Gender differences in esophageal variceal bleeding in the United States

Background and Aims: Esophageal variceal bleeding is a common reason for hospitalization in patients with cirrhosis. The main objective of this study was to analyze the effects of gender differences on outcomes in hospitalizations related to Esophageal variceal bleeding in the United States. Methods: A retrospective observational cohort study was performed using the National Inpatient Sample (NIS) database for all hospitalizations with a discharge diagnosis of esophageal varices with hemorrhage from 2016 to 2019. The primary outcome was in-hospital mortality, while secondary outcomes included rate of early endoscopy (defined as less than 1 day), AKI, blood transfusion, sepsis, ICU admission and TIPS (Transjugular Intrahepatic Portosystemic Shunt). We also compared the length of stay and total hospitalization charges. Results: We identified a total of 166,760 patients with variceal bleeding of which 32.7% were females. In-hospital mortality was higher in males, 9.91%, compared to females, 8.31% (adjusted odds ratio (aOR): 0.88, p-value=.008, when adjusted for confounding factors). The odds of undergoing an EGD, length of stay, or total hospitalization charges did not differ between the two groups. Compared to men, women had lower odds of receiving TIPS (aOR = 0.83, p-value=.002). Conclusion: Women hospitalised with esophageal variceal bleeding are at a lower risk of death compared to males. Further research is needed to elucidate the factors associated with this lower risk.Open access articleThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Incidence and factors associated with portal vein thrombosis in patients with acute pancreatitis: A United States national retrospective study.

BACKGROUND/OBJECTIVE: Portal vein thrombosis (PVT) is a well-known complication in patients with acute pancreatitis (AP). Limited data exist on the incidence and factors of PVT in patients with AP. We investigate the incidence and clinical predictors of PVT in AP. METHODS: We queried the 2016-2019 National Inpatient Sample database to identify patients with AP. Patients with chronic pancreatitis or pancreatic cancer were excluded. We studied demographics, comorbidities, complications, and interventions in these patients and stratified the results by the presence of PVT. A multivariate regression model was used to identify factors associated with PVT in patients with AP. We also assessed the mortality and resource utilization in patients with PVT and AP. RESULTS: Of the 1,386,389 adult patients admitted with AP, 11,135 (0.8%) patients had PVT. Women had a 15% lower risk of developing PVT (aOR-0.85, p \u3c 0.001). There was no significant difference between the age groups in the risk of developing PVT. Hispanic patients had the lowest risk of PVT (aOR-0.74, p \u3c 0.001). PVT was associated with pancreatic pseudocyst (aOR-4.15, p \u3c 0.001), bacteremia (aOR-2.66, p \u3c 0.001), sepsis (aOR-1.55, p \u3c 0.001), shock (aOR-1.68, p \u3c 0.001) and ileus (aOR-1.38, p \u3c 0.001). A higher incidence of in-hospital mortality and ICU admissions was also noted in patients with PVT and AP. CONCLUSION: This study demonstrated a significant association between PVT and factors such as pancreatic pseudocyst, bacteremia, and ileus in patients with AP

Effect of Hospital Teaching Status on Outcomes of Patients With Acute Pancreatitis.

Introduction Multiple studies have shown that outcomes of various diseases differ by the hospital teaching status. However, not much is known about the effects of hospital teaching status on outcomes of acute pancreatitis (AP). The aim of this study was to identify if there was an effect of hospital teaching status on the outcomes of AP. Methods The National Inpatient Sample (NIS) database was used to identify patients with a discharge diagnosis of AP from 2016 to 2019. Patients were classified according to whether they were admitted to teaching hospitals (TH) or non-teaching hospitals (NTH). Study outcomes were the length of stay (LOS), total hospitalization cost and charge, sepsis, shock, acute kidney injury, ICU admission, and mortality. Results A total of 1,689,334 patients were included in the study. Of these, 65.06% were in the TH group, while 34.94% were in the NTH group. Patients admitted to TH had a higher incidence of AKI (18.84% vs. 15.79%,

Predictors of leaving against medical advice in patients with alcohol-related hepatitis

BackgroundAlcohol-related hepatitis is one of the most severe manifestations of alcohol-related liver disease and has been associated with significant morbidity, mortality and financial burden. Patients with alcohol use disorders are at risk of leaving against medical advice (LAMA); however, there is currently a lack of data in the literature to show which patients are at higher risk. In this study, we investigated the specific demographic factors and comorbidities associated with LAMA.MethodsPatients with a primary or secondary discharge diagnosis of alcohol-related hepatitis (ICD10-CM codes K70.4 and K70.1) between January 2016 and December 2019 were included in this study. Demographics, comorbidities, complications and interventions were studied in for patients who LAMA. Multivariate analysis was conducted to elucidate factors contributing to the increased risk of alcohol-related hepatitis.ResultsA total of 538,750 patients were admitted with a diagnosis of alcohol-related hepatitis. Of these, 31,500 (5.84%) patients LAMA. Older age, Hispanic race, private insurance, and higher income status were associated with a lower risk of LAMA, while younger age, African American race, lack of insurance and being in the lowest income quartile were associated with the highest risk.ConclusionsOur findings demonstrated that significant differences exist between patients with alcohol-related hepatitis who LAMA and those who remain hospitalized until discharge. We believe that this study will help healthcare providers identify patients at risk of LAMA, and help promote the targeted education of specific subgroups to improve their understanding of their disease state and decrease adverse events

Hospitalization Outcomes of Acute Pancreatitis in Hematopoietic Stem Cell Transplant Recipients.

BACKGROUND: Acute pancreatitis (AP) carries a significant morbidity and mortality worldwide. AP is a potential complication of hematopoietic stem cell transplantation (HSCT) although its incidence remains unclear. HSCT recipients are at increased risk of AP due to various factors but the effect of AP on mortality and resource utilization in the adult population has not been studied. We investigated the impact of AP on hospitalization outcomes among patients following HSCT. METHODS: We queried the National Inpatient Sample (NIS) database using the International Classification of Diseases (ICD)-10 codes. All adult patients with a diagnosis or procedure code of HSCT were included in the study. Patients were divided into those with a diagnosis of AP and those without. Sensitivity analysis was performed for patients with a length of stay greater than 28 days. The relationship between AP and mortality, length of stay, total hospitalization cost, and charges was assessed using univariate analysis followed by multivariate analysis. RESULTS: Of the 140,130 adult patients with HSCT, 855 (0.61%) patients developed AP. There was 1.74 times higher risk of mortality in patients with AP as compared to controls (adjusted odds ratio (aOR): 1.74, P = 0.0055). There was no statistically significant difference in the length of stay, hospitalization charge, or cost before sensitivity analysis. After sensitivity analysis, 13,240 patients were included, from which 125 (0.94%) had AP. There was 3.85 times higher risk of mortality in patients who developed AP as compared to controls (aOR: 3.85, P = 0.003). There was a statistically significant increase noted in the length of stay (adj coeff: 20.3 days, P = 0.002), hospital charges (+$346,616, P = 0.017), and cost (+$121,932.4, P = 0.001) in patients with AP as compared to those who did not develop AP. CONCLUSION: Recipients of HSCT who develop AP have shown to have higher mortality on sensitivity analysis. This study highlights that AP in HSCT patients is associated with worse outcomes and higher resource utilization. Physicians should be aware of this association as the presence of pancreatitis portends a poor prognosis

Seasonal Variations of Hospital Admissions for Alcohol-Related Hepatitis in the United States

BackgroundClinical experience suggests an increased hospitalization rate for alcohol-related hepatitis (AH) in the winter months; however, seasonal variations in the prevalence of hospitalizations for AH have not been described previously. We hypothesized that AH hospitalizations would be higher in the winter months due to the holiday season and increased alcohol sales.MethodsPatients with primary or secondary discharge diagnosis of AH were included in the study (International Classification of Diseases, Clinical Modification-10th Revision codes K70.4 and K70.1) between January 2016 and December 2019. The primary outcome measure for this study was daily hospitalizations by each month of the year. Secondary outcome measures included the rate of in-hospital mortality associated with AH, for each month.ResultsThe highest number of AH-related admissions was reported in July (n = 56,800; 9%), followed by August (n = 55,700; 8.8%) and May (n = 54,865; 8.7%). February had the lowest number of admissions (n = 46,550; 7.37%). The adjusted mortality was highest in December (overall mortality: 9.6%; adjusted odds ratio: 1.29; 95% confidence interval: 1.142 - 1.461; P < 0.0001) and lowest in May (overall mortality rate: 7.7%). No difference was noted between length of stay and total hospitalization cost between months.ConclusionOur findings demonstrate that seasonal variations in hospitalizations related to AH do exist across the United States. Regional differences also exist and follow unique patterns. The increase in admissions for AH is in line with other studies suggesting that heavy drinking happens during the warm season. Hospital administrators and other stewards of healthcare resources can use seasonal patterns to guide allocation of resources

Multicenter Case–Control Study of COVID-19–Associated Mucormycosis Outbreak, India

We performed a case–control study across 25 hospitals in India for the period of January–June 2021 to evaluate the reasons for an COVID-19–associated mucormycosis (CAM) outbreak. We investigated whether COVID-19 treatment practices (glucocorticoids, zinc, tocilizumab, and others) were associated with CAM. We included 1,733 cases of CAM and 3,911 age-matched COVID-19 controls. We found cumulative glucocorticoid dose (odds ratio [OR] 1.006, 95% CI 1.004–1.007) and zinc supplementation (OR 2.76, 95% CI 2.24–3.40), along with elevated C-reactive protein (OR 1.004, 95% CI 1.002–1.006), host factors (renal transplantation [OR 7.58, 95% CI 3.31–17.40], diabetes mellitus [OR 6.72, 95% CI 5.45–8.28], diabetic ketoacidosis during COVID-19 [OR 4.41, 95% CI 2.03–9.60]), and rural residence (OR 2.88, 95% CI 2.12–3.79), significantly associated with CAM. Mortality rate at 12 weeks was 32.2% (473/1,471). We emphasize the judicious use of COVID-19 therapies and optimal glycemic control to prevent CAM