scholarly journals Impact of De-escalation on Prognosis of Patients With Bacteremia due to Enterobacteriaceae: A Post Hoc Analysis From a Multicenter Prospective Cohort

2018 ◽  
Vol 69 (6) ◽  
pp. 956-962 ◽  
Author(s):  
Zaira R Palacios-Baena ◽  
Mercedes Delgado-Valverde ◽  
Adoración Valiente Méndez ◽  
Benito Almirante ◽  
Silvia Gómez-Zorrilla ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Cox Regression ◽  
Length Of Hospital Stay ◽  
Multidrug Resistant ◽  
Lower Probability ◽  
Post Hoc Analysis ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Post Hoc ◽  
The Impact

Abstract Background More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate predictors of de-escalation and its impact on the outcome of patients with bloodstream infection due to Enterobacteriaceae (BSI-E). Methods A post hoc analysis was performed on a prospective, multicenter cohort of patients with BSI-E initially treated with ertapenem or antipseudomonal β-lactams. Logistic regression was used to analyze factors associated with early de-escalation (EDE) and Cox regression for the impact of EDE and late de-escalation (LDE) on 30-day all-cause mortality. A propensity score (PS) for EDE vs no de-escalation (NDE) was calculated. Failure at end of treatment and length of hospital stay were also analyzed. Results Overall, 516 patients were included. EDE was performed in 241 patients (46%), LDE in 95 (18%), and NDE in 180 (35%). Variables independently associated with a lower probability of EDE were multidrug-resistant isolates (odds ratio [OR], 0.50 [95% confidence interval {CI}, .30–.83]) and nosocomial infection empirically treated with imipenem or meropenem (OR, 0.35 [95% CI, .14–.87]). After controlling for confounders, EDE was not associated with increased risk of mortality; hazard ratios (HR) (95% CIs) were as follows: general model, 0.58 (.25–1.31); model with PS, 0.69 (.29–1.65); and PS-based matched pairs, 0.98 (.76–1.26). LDE was not associated with mortality. De-escalation was not associated with clinical failure or length of hospital stay. Conclusions De-escalation in patients with monomicrobial bacteremia due to Enterobacteriaceae was not associated with a detrimental impact on clinical outcome.

scholarly journals Relationship between hypoglycaemia, cardiovascular outcomes, and empagliflozin treatment in the EMPA-REG OUTCOME® trial

2019 ◽  
Vol 41 (2) ◽  
pp. 209-217 ◽  
Author(s):  
David Fitchett ◽  
Silvio E Inzucchi ◽  
Christoph Wanner ◽  
Michaela Mattheus ◽  
Jyothis T George ◽  
...  
Keyword(s):  
Cox Regression ◽  
Severe Hypoglycaemia ◽  
Glycated Haemoglobin ◽  
Protective Effects ◽  
Increased Risk ◽  
Symptomatic Hypoglycaemia ◽  
Post Hoc ◽  
The Impact ◽  
Time Varying Covariates

Abstract Aims Hypoglycaemia, in patients with Type 2 diabetes (T2D) is associated with an increased risk for cardiovascular (CV) events. In EMPA-REG OUTCOME, the sodium-glucose co-transporter-2 inhibitor empagliflozin reduced the risk of CV death by 38% and heart failure hospitalization (HHF) by 35%, while decreasing glycated haemoglobin (HbA1c) without increasing hypoglycaemia. We investigated CV outcomes in patients with hypoglycaemia during the trial and the impact of hypoglycaemia on the treatment effect of empagliflozin. Methods and results About 7020 patients with T2D (HbA1c 7–10%) were treated with empagliflozin 10 or 25 mg, or placebo and followed for median 3.1 years. The relationship between on-trial hypoglycaemia and CV outcomes, and effects of empagliflozin on outcomes by incident hypoglycaemia [HYPO-broad: symptomatic hypoglycaemia with plasma glucose (PG) ≤70 mg/dL, any hypoglycaemia with PG <54 mg/dL, or severe hypoglycaemia, and HYPO-strict: hypoglycaemia with PG <54 mg/dL, or severe hypoglycaemia] was investigated using adjusted Cox regression models with time-varying covariates for hypoglycaemia and interaction with treatment. HYPO-broad occurred in 28% in each group and HYPO-strict in 19%. In the placebo group, hypoglycaemia was associated with an increased risk of HHF for both HYPO-broad [hazard ratio (HR, 95% confidence interval, CI) 1.91 (1.25–2.93)] and HYPO-strict [1.72 (1.06–2.78)]. HYPO-broad (but not HYPO-strict) was associated with an increased risk of myocardial infarction (MI) [HR 1.56 (1.06–2.29)]. Empagliflozin improved CV outcomes, regardless of occurrence of hypoglycaemia (P-for interactions >0.05). Conclusion In this post hoc exploratory analysis, hypoglycaemia was associated with an increased risk of HHF and MI. Hypoglycaemia risk was not increased with empagliflozin and incident hypoglycaemia did not attenuate its cardio-protective effects.

scholarly journals The Impact of Delirium On Prognosis In Stroke: A Systematic Review and Meta-Analyses of Observational Studies

2021 ◽  
Author(s):  
jing zhang ◽  
xin wang ◽  
jie wang ◽  
kai liu ◽  
tao he ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Length Of Hospital Stay ◽  
Clinical Problem ◽  
Cochrane Library ◽  
Inpatient Mortality ◽  
Increased Risk ◽  
The Impact

Abstract Background The outcomes of post-stroke delirium are inconsistent. Therefore, we conduct a meta-analysis to provide a comprehensive description of the impact of delirium on the outcomes including including length of hospital stay and inpatient mortality after stroke. Methods We searched electronic databases including PubMed, Google scholar, Web of Science and Cochrane Library databases up to April, 2021. Fixed-effect or random-effect model was used to summary odds ratio (OR) and mean difference (MD ) with 95% confidence interval (CI). Results 13 individual studies with total of 3592 patients met the inclusion criteria. The summary results revealed that stroke patients with delirium increased risk of inpatient mortality (OR = 6.35, 95% CI: 4.35–9.25, p < 0.0001), and had longer length of hospital stay (MD = 5.93, 95% CI: 2.79–9.07, p < 0.0001) compared to non-delirious patients. Conclusions Delirium is associated with unfavorable outcomes in patients with stroke, particularly in higher inpatient mortality and longer length of stay. We should pay more attention to this clinical problem and managed appropriately to prevent poor prognosis.

scholarly journals Socioeconomic trajectories and risk of hospitalization in the Moli-sani Study cohort

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Bonaccio ◽  
A Di Castelnuovo ◽  
S Costanzo ◽  
M Persichillo ◽  
A De Curtis ◽  
...  
Keyword(s):  
Life Course ◽  
Social Mobility ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Educational Achievement ◽  
Study Cohort ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Direct Linkage ◽  
The Impact

Abstract Background A life course approach was used to explore the impact of socioeconomic status (SES) on risk of hospitalizations for all-cause and for cardiovascular disease (CVD). Methods Longitudinal analyses on 19,999 subjects apparently free from CVD and cancer, recruited in the Moli-sani Study, Italy (2005-2010). Low and high SES in childhood, educational attainment (low/high) and SES during adulthood (measured by a score including material resources and dichotomized as low/high) defined the trajectories over life course. First hospital admissions were recorded by direct linkage with hospital discharge form registry. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression. Results Over a median follow up of 7.3 y, we ascertained a total of 7,594 all-cause and 2,539 CVD hospitalizations. Poor childhood SES was associated with 11% and 17% increased risk of all-cause and CVD hospitalizations, respectively. Among subjects with poor childhood SES, an upward trajectory in education was associated with lower risk of hospital admission for all-cause (HR = 0.85; 95%CI 0.76-0.94) and CVD (HR = 0.78; 0.64-0.95), as opposed to subjects remained stably low (low education and adulthood SES). Individuals with high childhood SES, but not educational achievement, were at 26% increased risk of hospitalization for any cause, as compared to the stably high SES group, while failure to achieve both educational and material advancements was associated with 37% higher risk of CVD hospitalization. Conclusions In a large sample of healthy adults, social mobility (educational and/or material upward trajectories) was associated with lower incidence of hospital admissions for all-cause and CVD. Key messages Social mobility may counterbalance the negative health burden associated with low early-life SES. High SES in childhood poorly affects hospitalization risk if no additional achievements across life course occur.

Clinical and Economic Impact of Multidrug Resistance in Nosocomial Acinetobacter baumannii Bacteremia

2007 ◽  
Vol 28 (6) ◽  
pp. 713-719 ◽  
Author(s):  
Nan-Yao Lee ◽  
Hsin-Chun Lee ◽  
Nai-Ying Ko ◽  
Chia-Ming Chang ◽  
Hsin-I Shih ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Stay ◽  
Acinetobacter Baumannii ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Multidrug Resistant ◽  
Economic Outcomes ◽  
University Teaching ◽  
Attributable Mortality ◽  
The Impact

Objective.To investigate the impact of antimicrobial resistance on clinical and economic outcomes among hospitalized patients with multidrug-resistant (MDR) Acinetobacter baumannii bacteremia.Design.A retrospective, matched-cohort study.Setting.A tertiary care university teaching hospitalMethods.A matched case-control (1:1) study was conducted to compare the differences in clinical and economic outcomes of patients with MDR A. baumannii bacteremia and patients with non-MDR A. baumannii bacteremia. Case patients were matched to control patients on the basis of sex, age, severity of underlying and acute illness, and length of hospital stay before onset of bacteremia.Results.Forty-six (95.8%) of 48 cases with MDR A. baumannii bacteremia were eligible for the study and matched with appropriate controls. The sepsis-related mortality rate was 34.8% among cases and 13.0% among controls, for an attributable mortality rate of 21.8% (adjusted odds ratio, 4.1 [95% confidence interval, 1.1-15.7]; P = .036). After the onset of bacteremia, cases and controls had a significantly different length of hospital stay (54.2 vs 34.1 days; P = .006), hospitalization cost (US$9,349 vs US$4,865; P = .001 ), and antibiotic therapy cost (US$2,257 vs US$1,610; P = .014). Thus, bacteremia due to MDR A. baumannii resulted in 13.4 days of additional hospitalization and US$3,758 of additional costs, compared with bacteremia due to non-MDR A. baumannii.Conclusions.Patients with MDR A. baumannii bacteremia had a higher mortality rate and incurred greater medical costs than patients with non-MDR A. baumannii bacteremia.

In search of optimal lithium levels and olanzapine doses in the long-term treatment of bipolar I disorder. A post-hoc analysis of the maintenance study by Tohen et al. 2005

2010 ◽  
Vol 25 (8) ◽  
pp. 443-449 ◽  
Author(s):  
W.E. Severus ◽  
I.A. Lipkovich ◽  
R.W. Licht ◽  
A.H. Young ◽  
W. Greil ◽  
...  
Keyword(s):  
Cox Regression ◽  
Lithium Level ◽  
Bipolar I Disorder ◽  
Post Hoc Analysis ◽  
Increased Risk ◽  
Long Term Treatment ◽  
Significant Difference ◽  
Post Hoc ◽  
Depressive Episodes ◽  
Maintenance Study

AbstractPurposeThe aim of this study was to investigate whether lower lithium levels (LoLi) or olanzapine doses (LoOL) are risk factors for future mood episodes in patients with bipolar I disorder.MethodsA post-hoc analysis of the olanzapine-lithium-maintenance study [31] was performed using proportional hazards Cox regression models and marginal structural models (MSMs), adjusting for non-random assignments of dose during treatment.ResultsThe LoLi group (< 0.6 mmol/L) had a significantly increased risk of manic/mixed (hazard ratio [HR] = 1.96, p = 0.042), but not depressive (HR = 2.11, p = 0.272) episodes, compared to the combined medium (0.6–0.79 mmol/L) and high lithium level (≥ 0.8 mmol/L) groups. There was no significant difference in risk between the two higher lithium level groups (0.6-0.79 mmol/L; ≥ 0.8 mmol/L) for new manic/mixed (HR = 0.96, p = 0.893) or depressive (HR = 0.95, p = 0.922) episodes. The LoOL group (< 10 mg/day) showed a significantly increased risk of depressive (HR = 2.24, p = 0.025) episodes compared to the higher olanzapine (HiOL) dose group (HiOL: 10–20 mg/day), while there was no statistically significant difference in risk for manic/mixed episodes between the two groups (HR = 0.94, p = 0.895).ConclusionLithium levels ≥ 0.6 mmol/L and olanzapine doses ≥ 10 mg/day may be necessary for optimal protection against manic/mixed or depressive episodes, respectively in patients with bipolar I disorder.

Outcomes of nutritional jejunostomy in the curative treatment of esophageal cancer

2018 ◽  
Vol 32 (7) ◽  
Author(s):  
F Klevebro ◽  
A Johar ◽  
J Lagergren ◽  
P Lagergren
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Hospital Stay ◽  
Cox Regression ◽  
Gastroesophageal Junction ◽  
Length Of Hospital Stay ◽  
Cancer Surgery ◽  
Early Enteral Nutrition ◽  
Esophageal Cancer Surgery ◽  
Increased Risk

SUMMARY Substantial weight loss and eating problems are common before and after esophagectomy for cancer. The use of jejunostomy might prevent postoperative weight loss, but studies evaluating other outcomes are scarce. This study aims to assess the influence of jejunostomy on postoperative health-related quality of life (HRQOL), complications, reoperation, hospital stay, and survival. This prospective and population-based cohort study included all patients operated on for esophageal or gastroesophageal junction cancer in Sweden in 2001–2005 with follow-up until 31st December 2016. Data regarding patient and tumor characteristics and treatment were prospectively collected. Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI), whereas Cox regression provided hazard ratios with 95% CI. All risk estimates were adjusted for age, sex, tumor histology, stage, comorbidity, surgical approach, neoadjuvant therapy, and body mass index and weight loss at baseline. Among 397 patients, 181 (46%) received a jejunostomy during surgery. The use of jejunostomy did not influence the HRQOL at 6 months or 3 years after treatment. Jejunostomy users had no statistically significantly increased risk of postoperative complications (OR 1.27; 95% CI 0.86–1.87) or reoperation (OR 1.70; 95% CI 0.88–3.28). Intensive unit care and length of hospital stay was the same independent of the use of jejunostomy. The all-cause mortality was not increased in the jejunostomy group (HR 0.89, 95% CI: 0.74–1.07). This study indicates that jejunostomy does not influence postoperative HRQOL, complications, or survival after esophageal cancer surgery, it can be considered a safe method for early enteral nutrition after esophageal cancer surgery but benefits for the patients need further investigations.

Impact of statins on outcomes in patients (pts) with metastatic castration resistant prostate cancer (mCRPC): Post-hoc analysis of data from COU-AA-301 and COU-AA-302 trials.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 230-230
Author(s):  
Guillermo de Velasco ◽  
David Lora ◽  
David Lorente ◽  
Toni K. Choueiri ◽  
Christopher Sweeney ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Prognostic Factors ◽  
Randomized Clinical Trials ◽  
Cox Regression ◽  
Phase Iii ◽  
Interventional Treatment ◽  
Post Hoc Analysis ◽  
Post Hoc ◽  
The Impact ◽  
Statin Use

230 Background: Retrospective database studies have suggested that statins may have a positive impact on some mCRPC pts treated with prednisone (P)/abiraterone (AA) Methods: We conducted a post-hoc analysis of individual pt data of mCRPC pts treated with AA and/or P on randomized phase III clinical trials COU -AA-301 and COU-AA-302 to analyze the impact of statins on overall survival (OS). Statistical analyses were performed using the Kaplan Meier method and Cox regression adjusted for known prognostic factors. This study, was carried out under YODA Project #2016-1136 Results: 458 (41%) prechemotherapy pts and 348 (29%) postchemotherapy pts were statins users (Table). Improved OS was observed for mCPRC pts who were statins users in the postdocetaxel setting [HR: 0.82 (95% CI: 0.71 to 0.94); p = 0.006], and there was a trend towards a prolonged OS in the predocetaxel setting [HR: 0.89 (95% CI: 0.77 to 1.03); p = 0.13] adjusted by interventional treatment (AA and/or P). In the predocetaxel setting there were no significant differences in OS between the groups AA/P/non-statin users and placebo/P/statin users (p=0.3). In the multivariate analysis, patients randomized to AA/P who were statins users and presenting ECOG <2 had superior OS in the postdocetaxel setting. Similarly, age, ECOG and statin use were the strongest prognostic factors in the predocetaxel setting. Conclusions: In a post-hoc analysis of two prospective randomized clinical trials statin use was associated with superior OS in mCPRC pts treated with P or AA/P. Further studies are needed to confirm these results and guide use of statins as adjunct to P and A. [Table: see text]

Abstract 13814: Semaglutide Reduces Mace Consistently Across Baseline Triglyceride Levels in Patients With Type 2 Diabetes: A Post Hoc Analysis of the Sustain 6 and Pioneer 6 Trials

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Subodh Verma ◽  
Lawrence A Leiter ◽  
Marie M Michelsen ◽  
David Orsted ◽  
Soren Rasmussen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cox Regression ◽  
Density Lipoprotein ◽  
Statin Treatment ◽  
Continuous Variable ◽  
Post Hoc Analysis ◽  
Glucagon Like Peptide 1 ◽  
Post Hoc ◽  
The Impact

Introduction: Elevated triglyceride (TG) levels may predict CV events, although this has not been evaluated in large contemporary trials. The effects of glucagon-like peptide-1 receptor agonists on major adverse CV events (MACE) across TG levels are not fully characterized. SUSTAIN 6 (NCT01720446) and PIONEER 6 (NCT02692716) were randomized, CV outcomes trials investigating once-weekly and oral semaglutide vs placebo, respectively, in patients with type 2 diabetes at high CV risk. We performed a post hoc analysis to assess the effect of semaglutide vs placebo on the primary endpoints, MACE (CV death, nonfatal myocardial infarction, or nonfatal stroke), and its components in these two trials pooled, across baseline TG levels. Methods: The risk of first MACE with semaglutide vs placebo was evaluated across three baseline TG groups (≤151, >151-≤205, and >205 mg/dL). The effect of semaglutide vs placebo on MACE was estimated with Cox regression by TG level categorically, and continuously when adjusting for baseline TG and high-density lipoprotein-cholesterol (HDL-C) levels. The impact of statin treatment was also assessed. Results: In total, 6,417 patients had baseline TG measurements: 3,191 (49.7%) ≤151, 1,459 (22.7%) >151-≤205, and 1,767 (27.5%) >205 mg/dL; mean (±SD) TGs were 107.3 (26.0), 176.6 (15.6), and 326.5 (197.1) mg/dL, respectively. Overall, semaglutide reduced TGs vs placebo by 5% in SUSTAIN 6 and 6% in PIONEER 6 (p<0.01). The incidence of MACE with placebo increased across increasing TG levels (Figure) . Semaglutide generally reduced the risk of MACE and its components vs placebo across TG groups. Results were consistent when evaluating TGs as a continuous variable (adjusting for baseline TG and HDL-C levels), and regardless of statin treatment. Conclusions: In this post hoc analysis of SUSTAIN 6 and PIONEER 6, over half of patients had elevated TG levels (>151 mg/dL). Semaglutide consistently reduced the risk of MACE vs placebo across baseline TG levels.

The Impact of Smoking on Cardiovascular Outcomes and Comorbidities in Statin-treated Patients with Coronary Artery Disease: A Post hoc Analysis of the GREACE Study

2013 ◽  
Vol 11 (5) ◽  
pp. 779-784 ◽  
Author(s):  
Vasilios G. Athyros ◽  
Konstantinos Tziomalos ◽  
Niki Katsiki ◽  
Thomas D. Gossios ◽  
Olga Giouleme ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Outcomes ◽  
Post Hoc Analysis ◽  
Artery Disease ◽  
Post Hoc ◽  
The Impact
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