scholarly journals Higher Frequency of Hospital-Acquired Infections but Similar In-Hospital Mortality Among Admissions With Alcoholic Hepatitis at Academic vs. Non-academic Centers

2020 ◽  
Vol 11 ◽  
Author(s):  
Muhammad Waleed ◽  
Mohamed A. Abdallah ◽  
Yong-Fang Kuo ◽  
Juan P. Arab ◽  
Robert Wong ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Liver Disease ◽  
Hospital Mortality ◽  
Alcoholic Hepatitis ◽  
Academic Status ◽  
Hospital Acquired Infections ◽  
Academic Center ◽  
Hospital Acquired ◽  
The Impact ◽  
Total Charges

BackgroundAlcoholic hepatitis (AH) is a unique syndrome characterized by high short-term mortality. The impact of the academic status of a hospital (urban and teaching) on outcomes in AH is unknown.MethodsNational Inpatient Sample dataset (2006–2014) on AH admissions stratified to academic center (AC) or non-academic center (NAC) and analyzed for in-hospital mortality (IHM), hospital resource use, length of stay in days (d), and total charges (TC) in United States dollars (USD). Admission year was stratified to 2006–2008 (TMI), 2009–2011 (TM2), and 2012–2014 (TM3).ResultsOf 62,136 AH admissions, the proportion at AC increased from 46% in TM1 to 57% in TM3, Armitage trend, p < 0.001. On logistic regression, TM3, younger age, black race, Medicaid and private insurance, and development of acute on chronic liver failure (ACLF) were associated with admission to an AC. Of 53,264 admissions propensity score matched for demographics, pay status, and disease severity, admissions to AC vs. NAC (26,622 each) were more likely to have liver disease complications (esophageal varices, ascites, and hepatic encephalopathy) and hospital-acquired infections (HAI), especially Clostridioides difficile and ventilator-associated pneumonia. Admissions to AC were more likely transfers from outside hospital (1.6% vs. 1.3%) and seen by palliative care (4.8% vs. 3.3%), p < 0.001. Use of endoscopy, dialysis, and mechanical ventilation were similar. With similar IHM comparing AC vs. NAC (7.7% vs. 7.8%, p = 0.93), average LOS and number of procedures were higher at AC (7.7 vs. 7.1 d and 2.3 vs. 1.9, respectively, p < 0.001) without difference on total charges ($52,821 vs. $52,067 USD, p = 0.28). On multivariable logistic regression model after controlling for demographics, ACLF grade, and calendar year, IHM was similar irrespective of academic status of the hospital, HR (95% CI): 1.01 (0.93–1.08, p = 0.70). IHM decreased over time, with ACLF as strongest predictor. A total of 63 and 22% were discharged to home and skilled nursing facility, respectively, without differences on academic status of the hospital.ConclusionAdmissions with AH to AC compared to NAC have higher frequency of liver disease complications and HAI, with longer duration of hospitalization. Prospective studies are needed to reduce HAI among hospitalized patients with AH.

P007 CROHN’S DISEASE: PREDICTORS OF HOSPITAL DISPOSITION AND COSTS USING DEMOGRAPHIC, CLINICAL, AND TREATMENT DATA

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S48-S48
Author(s):  
Hartman Brunt ◽  
Mason Adams ◽  
Michael Barker ◽  
Diana Hamer ◽  
J C Chapman
Keyword(s):  
Logistic Regression ◽  
Crohn’S Disease ◽  
Abdominal Pain ◽  
Crohn's Disease ◽  
Hospital Admission ◽  
Categorical Variables ◽  
History Of ◽  
The Difference ◽  
The Impact ◽  
Total Charges

Abstract Purpose Crohn’s disease (CD) is an inflammatory bowel disease (IBD) caused by an abnormal immune response to intestinal microbes in a genetically susceptible host. The objective of this cohort analysis is to compare demographic characteristics, cost difference, and treatment modalities between patients who were discharged from the Emergency Department (ED) and those who were admitted to the hospital. Methods This study is a retrospective chart review of adult patients diagnosed with CD who were discharged from the ED and those who were admitted to the hospital between January 1, 2014 and January 1, 2017. We compared demographic and clinical characteristics as well as total charges incurred by these patients. A chi square test of independence and a Mann Whitney U-Test were used to compare categorical variables. Linear and logistic regression analyses were utilized to identify predictors of hospitalization and total charges. Results Of a total 195 patients, 97 were discharged from the ED and 98 were admitted to the hospital (Table 1). Patients who presented with fever, nausea/vomiting, or abdominal pain or who had a history of a fistula or stenosis were more likely to be hospitalized, as were patients who presented on steroids, 5-ASA compounds, or narcotics (Table 2). A logistic regression adjusted for these factors showed patients presenting with abdominal pain (OR=0.239, 95% CI 0.07 – 0.77) are less likely, while patients presenting with fever (OR=7.0, 95% CI 1.9 – 24.5) and history of stenosis (OR=17.8, 95% CI 5.7 – 55.9) are more likely to have a hospital admission. An increase in age and white blood cell count was associated with an increase in likelihood of admission (OR=1.04, 95% CI 1.01 – 1.07 and OR=1.2, 95% CI 1.1 – 1.4), while an increase in HGB was associated with a decrease in likelihood of admission (OR=0.682, 95% CI 0.55 – 0.83). Patients on 5-ASA compounds had the strongest association with hospital admission (OR=4.5, 95% CI 1.03 – 20.4). A linear regression analysis predicting total charges of hospitalization identified an increase of $37,500 (95% CI 6,600 – 68,489) for obese patients and of $29,000 (95% CI 20 – 57,000) for patients on narcotics prior to hospitalization. Notably, blacks were on average 6 years younger than whites (μ=36.2, st.d.=13.2 v μ=42.7, st.d.=18.2, p=0.031, respectively). No other differences in presentation or outcomes of CD were identified between these races. Conclusion This study describes the difference between CD patients who were admitted to the hospital compared to those who were discharged from the ED. The impact that 5-ASA compound, steroid, and narcotic use prior to presentation has on hospital admission and charges highlights the need for consistent outpatient care to manage the symptoms and disease progression in patients with CD in Baton Rouge. The difference in age at presentation between blacks and whites should also be considered in future research.

Abstract 16: Racial Disparities in Clinical Outcomes and Resource Utilization in Acute Ischemic Stroke Hospitalizations in the United States: Results from the 2012 National Inpatient Sample

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Nilay Kumar ◽  
Anand Venkatraman ◽  
Neetika Garg
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Racial Minorities ◽  
National Inpatient Sample ◽  
The Us ◽  
To Receive ◽  
Total Charges

Background and objectives: There are limited data on racial differences in clinical and economic outcomes of acute ischemic stroke (AIS) hospitalizations in the US. We sought to ascertain the effect of race on AIS outcomes in a population based retrospective cohort study. Methods: We used the 2012 National Inpatient Sample (NIS), which is the largest database of inpatient stays in the US, to identify cases of AIS using ICD9-CM codes 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91 and 437.1 in patients >=18 years of age. Cases with missing data on race were excluded (5% of study sample). Primary outcome was in-hospital mortality. Secondary outcomes included proportion receiving endovascular mechanical thrombectomy (EMT) or thrombolysis, mean inflation adjusted charges and length of stay. Linear and logistic regression was used to test differences in continuous and categorical outcomes respectively. Survey techniques were used for all analyses. Results: There were 452, 330 hospitalizations for AIS in patients >=18 years in 2012. In univariate logistic regression using race as predictor, in-hospital mortality was significantly lower for Blacks (p<0.001), Hispanics (p=0.025) and Native Americans (p=0.047) compared to Whites. However, after adjusting for age, sex, Charlson comorbidity index, EMT and thrombolysis only blacks had a significantly lower mortality compared to whites (OR 0.74, 95% CI 0.66 - 0.82, p<0.001). Black patients were less likely to receive thrombolysis (OR 0.87, 95% CI 0.79 - 0.95; p=0.003) whereas Asian or Pacific Islanders were more likely to receive thrombolysis (OR 1.20, 95% CI 1.01 - 1.44; p=0.043) compared to whites. There was no difference in rates of EMT by race (p=0.18). Total charges and length of stay were significantly higher in racial minorities compared to whites (table). Conclusions: Blacks hospitalized for AIS have significantly lower in-hospital mortality compared to whites but are significantly less likely to receive thrombolysis compared to whites. Total charges and length of stay are significantly higher for racial minorities. Future studies should investigate mechanisms of this apparent protective effect of black race on in-hospital mortality in AIS.

scholarly journals Highly sensitive detection of Staphylococcus aureus by a THz metamaterial biosensor based on gold nanoparticles and rolling circle amplification

RSC Advances ◽  
2020 ◽  
Vol 10 (45) ◽  
pp. 26824-26833 ◽  
Author(s):  
Ke Yang ◽  
Wenjing Yu ◽  
Guorong Huang ◽  
Jie Zhou ◽  
Xiang Yang ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Rolling Circle Amplification ◽  
Rolling Circle ◽  
Hospital Acquired Infections ◽  
Food Borne ◽  
Highly Sensitive ◽  
Food Borne Illness ◽  
Highly Sensitive Detection ◽  
Hospital Acquired ◽  
The Impact

A highly sensitive method for detecting Staphylococcus aureus (S. aureus) is urgently needed to reduce the impact and spread of hospital-acquired infections and food-borne illness.

Impact of Safety-Net Burden on In-Hospital Mortality and Hospitalization Costs Among Patients with Alcoholic Hepatitis and Alcoholic Cirrhosis

2020 ◽  
Author(s):  
Sanah Ladhani ◽  
Grishma Hirode ◽  
Ashwani K Singal ◽  
Robert J Wong
Keyword(s):  
African American ◽  
Hospital Mortality ◽  
Alcoholic Hepatitis ◽  
Alcoholic Cirrhosis ◽  
Safety Net ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Hospitalization Costs ◽  
The Usa ◽  
The Impact

Abstract Aims Alcoholic hepatitis (AH) and alcoholic cirrhosis disproportionately affect ethnic minority and safety-net populations. We evaluate the impact of a hospital’s safety net burden (SNB) on in-hospital mortality and costs among patients with AH and alcoholic cirrhosis. Methods We performed a cross-sectional analysis of 2012–2016 National Inpatient Sample. SNB was calculated as percentage of hospitalizations with Medicaid or uninsured payer status. Associations between hospital SNB and in-hospital mortality and costs were evaluated with adjusted multivariable logistic regression and linear regression models. Results Among 21,898 AH-related hospitalizations, compared to low SNB hospitals (LBH), patients hospitalized in high SNB hospitals (HBH) were younger (44.4 y vs. 47.4 y, P &lt; 0.001) and more likely to be African American (11.3% vs. 7.7%, P &lt; 0.001) or Hispanic (15.4% vs. 8.4%, P &lt; 0.001). AH-related hospitalizations in HBH had a non-significant trend towards higher odds of mortality (OR 1.27, 95% CI 0.98–1.65, P = 0.07) and higher mean hospitalizations costs. Among 108,669 alcoholic cirrhosis-related hospitalizations, patients in HBH were younger (53.3 y vs. 55.8 y, P &lt; 0.001) and more likely to be African American (8.2% vs. 7.3%, P &lt; 0.001) or Hispanic (24.4% vs. 12.0%, P &lt; 0.001) compared to LBH. Compared to alcoholic cirrhosis-related hospitalizations in LBH, mortality was higher among medium SNB (OR 1.10, 95% CI 1.03–1.17, P = 0.007) and HBH (OR 1.07, 95% CI 1.00–1.15, P = 0.05). Mean hospitalization costs were not different by SNB status. Conclusions HBH hospitals predominantly serve ethnic minorities and underinsured/uninsured populations. The higher in-hospital mortality associated HBH particularly for alcoholic cirrhosis patients is alarming given its increasing burden in the USA.

scholarly journals Hospital-Acquired Dysmagnesemia and In-Hospital Mortality

2020 ◽  
Vol 8 (3) ◽  
pp. 37 ◽  
Author(s):  
Wisit Cheungpasitporn ◽  
Charat Thongprayoon ◽  
Api Chewcharat ◽  
Tananchai Petnak ◽  
Michael A. Mao ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Serum Magnesium ◽  
Normal Serum ◽  
Hospitalized Patients ◽  
Normal Range ◽  
Multivariable Logistic Regression ◽  
Hospital Acquired

Background and Objectives: This study aimed to report the incidence of hospital-acquired dysmagnesemia and its association with in-hospital mortality in adult general hospitalized patients. Materials and Methods: We studied 26,020 adult hospitalized patients from 2009 to 2013 who had normal admission serum magnesium levels and at least two serum magnesium measurements during hospitalization. The normal range of serum magnesium was 1.7–2.3 mg/dL. We categorized in-hospital serum magnesium levels based on the occurrence of hospital-acquired hypomagnesemia and/or hypermagnesemia. We assessed the association between hospital-acquired dysmagnesemia and in-hospital mortality using multivariable logistic regression. Results: 28% of patients developed hospital-acquired dysmagnesemia. Fifteen per cent had hospital-acquired hypomagnesemia only, 10% had hospital-acquired hypermagnesemia only, and 3% had both hospital-acquired hypomagnesemia and hypermagnesemia. Compared with patients with persistently normal serum magnesium levels in hospital, those with hospital-acquired hypomagnesemia only (OR 1.77; p < 0.001), hospital-acquired hypermagnesemia only (OR 2.31; p < 0.001), and both hospital-acquired hypomagnesemia and hypermagnesemia (OR 2.14; p < 0.001) were significantly associated with higher in-hospital mortality. Conclusions: Hospital-acquired dysmagnesemia affected approximately one-fourth of hospitalized patients. Hospital-acquired hypomagnesemia and hypermagnesemia were significantly associated with increased in-hospital mortality.

The Impact of Hospital-Acquired Infections on the Microbial Etiology and Prognosis of Late-Onset Prosthetic Valve Endocarditis

CHEST Journal ◽  
2005 ◽  
Vol 128 (2) ◽  
pp. 764-771 ◽  
Author(s):  
Pablo Rivas ◽  
Julio Alonso ◽  
Javier Moya ◽  
Miguel de Górgolas ◽  
Jorge Martinell ◽  
...  
Keyword(s):  
Prosthetic Valve ◽  
Late Onset ◽  
Prosthetic Valve Endocarditis ◽  
Hospital Acquired Infections ◽  
Microbial Etiology ◽  
Hospital Acquired ◽  
The Impact

scholarly journals An effect of single high dose of vitamin D3 on the risk of nosocomial infections, hospitalization time and mortality in hospitalized elderly population. A preliminary report

2020 ◽  
Vol 2 (2) ◽  
pp. 1-5
Author(s):  
Dorota Leszczyńska ◽  
Agata Tuszyńska ◽  
Magdalena Zgliczyńska ◽  
Wojciech Zgliczyński ◽  
Waldemar Misiorowski
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Vitamin D3 ◽  
Nosocomial Infections ◽  
Control Group ◽  
High Dose ◽  
Single High Dose ◽  
Hospital Acquired Infections ◽  
Hospital Acquired ◽  
The Impact

Introduction: Observational studies indicate a significant impact of serum 25(OH)D concentration on incidence of hospital-acquired infections. However, we did not find any interventional study assessing the effect of vitamin D3 administration at the admission on the course of further hospitalization in internal medicine departments. Objective of the paper: Investigation of the impact of one-time high-dose vitamin D3 administration in elderly patients on the day of urgent admission to the hospital, on hospital-acquired infections. Materials and methods: A randomized, two-arms, open pilot study in 97 adults aged 60-100. A study group was given a single dose of 60,000 IU vitamin D3 and a control group was not subject to any intervention. Serum 25(OH)D and calcium were measured at the baseline and after 7 days. Results: 77.32% of studied patients were vitamin deficient, and among those, in 28.87% severe vitamin D deficiency was found. After single administration of 60,000 IU of vitamin D3, only 4 patients achieved recommended serum 25(OH)D concentration. The highest increase in serum 25(OH)D was observed in patients with severe deficiency. Numbers of observed nosocomial infections such as flu, hospital-acquired pneumonia or Klebsiella pneumoniae MBL+ infection did not differ significantly between study and control group, however there was a trend close to significance for lower incidence of Clostridium difficile infection in the vitamin D3 group. Conclusions: Preliminary results of the presented research indicate possible protective effect of single high dose of vitamin D3 against Clostridium difficile infection during hospitalization. Further research on larger group of patients, using higher dose of vitamin D3 is necessary.

scholarly journals Public Health Impact of Hospital-Acquired Infections on Traumatic Patients

2021 ◽  
Author(s):  
Ektha Parchuri ◽  
Roopa Koduri
Keyword(s):  
Public Health ◽  
Traumatic Injury ◽  
Health Impact ◽  
Public Health Issue ◽  
Traumatic Injuries ◽  
Hospital Acquired Infections ◽  
Duration Of Hospital Stay ◽  
Cytokine Levels ◽  
Hospital Acquired ◽  
The Impact

Blunt traumatic injuries leading cause of death, with TBI and hemorrhage >91% of all deaths, amounting to $37.8 billion per year. Traumatic patients are at high risk for developing infection, where infected patients are more likely to have been ventilated or have had multiple surgical procedures, exposing to ventilatorassociated pneumonia and other infections. Elevated cytokine levels post-infection affect patient mortality, making it a large public health issue. Lack of data centered around gender and ethnicity confounds the impact of this disease. Large Pittsburgh hospitals with capacity >300 report worse infection ratings than US baseline measures. Risk factors for infection including age and duration of hospital stay, directly affecting severity of traumatic injury. Infection should not be viewed as a confounder impacting mortality but rather an outcome arising from trauma.

scholarly journals Incidence and Risk Factors of Hospital-Acquired Pressure Ulcers Following Total Hip Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

2021 ◽  
Author(s):  
Qinfeng Yang ◽  
Jian Wang ◽  
Danping Shi ◽  
Jinlang Fu ◽  
Zhanjun Shi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Total Hip Arthroplasty ◽  
Hospital Mortality ◽  
Nationwide Inpatient Sample ◽  
Private Insurance ◽  
Large Hospital ◽  
Elective Admission ◽  
Hospital Acquired ◽  
Total Charges

Abstract BackgroundThe occurrence of hospital-acquired pressure ulcers (HAPUs) is disturbing and costly, leading to a variety of adverse effects. The objective of this study was to examine the incidence and risk factors of HAPUs following total hip arthroplasty (THA) using a large-scale national database. MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005-2014. Patients who underwent THA were included. Patient demographics, hospital characteristics, length of stay (LOS), total charges during hospitalization, in-hospital mortality, preoperative comorbidities, and perioperative complications were assessed.ResultsA total of 592,174 THAs were captured from the NIS database. The general incidence of HAPUs after THA was 0.05%, with a fluctuating trend annually. Patients suffered from HAPUs were older, less likely through elective admission, more likely in large hospital, more usage of Medicare, and less possibly paying via Private insurance compared to the nonaffected individuals. Additionally, the occurrence of HAPUs was associated with more preoperative comorbidities, longer LOS, extra total charges, and higher in-hospital mortality. Risk factors of HAPUs included advanced age (≥75 years), large hospital, multiple comorbidities (n≥3), diabetes with chronic complications, drug abuse, liver disease, fluid and electrolyte disorders, metastatic cancer, peripheral vascular disorders, psychoses, chronic renal failure, peptic ulcer disease, and weight loss. Besides, HAPUs were associated with inflammatory arthritis and femoral neck fracture (compared with primary/secondary osteoarthritis), frailty/senility, osteoporosis, acute renal failure, pneumonia, postoperative delirium, urinary tract infection, deep vein thrombosis, sepsis/septicemia, wound dehiscence/non-healing surgical wound, periprosthetic joint infection, and mechanical prosthesis-related complications. Both elective admission and Private insurance were detected as protective factors. ConclusionsIt is beneficial to study the risk factors of HAPUs after THA to ensure the preventive management and optimize consequences although a really low incidence was identified.

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