contact ◽  
Mechanical Thrombectomy ◽  
Disease Process ◽  
Stent Retriever ◽  
Large Vessel ◽  
First Line ◽  
Significant Difference

Introduction : Mechanical thrombectomy for large‐vessel acute ischemic stroke has been adopted as the standard of care treatment across the world, with dramatic improvements in long‐term functional outcomes for an otherwise debilitating disease process. Timely and complete recanalization are paramount in achieving good outcomes. Though several revascularization techniques have been described, direct contact aspiration and clot removal via stent‐retriever remain the foundation of endovascular stroke therapy. Utilizing the NeuroVascular Quality Initiative – Quality Outcomes Database (NVQI‐QOD), we present our data on real‐world, first‐line practice for treatment of large vessel occlusions (LVOs), and compare angiographic and clinical outcomes between direct contact aspiration and stent‐retriever mechanical thrombectomy techniques. Methods : Retrospective analysis of the NVQI‐QOD was performed. We included patients with LVOs that underwent mechanical thrombectomy who were older than 18 and whose baseline NIHSS ≥ 6. We compared procedural times, rate of revascularization, and outcomes, including in‐hospital mortality and discharge NIHSS. Results : We identified a total of 2381 patients who met the inclusion criteria, of which 998 (41.9%) underwent treatment with direct contact aspiration alone and 1383 (58.1%) underwent treatment utilizing a stent‐retriever (with or without local aspiration). There were no significant differences in the baseline median NIHSS scores (16 vs 17, p = 0.25) or baseline median ASPECTS scores (9 vs 9, p = 0.7). No significant difference was seen in time metrics, including last known well to puncture (282 min vs. 280 min, p = 0.22) or recanalization (323 min vs. 322 min, p = 0.39), ED to puncture (75 min vs. 71 min, p = 0.25) or recanalization (158 min vs. 160 min, p = 0.55), or median procedure times between the two groups (23 vs 23 min, p = 0.64). The median number of passes required for recanalization was lower in the direct aspiration group (1 vs 2, p = 0.01). Though there was no difference in successful recanalization (TICI 2B‐3) between the two groups (86.1% vs 88%, p = 0.71), there was a lower rate of complete recanalization (TICI 2C‐3) in the direct aspiration group (46% vs 51.7%, p = 0.007). There was also a lower rate of adjunct treatments (defined as the use of GP IIb/IIIa inhibitors, P2Y12 inhibitors, and/or salvage angioplasty and/or stenting) required in the direct contact aspiration group (36.1% vs 44.4%, p < 0.001). There were no differences noted in discharge NIHSS scores (5 vs 4, p = 0.21) or in‐hospital mortality (22.2% vs 22.5%, p = 0.92). Conclusions : In the NVQI‐QOD, stent‐retriever techniques were associated with higher rates of complete recanalization when compared to direct contact aspiration alone, although acceptable (TICI 2B‐3) recanalization rates were similar. There were no statistically significant differences in procedure times or clinical outcomes at discharge.

Abstract WP380: Thyrotoxicosis is Associated With Worse In-Hospital Mortality in Patients With Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sakiru O Isa ◽  
Olajide Buhari ◽  
Hameem Changezi
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Length Of Hospital Stay ◽  
The Body ◽  
Significant Difference ◽  
History Of ◽  
Group 3 ◽  
Group 2 ◽  
Time Of Presentation ◽  
Group 1

Introduction: Hyperthyroidism increases the basal metabolic rate and affects most systems in the body. Patients with hyperthyroidism have been shown to have a higher incidence of ischemic stroke. There is a paucity of information regarding its effects on the short-term outcomes of patients admitted with ischemic stroke. Hypothesis: Hyperthyroidism is associated with worse in-hospital outcomes in patients admitted for ischemic stroke. Methods: We queried the National Inpatient Sample to identify adult patients(aged 18 and above) admitted for ischemic stroke between January 2011 and December 2014. We compared those with a history of hyperthyroidism (group 1) and thyrotoxicosis on admission (group 2) with the rest of the patients (group 3). The main outcome was in-hospital mortality. Secondary outcomes included the length of hospital stay and cost of hospitalization. We used the logistic regression model and adjusted for baseline characteristics and co-morbidities. Results: There were 643,786 patients in the study, 0.44% had a history of hyperthyroidism, and 0.01% had thyrotoxicosis at the time of presentation. The odd of mortality in group 1 compared to group 3 was 0.89, 95% CI 0.75-1.05, p=0.16 while in group 2 compared to group 3, it was 2.42, 95% CI 1.29-4.52, p<0.006. The mean length of stay was also longer in group 2 with a mean difference of 8.06, 95% CI 4.74 - 11.39, p<0.0001. Conclusion: From the study, there was no significant difference in in-hospital mortality between patients with previously diagnosed hyperthyroidism and those without diagnosed hyperthyroidism. Patients who had thyrotoxicosis on admission, on the other hand, had worse outcomes compared to patients without thyrotoxicosis.

Acute kidney injury and major outcomes in cancer patients with no history of chronic kidney disease (CKD) with coronavirus 2019 (COVID-19) infection.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18816-e18816
Author(s):  
Cesar Simbaqueba ◽  
Omar Mamlouk ◽  
Kodwo Dickson ◽  
Josiah Halm ◽  
Sreedhar Mandayam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Hazard Model ◽  
Cancer Center ◽  
Icu Admission ◽  
Significant Difference ◽  
History Of

e18816 Background: Acute Kidney Injury (AKI) in patients with COVID-19 infection is associated with poor clinical outcomes. We examined outcomes (hemodialysis, mechanical ventilation, ICU admission and death) in cancer patients with normal estimated glomerular filtration rate (eGFR) treated in a tertiary referral center with COVID-19 infection, who developed AKI within 30 days of diagnosis. Methods: All patient data — demographics, labs, comorbidities and outcomes — were aggregated and analyzed in the Syntropy platform, Palantir Foundry (“Foundry”), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test; (2) baseline eGFR >60 ml/min/1.73m2most temporally proximal lab results within 30 days prior to the patient’s infection. AKI was defined by an absolute change of creatinine ≥0.3 within 30 days after the positive COVID-19 test. Kaplan-Meier analysis was used for survival estimates at specific time periods and multivariate Cox Proportional cause-specific Hazard model regression to determine hazard ratios with 95% confidence intervals for major outcomes. Results: 635 patients with Covid-19 infection had a baseline eGFR >60 ml/min/1.73m2. Of these patients, 124 (19.5%) developed AKI. Patients with AKI were older, mean age of 61+/-13.2 vs 56.9+/- 14.3 years (p=0.002) and more Hypertensive (69.4% vs 56.4%, p=0.011). AKI patients were more likely to have pneumonia (63.7% vs 37%, p<0.001), cardiac arrhythmias (39.5% vs 20.7%, p<0.001) and myocardial infarction (15.3% vs 8.8%, p=0.046). These patients had more hematologic malignancies (35.1% vs 19%, p=0.005), with no difference between non metastatic vs metastatic disease (p=0.284). There was no significant difference in other comorbidities including smoking, diabetes, hypothyroidism and liver disease. AKI patients were more likely to require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p<0.001), ICU admission (43.5% vs 11.5%, p<0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p<0.001). Multivariate Cox Proportional cause-specific Hazard model regression analysis identified history of Diabetes Mellitus (HR 10.8, CI 2.42 - 48.4, p=0.001) as an independent risk factor associated with worse outcomes. Mortality was higher in patients with COVID-19 infection that developed AKI compared with those who did not developed AKI (survival estimate 150 days vs 240 days, p=0.0076). Conclusions: In cancer patients treated at a tertiary cancer center with COVID-19 infection and no history of CKD, the presence of AKI is associated with worse outcomes including higher 90 day mortality, ICU stay and mechanical ventilation. Older age and hypertension are major risk factors, where being diabetic was associated with worse clinical outcomes.

scholarly journals 575. Evaluation of Risk Factors and Clinical Outcomes of Patients with Vancomycin-Resistant Enterococcus Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S271-S271
Author(s):  
Gauri Chauhan ◽  
Nikunj M Vyas ◽  
Todd P Levin ◽  
Sungwook Kim
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Subgroup Analysis ◽  
Term Care ◽  
Treatment Groups ◽  
Increased Risk ◽  
History Of ◽  
Vancomycin Resistant ◽  
The Impact

Abstract Background Vancomycin-resistant Enterococci (VRE) occurs with enhanced frequency in hospitalized patients and are usually associated with poor clinical outcomes. The purpose of this study was to evaluate the risk factors and clinical outcomes of patients with VRE infections. Methods This study was an IRB-approved multi-center retrospective chart review conducted at a three-hospital health system between August 2016-November 2018. Inclusion criteria were patients ≥18 years and admitted for ≥24 hours with cultures positive for VRE. Patients pregnant or colonized with VRE were excluded. The primary endpoint was to analyze the association of potential risk factors with all-cause in-hospital mortality (ACM) and 30-day readmission. The subgroup analysis focused on the association of risk factors with VRE bacteremia. The secondary endpoint was to evaluate the impact of different treatment groups of high dose daptomycin (HDD) (≥10 mg/kg/day) vs. low dose daptomycin (LDD) (< 10 mg/kg/day) vs. linezolid (LZD) on ACM and 30-day readmission. Subgroup analysis focused on the difference of length of stay (LOS), length of therapy (LOT), duration of bacteremia (DOB) and clinical success (CS) between the treatment groups. Results There were 81 patients included for analysis; overall mortality was observed at 16%. Utilizing multivariate logistic regression analyses, patients presenting from long-term care facilities (LTCF) were found to have increased risk for mortality (OR 4.125, 95% CI 1.149–14.814). No specific risk factors were associated with 30-day readmission. Patients with previous exposure to fluoroquinolones (FQ) and cephalosporins (CPS), nosocomial exposure and history of heart failure (HF) showed association with VRE bacteremia. ACM was similar between HDD vs. LDD vs. LZD (16.7% vs. 15.4% vs. 0%, P = 0.52). No differences were seen between LOS, LOT, CS, and DOB between the groups. Conclusion Admission from LTCFs was a risk factor associated with in-hospital mortality in VRE patients. Individuals with history of FQ, CPS and nosocomial exposure as well as history of HF showed increased risk of acquiring VRE bacteremia. There was no difference in ACM, LOS, LOT, and DOB between HDD, LDD and LZD. Disclosures All authors: No reported disclosures.

scholarly journals Acute Variceal Bleeding in Patients with Liver Cirrhosis with and without Diabetes

2015 ◽  
Vol 1 (1) ◽  
pp. 14-20
Author(s):  
Khafaga S ◽  
◽  
Khalil K ◽  
Mohamed Abdou ◽  
Miada M ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Variceal Bleeding ◽  
Acute Variceal Bleeding
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