Introduction: ST-segment elevation myocardial infarction (STEMI) in end-stage renal disease (ESRD) is associated with worse outcomes. Peritoneal dialysis (PD) has shown better hemodynamic tolerability and quality of life. We analyzed outcomes comparing PD to HD in ESRD patients with STEMI using the National Inpatient Sample (NIS) database. Methods: NIS (2016-2020) was queried to identify adult STEMI admissions with co-morbid dialysis-dependent ESRD using ICD-10-CM codes, then stratified to HD-ESRD and PD-ESRD using ICD-10-PCS codes. Propensity score matched HD-ESRD controls were derived based on demographics and baseline co-morbidities. Multivariate logistic/linear regression were used to analyze the outcomes, such as inpatient mortality and complications, length of stay (LOS) and total hospital charge (THC). Results: Of the ESRD patients with STEMI, 1225 underwent PD, and 10675 underwent HD. Trend analysis showed declining in-patient mortality despite increasing STEMI burden in HD group, with up-trending mean LOS and THC. In contrast, PD group showed unchanging trends. Upon propensity score matching, PD patients showed similar adjusted odds of inpatient mortality and mean LOS but significantly lower mean THC. Further, PD patients had lower adjusted odds of inpatient complications, mainly ischemic strokes, pulmonary embolism, and hemopericardium. Conclusions: Our analysis showed a declining trend in inpatient mortality with STEMI in HD group. Although propensity-matching showed similar inpatient mortality, our research deemed PD superior to HD in STEMI patients, given lower financial burden and better outcomes with lower odds of inpatient complications.
Coronavirus-19, primarily a respiratory virus, also affects the nervous system. Acute ischemic stroke (AIS) is a well-known complication among COVID-19 infections, but large-scale studies evaluating AIS outcomes related to COVID-19 infection remain limited. We used the National Inpatient Sample database to compare acute ischemic stroke patients with and without COVID-19. A total of 329,240 patients were included in the study: acute ischemic stroke with COVID-19 (n = 6665, 2.0%) and acute ischemic stroke without COVID-19 (n = 322,575, 98.0%). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation, vasopressor use, mechanical thrombectomy, thrombolysis, seizure, acute venous thromboembolism, acute myocardial infarction, cardiac arrest, septic shock, acute kidney injury requiring hemodialysis, length of stay, mean total hospitalization charge, and disposition. Acute ischemic stroke patients who were COVID-19-positive had significantly increased in-hospital mortality compared to acute ischemic stroke patients without COVID-19 (16.9% vs. 4.1%, aOR: 2.5 [95% CI 1.7-3.6], p < 0.001). This cohort also had significantly increased mechanical ventilation use, acute venous thromboembolism, acute myocardial infarction, cardiac arrest, septic shock, acute kidney injury, length of stay, and mean total hospitalization charge. Further research regarding vaccination and therapies will be vital in reducing worse outcomes in patients with acute ischemic stroke and COVID-19.
Objective About 41 million people aged ≥18 years reported lifetime use of cocaine, and 5.4 million people reported having used cocaine in 2019. We aim to identify trends of cocaine use, manifestations, concomitant drug use, and financial burden on health care among hospitalized patients. Methods We utilized National Inpatient Sample from years 2006-2018. Patients with age ≥18 years, admitted to the hospital with a diagnosis of cocaine abuse, dependence, poisoning, or unspecified cocaine use were included in the study. We used ICD-9 Clinical Modification (CM) and ICD-10-CM codes to retrieve patient samples and comorbid conditions. The primary outcome was the trend in cocaine use among hospitalized patients from the year 2006 to 2018. Cochran-Mantel-Haenszel test was used to assess the significance of trends. Results In the year 2006, the prevalence of cocaine abuse among hospitalized patients was 10,751 per million with an initial decline to 7,451 per million in 2012 and a subsequent increase to 11,891 per million hospitalized patients in 2018 with p =0.01. The majority of patients admitted were older than 50 years (43.27%), and a greater percentage of patients were males. All ethnicities showed a rising trend in the use of cocaine except for Native Americans. Cardiovascular effects, neuropsychiatric and infectious manifestations in hospitalized patients with cocaine abuse showed a consistent increase from year 2006 to 2018 with p <0.001. Conclusions There is a recent uptrend in cocaine use among hospital admissions in the US from 2006 to 2018 with an increased rate of systemic manifestations. This highlights the impact of cocaine use on the health system and the dire need to address this growing problem.
Introduction: Trainees early in their career are on the path to acquiring new knowledge and skills & this applies to all fields of work including gastroenterology. As fellows begin the journey in navigating realm of endoscopy, they are prone to inadvertently making mistakes. Aim of our study is to evaluate differences in outcomes of upper endoscopies performed before and after new trainees join programs across the nation. Methods: Retrospective study utilizing the 2016 to 2018 National inpatient sample, and we included patients aged 18 or older who underwent upper endoscopy during hospitalization at teaching hospitals. We excluded patients who were admitted from January-March and October-December, transferred from another facility & admitted to non-teaching hospitals. Procedural complications, all cause in hospital mortality, length of stay (LOS), hospitalization cost was compared between early academic months (July-September) to late academic months (April-June). Multivariate logistic regression model was used to for procedural complications, all-cause mortality and linear regression was used for the analysis of LOS and hospitalization cost. Results: Total sample size attained was 911,235 upper endoscopies performed and nearly comparable percentages of these were performed in the months of July-September and April-June. No significant difference in age of patients in these two groups and neither for gender. Majority of patients in both groups were Caucasian but distribution of races between the two groups was not significant. Medicare was predominant form of insurance in these patients but distribution was not significant. Procedure related complications such as aspiration, bleeding, accidental puncture/laceration, were not statistically different between the two groups. However, in-hospital all-cause mortality, cost of hospitalization, length of stay were all significantly higher in group with upper endoscopies performed between months of July-September. Adjusted odds ratio for in-hospital mortality was 1.09 (95% CI 1.01-1.17) (Table). Conclusion: Upper endoscopy related 3 major adverse events were not different in both groups likely as a result of adequate procedural supervision. Our study showed that there was a significant increase in cost, length of hospitalization, all-cause mortality in upper endoscopies that were performed in the months of July-September when new trainees enter residency and fellowship. Further measures may be needed to improve these outcomes early on, though some may be unavoidable. Table 1. - In Hospital Outcomes OUTCOMES EGD DURING JULY-SEPTEMBER EGD DRURING APRIL-JUNE P-VALUE Aspiration (N=28,695) 3.09% 3.07% 1Adjusted Odds ratio1.01 (95% CI 0.94-1.06) 0.81 Bleeding or hematoma (N=1,870) 0.22% 0.2% 1Adjusted Odds ratio1.12 (95% CI 0.89-1.41) 0.39 Accidental puncture or laceration (N=1,155) 0.12% 0.13% 1Adjusted Odds ratio1.01 (95% CI 0.75-1.3) 0.97 In-hospital mortality (N=19,280) 2.14% 1.95% 1Adjusted Odds ratio1.09 (95% CI 1.01-1.17) 0.01 Mean total hospitalization charge 81,597$ 79,023$ 1Adjusted total charge2052$ higher 0.005 Mean length of stay (days) 6.8 6.6 < 0.001
This study aims to provide comparative data on clinical features and in-hospital outcomes among U.S. adults admitted to the hospital with COVID-19 and influenza infection using a nationwide inpatient sample (N.I.S.) data 2020. Data were collected on patient characteristics and in-hospital outcomes, including patient's age, race, sex, insurance status, median income, length of stay, mortality, hospitalization cost, comorbidities, mechanical ventilation, and vasopressor support. Additional analysis was performed using propensity matching. In propensity-matched cohort analysis, influenza-positive (and COVID-positive) patients had higher mean hospitalization cost (USD 129,742 vs. USD 68,878, p = 0.04) and total length of stay (9.9 days vs. 8.2 days, p = 0.01), higher odds of needing mechanical ventilation (OR 2.01, 95% CI 1.19-3.39), and higher in-hospital mortality (OR 2.09, 95% CI 1.03-4.24) relative to the COVID-positive and influenza-negative cohort. In conclusion, COVID-positive and influenza-negative patients had lower hospital charges, shorter hospital stays, and overall lower mortality, thereby supporting the use of the influenza vaccine in COVID-positive patients.
Background The available literature indicates a link between SARS-CoV-2 infection during pregnancy and a heightened probability of experiencing negative outcomes for both the pregnant patient and the developing fetus. We compared clinical outcomes of pregnant patients with or without COVID-19 hospitalized during delivery.
Patients with cirrhosis that are hospitalized with COVID-19 infection have been found to have worse outcomes. No comparative study has been conducted between gastrointestinal (GI) bleeding in patients with cirrhosis who are diagnosed with COVID-19. We utilized the National Inpatient Sample (NIS) database to perform a retrospective analysis of 24, 050 patients diagnosed with cirrhosis and COVID-19. The identified patients were separated into variceal bleeding, nonvariceal bleeding, and no (or neither) GI bleeding groups. After performing propensity sample matching and multivariate analysis of mortality, we found no significant differences in mortality among the three groups. However, the variceal bleed group had a shorter length of stay (5.67 days lower than the no-bleed group). Esophagogastroduodenoscopy (EGD) with intervention was associated with reduced mortality in the variceal and nonvariceal bleeding groups. Acute kidney injury was a strong predictor of mortality in both bleeding groups. A native American race was found to be associated with higher mortality in the nonvariceal bleeding group. Our study suggests that there are various pathophysiological processes among the three groups, with no significant mortality differences with cirrhosis complications of GI bleeding.
