scholarly journals Acute Post Streptococcal Glomerulonephritis among Children from Sokoto, North-Western Nigeria

2021 ◽  
pp. 27-36
Author(s):  
Fatima Bello Jiya ◽  
Paul Kehinde Ibitoye ◽  
Nma Muhammed Jiya ◽  
Mohammed Hassan Abba
Keyword(s):  
Hospital Mortality ◽  
Economic Status ◽  
Statistical Significance ◽  
Kidney Injury ◽  
University Teaching ◽  
Systemic Hypertension ◽  
P Value ◽  
Post Discharge ◽  
Paediatric Unit ◽  
Post Streptococcal Glomerulonephritis

Aims: To determine the clinical and laboratory profile of children with acute post streptococcal glomerulonephritis (APSGN) admitted into Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, the outcome, and factors associated with in-hospital mortality. Study Design: A 5- year retrospective study. Place of Study: Emergency Paediatric Unit (EPU) and Paediatric Medical Ward (PMW) of the Department of Paediatrics, UDUTH Sokoto. Methodology: The records of children aged 4 to 14 years with the diagnosis of APSGN were reviewed. Relevant history, physical examination findings, laboratory and radiologic investigation findings were extracted from their case folders and recorded into a proforma sheet. Data was analyzed using SPSS version 23. (IBM SPSS Inc., USA). The level of statistical significance was set at 5%, which is p-value < 0.05. Results: Fifty-four (0.9%) of the 6128 children were managed for APSGN giving a prevalence of 10.8 APSGN cases per 1000 children. Forty-one folders were utilized for the study. There were 21(51.2%) females and 20(48.8%) males, with F:M ratio of 1.1:1. Mean age at presentation was 9.1± 3.1 years. Majority (92.6%) were ≥5 years and mainly 22(53.7%) of low socio-economic status. The main features were body swelling 40(97.6%), fever 25(61.0%), oliguria 24(58.5%), systemic hypertension 37(90.2%), proteinuria 41(100.0%), and haematuria 41(100.0%). Acute kidney injury was the commonest 25(61.0%) complication. Thirty (73.2%) cases were discharged, 5 (12.2%) died, 6(14.6%) left against medical advice. Low social status (0.03), requirement for dialysis (p=0.003), congestive cardiac failure (p=0.01), and pulmonary oedema (p=0.04) were significantly associated with in-hospital mortality. Requirement for dialysis (p=0.005) was the independent predictor of in-hospital mortality. At three months post discharge, 20(48.8%) of the 31 cases had achieved complete resolution of APSGN. Conclusion: APSGN is common in Sokoto and similar in pattern to other reports from Nigeria. The presence of complications at presentation increases the risk of in-hospital mortality.

scholarly journals Clinical outcome and Predictors of Acute Kidney Injury in Adult Patients Admitted to the Medical Ward of Jimma Medical Center, South West Ethiopia: A prospective Observational Study

2021 ◽  
Author(s):  
Abinet Abebe ◽  
Kabaye Kumela ◽  
Maekel Belay ◽  
Bezie Kebede
Keyword(s):  
Clinical Outcome ◽  
Observational Study ◽  
Hospital Mortality ◽  
Prospective Observational Study ◽  
Cox Regression ◽  
Medical Center ◽  
Statistical Significance ◽  
Kidney Injury ◽  
Public Health Problem ◽  
P Value

Abstract BackgroundAcute kidney injury is a major global public health problem occur both in community and hospital settings. It is expensive to manage, prolongs hospitalization and associated with high rates of in-hospital mortality. We aim to evaluate the clinical outcome and predictors of AKI in a single center hospitalized patients.MethodA hospital based prospective observational study was employed. Patients were recruited using consecutive sampling technique after informed consent was secured from all patients. Data was cleaned, coded and entered in to Epi-data software version 4.4.2 and analyzed with SPSS version 21. Cox regression model was fitted to identify predictors of mortality. Statistical significance was considered at p-value of less than 0.05.ResultA total of 203 patients were enrolled over five months. Out of this, 121(59.6%) were males and 58(28.6%) aged greater than 60. Most common causes of AKI were; Hypovolemia 99(48.77%), Glomerulonephritis 51 (25.11%), Sepsis 32(15.79%). The overall in hospital mortality was 12.8%. Stage3 AKI (AHR = 9.61, 95%CI: 1.17–28.52, p = 0.035), duration of AKI (AHR = 7.04, 95% CI: 1.37–36.08, p = 0.019), length of hospital stay (AHR = 0.19, 95% CI: 0.05–0.73 p = 0.012) and hyperkalemia (AHR = 3.61, 95% CI: 1.12–11.71, p = 0.032) were significantly associated with in hospital mortality.ConclusionAcute kidney injury was associated with a significant five month in hospital mortality. Most of causes of AKI are preventable and patients would have been benefited from early identification and treatment of these reversible causes.

scholarly journals Association of Blood Type on Clinical Outcomes in Black/African Americans Hospitalized for COVID-19 Infection

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 14-14
Author(s):  
Yan Cheng ◽  
Sharif Mohammed ◽  
Alexis Okoh ◽  
Ki (Steve) Lee ◽  
Corinne Raczek ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
African Americans ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Type A ◽  
Blood Type ◽  
P Value ◽  
Single Center ◽  
Black African ◽  
O 31

Introduction: Early studies from Wuhan, China have reported an association between blood type and outcomes in COVID-19 infected patients. Conflicting reports in literature have investigated the protective role of blood type O against worst outcomes associated with COVID-19 infections. Approximately 50% of Black/African Americans (AA) have blood group O. Our study is the only study to date looking at the association between Black/AA and blood type. We aimed to determine the association between blood type and Black/AA patients hospitalized for COVID-19. Methods: We retrospectively reviewed data on patients with known blood type, who were admitted for COVID-19 at a single center between March and April 2020. We excluded other races in our study because only about 2% of the population was Caucasian and 8% representing other races, representing a small subset of patients under study whereas Black/AA represented about 90% of our hospitalized patients. Patients were stratified into 4 groups based on their ABO blood type. Baseline demographic, clinical characteristics and clinical course of the disease were compared. The primary end point was in-hospital mortality. Secondary endpoints included admission to the intensive care unit (ICU), acute kidney injury requiring hemodialysis and length of stay (LOS). Results: During the study period, a total of 256 patients were reviewed. Distribution of ABO type was as follows; A: (N=65) 25%, B: (N=62) 24%, AB: (N=9) 4%, O: (N=120) 47%. Compared to blood types A, B and O, AB patients were younger (mean; yrs. 63 vs. 63 vs. 62 vs. 43 yrs. p=0.0242). Blood type B patients were more likely to present with nausea, than groups A, AB, and O. (27% vs. 10% vs. 0% vs. 5%; p=0.017). All other characteristics including baseline inflammatory markers were comparable. There was no difference among groups regarding in-hospital mortality (A: 39% B: 29% AB: 33% O: 31% p value: 0.676) or admission to the ICU (A:31% B: 28% AB: 33% O: 34% p value: 0.840). The incidence of acute kidney injury requiring hemodialysis was higher in blood type A patients compared to B, AB, and O. (31% vs. 0% vs. 23% vs. 19%; p=0.046). In hospital LOS was comparable among all groups. Conclusions: In this single center analysis of black/AA patients admitted for COVID-19, there was no association between blood type and in-hospital mortality or admission to ICU. Blood type A patients had a higher propensity of kidney injury, but this did not translate into worse in-hospital survival. Disclosures Cohen: GBT: Speakers Bureau.

scholarly journals Prevalence and Causes of Low Vision and Blindness among Adult Patients Attending Eye Clinic in a Tertiary Hospital in South East, Nigeria

2021 ◽  
pp. 20-28
Author(s):  
O. A. I. Otuka ◽  
N. C. Ekeleme ◽  
E. N. Akaraiwe ◽  
E. C. Iwuoha ◽  
L. I. Eweputanna ◽  
...  
Keyword(s):  
Low Vision ◽  
Statistical Significance ◽  
Tertiary Hospital ◽  
Adult Patients ◽  
University Teaching ◽  
P Value ◽  
Social Challenges ◽  
Care Givers ◽  
Significant Public Health ◽  
Eye Clinic

Background: Low vision and blindness are significant public health issues worldwide. They result in educational, occupational, and social challenges in the affected persons. Their care givers/ families are also severely affected. There is however limited data on the magnitude of visual impairment in Aba, South East Nigeria. Objective: To determine the prevalence and causes of low vision and blindness among adult patients attending eye clinic in a tertiary hospital in South East Nigeria. Materials and Methods: This was an institutional-based retrospective, descriptive study involving 457 patients who attended Abia State University Teaching Hospital eye clinic between April and September 2018. Data was obtained from patient’s hospital records within the period under study and analyzed using IBM SPSS version 25.0. Statistical significance was set at a P-value of < 0.05. Results: Data of 457 ophthalmic patients who met the inclusion criteria for this study were analyzed. Mean age of respondents was 48.5 ± 17.7 years. A total 5.4% of the patients had bilateral low vision, while 30.2% and 7% had monocular and bilateral blindness respectively. Cataract-related diagnosis, refractive errors and glaucoma (28.4%, 28.2% and 14.7%) respectively were the major causes of low vision and blindness among the patients. Statistically significant association was found between respondent’s diagnosis and age as well as occupation (P<0.001). Conclusion: Results from this study will aid in planning low vision & blindness preventive programs and improving eye care services.

scholarly journals Evaluation of zinc sulfate as an adjunctive therapy in COVID-19 critically ill patients: a two center propensity-score matched study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Ohoud Aljuhani ◽  
Abdulrahman I. Al Shaya ◽  
Abdullah Kharbosh ◽  
Raed Kensara ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Adjunctive Therapy ◽  
Zinc Sulfate ◽  
Statistical Significance ◽  
Kidney Injury ◽  
Additional Treatment ◽  
Icu Stay

Abstract Background Zinc is a trace element that plays a role in stimulating innate and acquired immunity. The role of zinc in critically ill patients with COVID-19 remains unclear. This study aims to evaluate the efficacy and safety of zinc sulfate as adjunctive therapy in critically ill patients with COVID-19. Methods Patients aged ≥ 18 years with COVID-19 who were admitted to the intensive care unit (ICU) in two tertiary hospitals in Saudi Arabia were retrospectively assessed for zinc use from March 1, 2020 until March 31, 2021. After propensity score matching (1:1 ratio) based on the selected criteria, we assessed the association of zinc used as adjunctive therapy with the 30-day mortality. Secondary outcomes included the in-hospital mortality, ventilator free days, ICU length of stay (LOS), hospital LOS, and complication (s) during ICU stay. Results A total of 164 patients were included, 82 patients received zinc. Patients who received zinc sulfate as adjunctive therapy have a lower 30-day mortality (HR 0.52, CI 0.29, 0.92; p = 0.03). On the other hand, the in-hospital mortality was not statistically significant between the two groups (HR 0.64, CI 0.37–1.10; p = 0.11). Zinc sulfate use was associated with a lower odds of acute kidney injury development during ICU stay (OR 0.46 CI 0.19–1.06; p = 0.07); however, it did not reach statistical significance. Conclusion The use of zinc sulfate as an additional treatment in critically ill COVID-19 patients may improve survival. Furthermore, zinc supplementation may have a protective effect on the kidneys.

scholarly journals Impact of ICU saturation on hospital mortality from COVID-19 in a secondary care center in Iztapalapa, Mexico City

2021 ◽  
Author(s):  
José Martín Alanís-Naranjo ◽  
Víctor Manuel Anguiano-Álvarez ◽  
Eduardo Federico Hammeken-Larrondo
Keyword(s):  
Hospital Mortality ◽  
Mexico City ◽  
Care Center ◽  
Severe Disease ◽  
Kidney Injury ◽  
Study Data ◽  
P Value ◽  
Factors Associated ◽  
Intravenous Antibiotics ◽  
Male Sex

Abstract INTRODUCTION: A saturated intensive care unit (ICU) setting and socioeconomic factors such as higher poverty rates have been associated with increased rates of in-hospital mortality in COVID-19 patients. Mexico City has become the national epicenter of the pandemic, with Mexico’s highest death toll. Iztapalapa is the delegation with the highest population density and the most notorious conditions of marginalization in Mexico City. We describe the clinical characteristics and risk factors associated with mortality in 164 patients who received care in a hospital ward setting due to ICU saturation in a hospital in Iztapalapa, Mexico City.MATERIALS AND METHODS: In this retrospective cohort study, data from confirmed COVID-19 patients hospitalized between April 1, 2020 and May 31, 2020 were collected. Patients were categorized into different subgroups: alive vs. deceased and intubated vs. nonintubated for analysis between groups. A p-value <0.05 was considered statistically significant.RESULTS: In this setting, 67% of the patients required mechanical ventilation, and 32.3% needed vasopressor support, with an in-hospital mortality of 68.3%. The most common complications during hospitalization were acute kidney injury (36%) and acute respiratory distress syndrome (34.8%). We observed similar factors associated with death as previous studies: male sex, older age, comorbidities, laboratory values indicating increased inflammatory/organ failure markers, and severe disease at admission. Additionally, we found that routine use of intravenous antibiotics was associated with a higher rate of in-hospital mortality (RR 3.45, 95% CI 1.69-7.06, p <0.001).

Outcome of dialysis-requiring acute kidney injury in patients with infective endocarditis: A nationwide study

2020 ◽  
Author(s):  
Jeppe Kofoed Petersen ◽  
Andreas Dalsgaard Jensen ◽  
Niels Eske Bruun ◽  
Anne-Lise Kamper ◽  
Jawad Haider Butt ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Valve Surgery ◽  
Cardiac Valve ◽  
Post Discharge ◽  
Dialysis Treatment ◽  
Cardiac Valve Surgery ◽  
One Year

Abstract Background Infective endocarditis (IE) may be complicated by acute kidney injury, yet data on the use of dialysis and subsequent reversibility are sparse. Methods Using Danish nationwide registries, we identified patients with first-time IE from 2000 to 2017. Dialysis naïve patients were grouped into: those with and those without dialysis during admission with IE. Continuation of dialysis was followed one year post-discharge. Multivariable adjusted Cox proportional hazard analysis was used to examine one-year mortality for patients surviving IE according to use of dialysis. Results We included 7,307 patients with IE; 416 patients (5.7%) initiated dialysis treatment during admission with IE and these were younger, had more comorbidities and more often underwent cardiac valve surgery compared with non-dialysis patients (47.4% vs. 20.9%). In patients with both cardiac valve surgery and dialysis treatment (n=197), 153 (77.7%) initiated dialysis on- or after the date of surgery. The in-hospital mortality was 40.4% and 19.0% for patients with and without dialysis, respectively (p&lt;0.0001). Of those who started dialysis and survived hospitalization, 21.6% continued dialysis treatment within one year after discharge. In multivariable adjusted analysis, dialysis during admission with IE was associated with an increased one-year mortality from IE discharge, HR=1.64 (95% CI: 1.21-2.23). Conclusion In dialysis-naïve patients with IE, approximately 1 in 20 patients initiated dialysis treatment during admission with IE. Dialysis identified a high-risk group with an in-hospital mortality of 40% and an approximately 20% risk of continued dialysis. Those with dialysis during admission with IE showed worse long-term outcomes than those without.

scholarly journals Investigate predictive capacity of in-hospital mortality of four severity score systems on critically ill patients with acute kidney injury

2019 ◽  
Vol 67 (8) ◽  
pp. 1103-1109 ◽  
Author(s):  
Yu Gong ◽  
Feng Ding ◽  
Fen Zhang ◽  
Yong Gu
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Mortality Prediction ◽  
Apache Ii ◽  
University Teaching ◽  
Predictive Capacity ◽  
Saps Ii

Although significant improvements have been achieved in the renal replacement therapy of acute kidney injury (AKI), the mortality of patients with AKI remains high. The aim of this study is to prospectively investigate the capacity of Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II), Sepsis-related Organ Failure Assessment (SOFA) and Acute Tubular Necrosis Individual Severity Index (ATN-ISI) to predict in-hospital mortality of critically ill patients with AKI. A prospective observational study was conducted in a university teaching hospital. 189 consecutive critically ill patients with AKI were selected according Risk, Injury, Failure, Loss, or End-stage kidney disease criteria. APACHE II, SAPS II, SOFA and ATN-ISI counts were obtained within the first 24 hours following admission. Receiver operating characteristic analyses (ROCs) were applied. Area under the ROC curve (AUC) was calculated. Sensitivity and specificity of in-hospital mortality prediction were calculated. In this study, the in-hospital mortality of critically ill patients with AKI was 37.04% (70/189). AUC of APACHE II, SAPS II, SOFA and ATN-ISI was 0.903 (95% CI 0.856 to 0.950), 0.893 (95% CI 0.847 to 0.940), 0.908 (95% CI 0.866 to 0.950) and 0.889 (95% CI 0.841 to 0.937) and sensitivity was 90.76%, 89.92%, 90.76% and 89.08% and specificity was 77.14%, 70.00%, 71.43% and 71.43%, respectively. In this study, it was found APACHE II, SAPS II, SOFA and ATN-ISI are reliable in-hospital mortality predictors of critically ill patients with AKI. Trial registration number: NCT00953992.

scholarly journals MO369ACUTE KIDNEY INJURY IS ASSOCIATED WITH ELEVATED AMINOTRANSFERASES AT ADMISSION IN HOSPITALIZED PATIENTS WITH COVID-19

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Yulia Khruleva ◽  
Olga Arisheva ◽  
Elena Troitskaya ◽  
Marina Efremovtseva ◽  
Zhanna Kobalava
Keyword(s):  
Lung Injury ◽  
Serum Creatinine ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
P Value ◽  
Icu Patients ◽  
Coagulation Status ◽  
Definition Of ◽  
Novel Coronavirus

Abstract Background and Aims Initial reports indicate a high incidence of abnormal liver tests and acute kidney injury (AKI) in the novel coronavirus infection (COVID-19). However, outcomes in hospitalized patients with COVID-19 and elevated aspartate transaminase (AST) and alanine transaminase (ALT) levels at admission and their associations with AKI are not well understood. The aim of the study was to investigate the incidence of cytolysis at admission and its contribution to the development of AKI, severity of COVID-19 and outcomes. Method A retrospective analysis of the register of patients hospitalized with COVID-19 was performed (n=481). COVID-19 was defined as the laboratory-confirmed infection and/or presence of the typical computer tomography (CT) picture. We excluded patients with previously known liver disease, re-hospitalization, acute surgical pathology, single serum creatinine measurement during hospitalization. Abnormality in aminotransferases was defined as ALT and/or AST &gt;40 U/L. Definition of AKI was based on KDIGO criteria. P value &lt;0.05 was considered statistically significant. Results 462 patients were included (50.4% males, mean age 63±16 years, mean Charlson index 3±2.4, 67% with hypertension, 48% with obesity, 25% with diabetes mellitus). 26,4% (122) of patients were hospitalized in the intensive care unit (ICU), 71,3% (87) of them were treated with mechanical ventilation. The median length of stay was 11 [9;15] days, in the ICU – 4 [2;9] days. 20% (92) of patients died. At admission 43% (200) of the patients had abnormal level of aminotransferases. Elevated AST was more common than ALT, (39% (178) vs 29% (132)). The median levels of AST and ALT at admission were 54.5[44;72] and 45.9[34;66] U/L in the group with cytolysis and 26[19;33] and 19[11;27] U/L in the group without it, respectively. The AKI incidence in the register was 24.8%. The 1st stage of AKI was observed in the majority of the patients (46% - 1st stage, 36% - 2nd stage, 18% - 3rd stage. Patients in ICU compared to non-ICU patients more often had AKI (50% vs 13%, p&lt;0.001). In-hospital mortality was significantly higher in the group with AKI (54% vs 10% for patients with and without AKI development, respectively, p&lt;0.001). Groups with and without aminotransferases elevation were similar in age, gender, presence of comorbidities, coagulation status, statins and frequency of antibiotic intake before admission. Increase in AST and/or ALT levels at admission showed no association with AKI severity. The higher incidence of elevated ALT or/and AST was observed in ICU compared with non-ICU patients (59% vs 37%, p&lt;0.001). Patients with elevation of aminotransferases at admission compared to patients without it had more severe lung injury by CT scan (22.4% vs 18.6%, with 50-75% lung injury; 5.5% vs 0.4% with 75-90% lung injury, p=0.008 for the trend), higher ferritin (598[404;715] vs 391[189;587] µkg/l, p=0.03) and serum creatinine levels (91[78;118] vs 86[74;109] µmol/l, p=0.008), higher rate of AKI development (29% vs 18%, p=0.005) and in-hospital mortality (26% vs 15,4%, p=0.005). Elevated ALT and/or AST at admission were the independent predictors for the development of AKI (OR 1.87 95%CI 1.17-2.92, p=0.005) and in-hospital mortality (OR 1.89 95%CI 1.17-3.08, p=0.006). Conclusion Syndrome of cytolysis is common among hospitalized patients with COVID-19. Development of AKI and disease severity were associated with elevated levels of aminotransferases at admission, and are predictors for AKI development and in-hospital mortality in this population.

Weekend Versus Weekday Mortality for Thrombotic Thrombocytopenic Purpura (TTP) Related Hospitalizations in the United States: Data from the National Inpatient Sample

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4863-4863
Author(s):  
Smith Giri ◽  
Ranjan Pathak ◽  
Madan Raj Aryal ◽  
Paras Karmacharya ◽  
Michael G Martin
Keyword(s):  
United States ◽  
Acute Kidney Injury ◽  
Relative Risk ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
The United States ◽  
P Value ◽  
Adjusted Relative Risk ◽  
Hospital Type ◽  
Thrombocytopenic Purpura

Abstract Introduction: Previous research has shown that weekend hospital admissions are associated with an increased mortality in comparison to weekday admissions for a number of emergent conditions including myocardial infarction [Relative Risk (RR) 1.048; 95% confidence interval [CI], 1.022 to 1.076; P value <0.001], pulmonary embolism (RR 1.17, 95% CI 1.03 to 1.34, P value <0.01) and gastrointestinal hemorrhage (RR 1.17, 95% CI 1.03 to 1.34, P value <0.01) . Thrombotic Thrombocytopenic Purpura (TTP) is a hematological emergency with a significant morbidity and mortality if not recognized early. However, studies evaluating if a similar "weekend" effect exists in TTP are lacking. Methods: We used the Nationwide Inpatient Sample database to identify patients admitted with TTP in the United States using ICD 9 CM code 446.6 from 2009 to 2011. Baseline data for demographic variables, age, gender, race, hospital characteristics- region, hospital type (rural versus urban, teaching versus non-teaching), bed-size, insurance payer and comorbidities were derived for weekend and weekday admissions. Logistic regression analysis was used to calculate the adjusted relative risk of in-hospital mortality of weekend versus weekday admissions. Data analysis was done using STATA 13.0 (College Station, TX: StataCorp LP) Results: Of the 6634, estimated TTP related hospitalizations, 19.5 % were admitted on the weekends and 80.5 % admitted on the weekdays. The mean age was 48±0.5 years and 66.4 % were females. A higher in-hospital mortality rate was seen among weekend admissions as compared to weekday admissions (RR 1.32, 95% CI 1.30-1.33, p value <0.01). On multivariate analysis (table 1), weekend admission remained as an independent predictor of increased mortality (adjusted RR 1.16, 95% CI 1.15-1.17, P value <0.01) after adjusting for other confounders including age, gender, comorbidities, hospital type and size. Similarly, acute kidney injury (adjusted RR 3.41, 95% CI 3.34-3.43, P value <0.001), stroke (adjusted RR 5.46, 95% CI 5.31-5.62, P value <0.001), and sepsis (adjusted RR 6.57, 95% CI 6.40-6.75, Pvalue <0.001) were associated with significantly increased risk of mortality among patients with TTP (table 1). Conclusions: A significantly higher in-hospital mortality occurs among TTP patients admitted on the weekends as compared to weekdays. Future research should focus on identifying the underlying factors for this difference so that quality improvement measures could be taken to mitigate this difference. Table 1: Logistic Regression Analysis showing the adjusted relative risk (RR) of various patient and hospital characteristics in predicting in-hospital mortality for patients with TTP. Variable Adjusted RR 95% CI of Adjusted RR P value Weekend admission 1.16 1.15-1.17 <0.001 Pay - Medicare - Medicaid - Private including HMO - self-pay - no charge - other 1.0 1.33 1.19 1.63 1.36 2.02 .. 1.28-1.38 1.14-1.25 1.50-1.77 1.11-1.67 1.73-2.36 <0.001 <0.001 <0.001 <0.001 <0.001 Race - white - black - hispanic - asian or pacific islander - native american - other 1.0 1.01 0.93 1.13 1.05 1.07 0.98-1.03 0.89-0.97 1.07-1.19 0.94-1.16 1.02-1.13 0.47 0.003 <0.001 0.34 0.003 Region - Northeast -Midwest - South - West 1 0.92 1.05 0.97 0.86-0.98 0.99-1.11 0.91-1.04 0.01 0.06 0.48 Co-morbidities - smoking - obesity - dyslipidemia - hypertension - diabetes mellitus - peripheral vascular disease - coronary artery disease - acute kidney injury - chronic kidney disease - stroke - sepsis 0.90 0.78 0.60 0.68 0.99 1.32 1.06 3.41 1.10 5.46 6.57 0.88-0.92 0.76-0.79 0.59-0.61 0.67-0.69 0.97-1.00 1.29-1.34 1.05-1.07 3.34-3.43 1.08-1.11 5.31-5.62 6.40-6.75 <0.001 <0.001 <0.001 <0.001 0.12 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 Age 1.04 1.043-1.046 <0.001 Female 0.78 0.78-0.79 <0.001 Hospital Type - rural - urban non teaching - urban teaching 1.0 0.92 1.05 0.88-0.97 0.99-1.11 0.002 0.061 Bed size - small - medium - large 0.95 1.01 0.89-1.01 0.96-1.07 0.11 0.51 Disclosures No relevant conflicts of interest to declare.

scholarly journals Clinical profile, in-hospital outcome and associated factors of stroke after the start of a standard organized stroke care unit at university of Gondar hospital, northwest Ethiopia.

2019 ◽  
Author(s):  
Seid Getahun Abdella ◽  
Nebiyu Bekele Gebi ◽  
Ermias Shenkutie Gerffie ◽  
Koku Sisay Tamirat
Keyword(s):  
Hospital Mortality ◽  
Hospital Stay ◽  
Associated Factors ◽  
Public Health Problem ◽  
Stroke Care ◽  
Clinical Profile ◽  
P Value ◽  
Post Discharge ◽  
Hospital Outcome ◽  
Disability Outcome

Abstract Background: Stroke is the leading public health problem globally. Stroke management largely depends on non-drug interventions. Stroke care units are facilities in hospitals that showed patients increased survival, return home, and regain independence in daily activities. This study was aimed to assess clinical profile, in-hospital outcome and its associated factors of stroke after the start of a standard organized stroke care unit in the study area. Method: Hospital based cross sectional study was conducted from July 2015 to September 2017. A total of 151 stroke patients with computed tomography (CT) scan result were included in the study. Data was collected using standardized questionnaire from secondary sources like patients medical records. Binary logistic regression were fitted to identify predictor variables. Adjusted Odds ratio(OR) with 95% confidence interval was computed and variables with p-value less than 0.05 in the multi-variable regression model considered as significantly associated with the dependent variables. Result: Ischemic stroke (60.3%) subtype was the most common. The median age at presentation was 65 (IQR: 55-75) years. Hypertension (49.7%) and carotid atherosclerosis (54.7%) were the most commonly identified risk factors. Overall In-hospital mortality was 9.3% (95% CI: 5.2%-15.1%), poor disability outcome at discharge was 55.6% (95%CI: 47.3%-63.7%), and median length of hospital stay was 10 (IQR: 7-14) days. Being male (AOR=0.19, 95%CI: 0.038 0.97), longer in-hospital stays (AOR=0.21, 95%CI: 0.048 0.93) were significant predictors of in-hospital mortality. Furthermore increased ICP (AOR=2.81, 95%CI: 1.22 6.92) was also the predictor of poor disability outcome at discharge. Conclusion: In-hospital mortality was lower than previous studies. However post-discharge disability is higher. Male sex, length of in-hospital stay, was significant predictors of in-hospital mortality. Increased intracranial pressure was also significant predictor of poor disability outcome at discharge. Key words: In hospital outcome, Mortality, poor outcome, stroke care unit, Gondar

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