Vascular complications of pancreatitis

More than 200000 hospital admissions happen per year for acute pancreatitis and more than 50000 for chronic pancreatitis in the United States of America. Necrotizing pancreatitis accounts for 20%-30% of the cases. One-quarter of the patients with pancreatitis develop vascular complications, which carries a high mortality. This mini-review will address these complications that can help primary care physicians and hospitalists in managing their patients effectively.

Sleepiness in critical care nurses: results of a pilot study

BACKGROUND

Sleep deprivation, compounded by circadian disruptions, is a common problem in health care workers. Sleepiness in nurses has important implications for patients as well as nurses' own safety.

OBJECTIVE

The objective of the study was to assess comprehensively sleepiness levels in post-night-shift nurses.

METHODS

Post-night-shift nurses in the ICU and on general floors (medicine and surgery) were assessed using subjective (Epworth Sleepiness Scale [ESS]) and objective (Mean Sleep Latency Test [MSLT]) measures.

RESULTS

ESS was abnormal (>8) in 7 of 10 ICU nurses compared with 2 of 10 floor nurses (P < .005), and mean ESS score was also higher (8.7 +/- 3.9 vs. 5.6 +/- 2.1, respectively; P = 0.042). MSLT values for the first nap period were in the pathologic range in the ICU nurses compared with the floor nurses (4.65 +/- 5.5 vs. 10.85 +/- 7.4 minutes, respectively; P < .05).

CONCLUSIONS

Post-night-shift RNs working in the ICU have a pathologic degree of sleepiness.

Breaking Bad News, a Pertinent Yet Still an Overlooked Skill: An International Survey Study

Delivering bad news to patients is a challenging yet impactful everyday task in clinical practice. Ideally, healthcare practitioners should receive formal training in implementing these protocols, practice in simulation environments, and real-time supervision with feedback. We aimed to investigate whether healthcare providers involved in delivering bad news have indeed received formal training to do so. We conducted a cross-sectional survey study that targeted all healthcare providers in the intensive care units of 174 institutions in 40 different countries. Participants included physicians, nurses, medical students, nursing students, pharmacists, respiratory technicians, and others. The survey tool was created, validated, and translated to the primary languages of these countries to overcome language barriers. A total of 10,106 surveys were collected. Only one third of participants indicated that they had received a formal training. Providers who had received formal training were more likely to deliver bad news than those who had not. Younger and less experienced providers tend to deliver bad news more than older, more experienced providers. The percentage of medical students who claimed they deliver bad news was comparable to that of physicians. Medical schools and post-graduate training programs are strongly encouraged to tackle this gap in medical education.

Painful Sleep: Insomnia in Patients with Chronic Pain Syndrome and its Consequences

Insomnia is a chronic condition that occurs a minimum of three times per week over a period of three or more subsequent months. There are multiple causes of insomnia, and even though it is considered a symptom, it can be associated with chronic illnesses. Chronic pain syndrome, which is defined as pain that persists for a period longer than 3 months, is one of several etiologies of insomnia. The prevalence of insomnia among chronic pain patients is greater in comparison with the general population (percentage or ratio). Chronic pain is common in patients with rheumatoid arthritis, spinal pain (such as chronic back pain) and fibromyalgia. The prevalence of in-somnia is also higher in cancer patients when compared to the general population. When the clinical history indicates a straightforward diagnosis of chronic pain syndrome, patients will complain of insomnia as part of their symptomatology. It is imperative to manage their underlying illness to alleviate their sleep disorder. Various medications may be used to relieve and even improve pain symptoms. Other than pharmacological interventions, non-pharmacological alternatives such as yoga, meditation, acupuncture, and psychotherapy can help improve the quality of life of these patients. The purpose of this article is to review the diagnosis and management of insomnia in chronic pain syndrome and its impact on the quality of life.

Hypertonic saline in elevated intracranial pressure: past, present, and future

Hypertonic Saline (HS) has been a proven and effective therapy and a safe alternative to mannitol in patients with increase intracranial pressure (ICP). We hereby present a case of 25-year-old women with intracranial bleed secondary to right parietal arteriovenous malformation. Patient underwent surgery for evacuation of hematoma and resection of arteriovenous malformation. Post- operative course was complicated by recurrent episodes of elevated ICP. She received total of 17 doses of 23.4% HS and 30 doses of mannitol with good outcome. Despite reluctance from some clinicians to use HS, hypertonic saline seems to be a safe and effective therapy.

Safety and efficacy of colchicine in COVID-19 patients: A systematic review and meta-analysis of randomized control trials

BACKGROUND

Colchicine has been used an effective anti-inflammatory drug to treat gout diseases. Owing to its pharmacodynamic of inhibiting interleukins, it has been repurposed to target the cytokine storm post-SARS-CoV-2 invasion. The goal of this meta-analysis was to evaluate the safety profile of colchicine in COVID-19 patients using the gold-standard randomised-control trials.

METHODS

Electronic databases (Pubmed, Google Scholar, and Cochrane) were systematically searched until June 2021 and RCTs were extracted. Outcomes of interest included all-cause mortality, COVID-19 severity, mechanical ventilation, C-reactive protein and D-dimer levels. Using a random-effects model, dichotomous outcomes were pooled using odds ratios (OR) through the generic inverse variance formula while weighted mean differences were calculated using the Wan's method. P-values < 0.05 were considered statistically significant for all outcomes.

RESULTS

A total population of 16,048 from five RCTs were included in the analysis. Of this, 7957 were randomized to colchicine, and 8091 received standard care, with an average age of 60.67 years. Colchicine was observed to significantly reduce COVID-19 severity (OR: 0.41, 95% CI [0.22, 0.76]; p = 0.005), and CRP levels (WMD: -19.99, 95% CI [-32.09, -7.89]; p = 0.001). However, there was no significant difference in D-dimer levels (WMD: 0.31, 95% CI [-0.61, 1.23]; p = 0.51), mechanical ventilation (OR: 0.42, 95% CI [0.17, 1.03]; p = 0.06; I2 = 74%) and all-cause mortality (OR: 0.98, 95% CI [0.83, 1.16]; p = 0.84) among patients receiving colchicine or standard care.

CONCLUSION

Colchicine treatment decreased CRP levels and COVID-19 severity, with dimer levels, all-cause mortality and mechanical ventilation remaining seemingly unaffected. Thus, clinical trials need to be carried out that allow effective evaluation of colchicine in COVID-19 patients.

Preliminary noise reduction efforts in a medical intensive care unit

Noise is a significant contributor to sleep disruption in the intensive care unit (ICU) that may result in increased patient morbidity such as delirium and prolonged length of stay in ICU. We conducted a pre-post intervention study in a 24-bed tertiary care academic medical ICU to reduce the mean noise levels. Baseline dosimeter recordings of ICU noise levels demonstrated a mean noise level of 54.2 A-weighted decibels (dBA) and peak noise levels of 109.9 dBA, well above the Environmental Protection Agency's recommended levels. There were 1735 episodes of "defects" (maximum noise levels > 60 dBA). Following implementation of multipronged interventions, although the mean noise levels did not change significantly between pre- and post-intervention (54.2 vs 53.8 dBA; p = 0.96), there was a significant reduction in the number of "defects" post-intervention (1735 vs 1289, p ≤ 0.000), and the providers felt that the patients were sleeping longer in the ICU post-intervention.

A Case Series of Vaping-Induced Lung Injury in a Community Hospital Setting

Acute and subacute injury to the lung parenchyma can be caused by multiple products. Over the past few years, vaping (also known as E-cigarettes) has become a popular trend and has been considered "safer" alternative to smoking cigarettes, especially among young adults. The use of E-cigarettes has rapidly increased, and according to the most recent report by CDC released at the end of December 2019, 2,506 cases and more than 54 associated deaths due to vaping/E-cigarette-associated lung injury were reported. Though vitamin E acetate and tetrahydrocannabinol (THC) have been found in most of the bronchoalveolar lavage samples, there are still small numbers of cases that have not reported to using THC-containing compounds. Research looking into other possible constituents in E-cigarettes that can account for the etiology of disease and effects of vaping as it relates to pulmonary physiology still remains limited and uncertain. We hereby present a case series of 5 patients who were admitted primarily for respiratory symptoms of cough, dyspnea, and fevers and were diagnosed with vaping-induced pulmonary injury.

A case of severe heatstroke and review of pathophysiology, clinical presentation, and treatment

Heatstroke is life-threatening condition characterized by hyperthermia and central nervous system disturbances. It can also be classified as a form of systemic inflammatory response syndrome with multiple organ dysfunction and in many ways resembles sepsis. Like sepsis, most patients with heatstroke demonstrate a hyperdynamic hemodynamic response. In contrast to sepsis, rhabdomyolysis may complicate management and initial fluid resuscitation is not well defined. We present an illustrative case report and review of literature.

Actinomyces odontolyticus: Rare Etiology for Purulent Pericarditis

Purulent pericarditis is one of the most common causes of cardiac tamponade and if left untreated has a mortality of 100%. Staphylococcus aureus and Streptococcus pneumonia have been implicated as the main etiology of purulent pericardial effusion followed by fungi and anaerobic sources. Actinomyces odontolyticus pericardial involvement has been reported in the literature only once. To our knowledge, this is the first fatal case of A. odontolyticus purulent pericarditis in the absence of periodontal disease.

Endocarditis caused by Candida dubliniensis

Endocarditis caused by Candida dubliniensis is a rare event and limited to few case reports. In this report, the authors present a patient with a history of intravenous drug use and hepatitis C and endocarditis involving a prosthetic aortic valve. Also reviewed are the treatment guidelines for Candida sp. endocarditis.

Influence of Hispanic ethnicity in prevalence of diabetes mellitus in sleep apnea and relationship to sleep phase

INTRODUCTION

Recent studies have shown a strong association between insulin resistance, diabetes mellitus, and obstructive sleep apnea (OSA). This association has not been previously reported in the Hispanic population. The objective of this study was to study the prevalence of diabetes in a cohort of Hispanic patients with OSA in comparison with a white cohort.

METHOD

We performed a retrospective chart review of 103 Hispanic patients and 69 white patients with OSA. All patients had undergone full-night baseline polysomnography. We excluded charts of patients who underwent split-night studies and those who did not have rapid eye movement (REM) sleep.

RESULTS

Both groups were well matched in terms of age, gender distribution, and body mass index. The prevalence of self-reported diabetes in Hispanic patients with OSA was 42.71% compared with 24.28% of whites (P = 0.005). A REM apnea hypopnea index (AHI) of > 20 was significantly associated with an increased prevalence of diabetes in the Hispanic population; this association was not seen in the white population.

CONCLUSION

There was a very high prevalence of diabetes in an unselected cohort of Hispanic patients with OSA compared with white patients.

Comorbid insomnia and sleep apnea: characterization of the syndrome and understanding its associations with comorbid sleep conditions

PURPOSE

Obstructive sleep apnea (OSA) is traditionally associated with excessive daytime sleepiness. Insomnia is characterized by hyperarousal, and is seen as a predominant feature in a subgroup of patients with OSA. The aim of this study was to describe the prevalence of comorbid insomnia and sleep apnea (COMISA) in a sleep apnea population and to characterize its features.

METHODS

This was a chart review of patients who underwent overnight polysomnography (PSG). All patients completed questionnaires with the Epworth Sleepiness Scale (ESS), and symptoms of insomnia and other sleep-related comorbidities. Patients with OSA on the PSG were included.

RESULTS

A total of 296 patients with OSA were included, of which 80% reported at least 1 major symptom of insomnia: 57% reported sleep onset insomnia, 68% sleep maintenance insomnia, and 48% had early morning awakenings. COMISA (OSA plus 2 or more major symptoms of insomnia) was seen in 63%. These patients were more likely to report an abnormal ESS score, gastroesophageal reflux (GER), and restless legs (RL) than those without; no difference was seen in self-reported sleep bruxism. Among the patients with COMISA, 85% reported at least 1 representative symptom of psychophysiological insomnia (PPI); each of the 5 PPI symptoms was present in at least 40% of patients with COMISA.

CONCLUSIONS

Insomnia is extremely prevalent in our population of patients with OSA, accompanied by daytime sleepiness and symptoms of PPI, GER, and RL. Further study is needed to determine the interactions between symptoms and OSA treatments in these patients.

Infection risk with the use of interleukin inhibitors in hospitalized patients with COVID-19: A narrative review

INTRODUCTION

To date, only corticosteroids and interleukin-6 (IL-6) inhibitors have been shown to reduce mortality of hospitalized patients with COVID-19. In this literature review, we aimed to summarize infection risk of IL inhibitors, with or without the use of corticosteroids, used to treat hospitalized patients with COVID-19.

METHODS

A literature search was conducted using the following evidence-based medicine reviews: Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Embase; Ovid Medline; and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions 1946 to April 28, 2021. All relevant articles were identified using the search terms COVID-19 or SARS-coronavirus-2, infections, interleukins, inpatients, adults, and i ncidence.

RESULTS

We identified 36 studies of which 2 were meta-analyses, 5 were randomized controlled trials, 9 were prospective studies, and 20 were retrospective studies. When anakinra was compared with control, 2 studies reported an increased risk of infection, and 3 studies reported a similar or decreased incidence of infection. Canakinumab had a lower associated incidence of infection compared with placebo in one study. When sarilumab was compared with placebo, one study reported an increased risk of infection. Nine studies comparing tocilizumab with placebo reported decreased or no difference in infection risk (odds ratio [OR] for the studies ranged from 0.39-1.21). Fourteen studies comparing tocilizumab with placebo reported an increased risk of infection, ranging from 9.1% to 63.0% (OR for the studies ranged from 1.85-5.04). Infection most commonly presented as bacteremia. Of the 6 studies comparing tocilizumab and corticosteroid use with placebo, 4 reported a nonsignificant increase toward corticosteroids being associated with bacterial infections (OR ranged from 2.76-3.8), and 2 studies reported no increased association with a higher infection risk.

CONCLUSIONS

Our literature review showed mixed results with variable significance for the association of IL-6 inhibitors with risk of infections in patients with COVID-19.

Overlap of diabetic ketoacidosis and hyperosmolar hyperglycemic state

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia state (HHS) are two life-threatening metabolic complications of diabetes that significantly increase mortality and morbidity. Despite major advances, reaching a uniform consensus regarding the diagnostic criteria and treatment of both conditions has been challenging. A significant overlap between these two extremes of the hyperglycemic crisis spectrum poses an additional hurdle. It has well been noted that a complete biochemical and clinical patient evaluation with timely diagnosis and treatment is vital for symptom resolution. Worldwide, there is a lack of large-scale studies that help define how hyperglycemic crises should be managed. This article will provide a comprehensive review of the pathophysiology, diagnosis, and management of DKA-HHS overlap.

Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 Guidelines Reviewed

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report is an essential resource for all clinicians who strive to provide optimal care to patients with chronic obstructive lung disease (COPD). The annual report of GOLD makes few revisions and updates besides including data from the preceding year. At an interval, GOLD comes up with a significant modification in its guidelines, which is generally a major overhaul of the pre-existing guidelines. According to the latest 2023 updates, published in November 2022, there have been significant advancements made in the field of COPD. These include the development of more precise definitions for COPD and its exacerbations, the introduction of a new set of parameters to measure exacerbation severity, and updating the COPD assessment tool. Additionally, revisions have been made to the initial and follow-up treatment guidelines. The report also simplifies the treatment algorithm and sheds light on new findings that suggest the use of pharmacological triple therapy can reduce mortality rates. Furthermore, the report includes discussions on inhaler device selection and adherence to COPD medications. These improvements demonstrate a continued effort to enhance COPD treatment and management. Although there are some areas that could benefit from more detailed guidance and explanation, such as the proper utilization of blood eosinophil counts for treatment decisions, and the establishment of treatment protocols post-hospitalization, the latest modifications to the GOLD recommendations will undoubtedly aid healthcare providers in addressing any gaps in patient care. We aim to highlight key changes in the GOLD 2023 report and present a viewpoint about their potential implications in a real-world clinical scenario.

Factors Associated with Mortality Among Hospitalized Adults with COVID-19 Pneumonia at a Private Tertiary Hospital in Tanzania: A Retrospective Cohort Study

BACKGROUND

The emergence of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. There has been paucity of data for hospitalized African patients suffering from COVID-19. This study aimed to identify factors associated with in-hospital mortality in patients suffering from COVID-19 in Tanzania.

METHODS

This was a single center, retrospective, observational cohort study in adult patients hospitalized with confirmed COVID-19 infection. Demographics, clinical pattern, laboratory and radiological investigations associated with increased odds of mortality were analyzed.

RESULTS

Of the 157 patients, 107 (68.1%) patients survived and 50 (31.8%) died. Mortality was highest in patients suffering with severe (26%) and critical (68%) forms of the disease. The median age of the cohort was 52 years (IQR 42-61), majority of patients were male (86%) and of African origin (46%), who presented with fever (69%), cough (62%) and difficulty in breathing (43%). Factors that were associated with mortality among our cohort were advanced age (OR 1.07, 95% CI 1.03-1.11), being overweight and obese (OR 9.44, 95% CI 2.71-41.0), suffering with severe form of the disease (OR 4.77, 95% CI 1.18-25.0) and being admitted to the HDU and ICU (OR 6.68, 95% CI 2.06-24.6).

CONCLUSION

The overall in-hospital mortality was 31.8%. Older age, obesity, the severe form of the disease and admission to the ICU and HDU were major risk factors associated with in-hospital mortality.

Rhinocerebral mucormycosis complicated by bacterial brain abscess

Mucormycosis is a rare life-threatening fungal infection occurring primarily in patients with diabetics or immunocompromised patients. The authors report a case of mucormycosis in a patient with diabetes complicated by bacterial brain abscess. The bacteria cultured from the abscess were Staphylococcus epidermidis and Enterococcus faecalis. The abscess was surgically drained and treated with antibiotics. A brief review of mucormycosis and brain abscess including treatment is provided in the discussion.

Sleep among opioid users

Use of opioids in the treatment of both acute and chronic pain has increased significantly in the past 2 decades. Recent literature suggests that chronic opioid use is related to sleep-related breathing disorders, particularly central sleep apnea of both the periodic and nonperiodic breathing pattern. The clinical significance, pathogenesis, and treatment options of these sleep-related breathing disorders are not well understood. This article summarizes the current literature on the effects of both acute and chronic opioid use on sleep, sleep-disordered breathing, and the current evidence on various treatment options for breathing disorders related to chronic opioid use.

Hepatopulmonary syndrome: An update

Hepatopulmonary syndrome (HPS) is characterized by defects in oxygenation caused by intra-pulmonary vasodilation occurring because of chronic liver disease, portal hypertension, or congenital portosystemic shunts. Clinical implications of portal hypertension are very well-known, however, awareness of its effect on multiple organs such as the lungs are less known. The presence of HPS in chronic liver disease is associated with increased mortality. Medical therapies available for HPS have not been proven effective and definitive treatment for HPS is mainly liver transplantation (LT). LT improves mortality for patients with HPS drastically. This article provides a review on the definition, clinical presentation, diagnosis, and management of HPS.

Multifaceted interventions to decrease mortality in patients with severe sepsis/septic shock-a quality improvement project

Despite knowledge that EGDT improves outcomes in septic patients, staff education on EGDT and compliance with the CPOE order set has been variable. Based on results of a resident survey to identify barriers to decrease severe sepsis/septic shock mortality in the medical intensive care unit (MICU), multifaceted interventions such as educational interventions to improve awareness to the importance of early goal-directed therapy (EGDT), and the use of the Computerized Physician Order Entry (CPOE) order set, were implemented in July 2013. CPOE order set was established to improve compliance with the EGDT resuscitation bundle elements. Orders were reviewed and compared for patients admitted to the MICU with severe sepsis/septic shock in July and August 2013 (controls) and 2014 (following the intervention). Similarly, educational slide sets were used as interventions for residents before the start of their ICU rotations in July and August 2013. While CPOE order set compliance did not significantly improve (78% vs. 76%, p = 0.74), overall EGDT adherence improved from 43% to 68% (p = 0.0295). Although there was a trend toward improved mortality, this did not reach statistical significance. This study shows that education interventions can be used to increase awareness of severe sepsis/septic shock and improve overall EGDT adherence.

Review of Application of Machine Learning as a Screening Tool for Diagnosis of Obstructive Sleep Apnea

Obstructive sleep apnea syndrome (OSAS) is a pervasive disorder with an incidence estimated at 5-14 percent among adults aged 30-70 years. It carries significant morbidity and mortality risk from cardiovascular disease, including ischemic heart disease, atrial fibrillation, and cerebrovascular disease, and risks related to excessive daytime sleepiness. The gold standard for diagnosis of OSAS is the polysomnography (PSG) test which requires overnight evaluation in a sleep laboratory and expensive infrastructure, which renders it unsuitable for mass screening and diagnosis. Alternatives such as home sleep testing need patients to wear diagnostic instruments overnight, but accuracy continues to be suboptimal while access continues to be a barrier for many. Hence, there is a continued significant underdiagnosis and under-recognition of sleep apnea in the community, with at least one study suggesting that 80-90% of middle-aged adults with moderate to severe sleep apnea remain undiagnosed. Recently, we have seen a surge in applications of artificial intelligence and neural networks in healthcare diagnostics. Several studies have attempted to examine its application in the diagnosis of OSAS. Signals included in data analytics include Electrocardiogram (ECG), photo-pletysmography (PPG), peripheral oxygen saturation (SpO2), and audio signals. A different approach is to study the application of machine learning to use demographic and standard clinical variables and physical findings to try and synthesize predictive models with high accuracy in assisting in the triage of high-risk patients for sleep testing. The current paper will review this latter approach and identify knowledge gaps that may serve as potential avenues for future research.

Effect of animated movie in combating child sleep health problems

OBJECTIVE

Sleep deprivation among teens is a major health issue. Only 15% of teens get 8.5 h of sleep on school nights. Sleep deprivation can lead to poor grades, sleepiness and moodiness. We undertook a study to assess the prevalence of sleep habit disturbance among elementary school students in South Texas with Hispanic ethnicity predominance. We also found how much a video based on sleep education had an impact on these children.

METHOD

Once the Corpus Christi Independent School District (CCISD) approved the collection of baseline sleep data, questionnaires were administered using the Children's Sleep Habit Questionnaire (CSHQ.) These questionnaires were distributed prior to the viewing of the educational and animated movie KNIGHTS (Keep Nurturing and Inspiring Good Habits in Teen Sleep). Four months later, a random follow-up was performed and the children were requested to respond to the same CSHQ.

RESULTS

264 children from two elementary schools participated in this educational program. At baseline, 55.56% of the children had trouble sleeping. When the questionnaire was administered four months later, only 23.26% (p < 0.05) had trouble sleeping. Additionally, at baseline, approximately 60-70% children had some baseline bedtime resistance, anxiety dealing with sleep, issues with sleep duration and/or awakenings in the middle of the night. In the follow up questionnaire, results showed significant improvements in overall sleep habits, bedtime resistance, sleep anxiety and night awakenings amongst students (p < 0.05). However, no significant differences were seen in sleep duration and daytime sleepiness.

CONCLUSION

Sleep deprivation and good sleep habits remain as a pervasive challenge among elementary school students. Administering an animated video about sleep education along with a provider-based education may be an effective tool for educating elementary school students and decreasing the prevalence of these sleep-related issues. Future prospective randomized studies are suggested.

Sarcoidosis and Its Splenic Wonder: A Rare Case of Isolated Splenic Sarcoidosis

Sarcoidosis is a systemic granulomatous disease of unknown etiology characterized by presence of noncaseating granulomas in the involved organs. The pulmonary interstitium is most commonly affected but extrapulmonary involvement can occur in almost any other organ system. Such an involvement can occur with or without the presence of pulmonary involvement, but isolated extrapulmonary involvement has been noted only in around 10% of cases. Isolated splenomegaly is very rare and an uncommon presentation of sarcoidosis. It is clinically challenging because of the extensive differential diagnosis. Among the many considerations are hematologic malignancies, primary splenic or metastatic tumors, infiltrative disorders, inflammatory disorders, and infections. We hereby discuss an interesting case of a 40-year-old female with isolated splenic sarcoidosis.

Incidence, predictors, and outcomes of early hospital readmissions after kidney transplantation: Systemic review and meta-analysis

BACKGROUND

Early hospital readmission (EHR) within 30 days after kidney transplantation is a significant quality indicator of transplant centers and patient care. This meta-analysis aims to evaluate the incidence, predictors, and outcomes of EHR after kidney transplantation.

METHODS

We comprehensively searched the databases, including PubMed, Cochrane CENTRAL, and Embase, from inception until December 2021 to identify studies that assessed incidence, risk factors, and outcome of EHR. The outcomes included death-censored graft failure and mortality. Data from each study were combined using the random effect to calculate the pooled incidence, mean difference (MD), odds ratio (OR), and hazard ratio (HR) with 95% confidence interval (CI).

RESULTS

A total of 17 studies were included. The pooled EHR incidence after kidney transplant was 24.4% (95% CI 21.7-27.3). Meta-analysis showed that recipient characteristics, including older recipient age (MD 2.05; 95% CI 0.90-3.20), Black race (OR 1.31; 95% CI 1.11, 1.55), diabetes (OR 1.32; 95% CI 1.22-1.43), and longer dialysis duration (MD 0.85; 95% CI 0.41, 1.29), donor characteristics, including older donor age (MD 2.02; 95% CI 0.93-3.11), and transplant characteristics, including delayed graft function (OR 1.75; 95% CI 1.42-2.16) and longer length of hospital stay during transplantation (MD 1.93; 95% CI 0.59-3.27), were significantly associated with the increased risk of EHR. EHR was significantly associated with the increased risk of death-censored graft failure (HR 1.70; 95% CI 1.43-2.02) and mortality (HR 1.46; 95% CI 1.27-1.67) within the first year after transplantation.

CONCLUSION

Almost one-fourth of kidney transplant recipients had EHR within 30 days after transplant, and they had worse post-transplant outcomes. Several risk factors for EHR were identified. This calls for future research to develop and implement for management strategies to reduce EHR in high-risk patients.