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Wermine K, Song J, Gotewal S, Huang L, Corona K, Bagby S, Villarreal E, Chokshi S, Efejuku T, Chaij J, Joglar A, Iglesias NJ, Keys P, De La Tejera G, Golovko G, El Ayadi A, Wolf SE. The Utilisation of INR to identify coagulopathy in burn patients. PLoS One 2024; 19:e0278658. [PMID: 38394094 PMCID: PMC10889632 DOI: 10.1371/journal.pone.0278658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/21/2022] [Indexed: 02/25/2024] Open
Abstract
Studies conflict on the significance of burn-induced coagulopathy. We posit that burn-induced coagulopathy is associated with injury severity in burns. Our purpose was to characterize coagulopathy profiles in burns and determine relationships between % total burn surface area (TBSA) burned and coagulopathy using the International Normalized Ratio (INR). Burned patients with INR values were identified in the TriNetX database and analyzed by %TBSA burned. Patients with history of transfusions, chronic hepatic failure, and those on anticoagulant medications were excluded. Interquartile ranges for INR in the burned study population were 1.2 (1.0-1.4). An INR of ≥ 1.5 was used to represent those with burn-induced coagulopathy as it fell outside the 3rd quartile. The population was stratified into subgroups using INR levels <1.5 or ≥1.5 on the day of injury. Data are average ± SD analyzed using chi-square; p < .05 was considered significant. There were 7,364 burned patients identified with INR <1.5, and 635 had INR ≥1.5. Comparing TBSA burned groups, burn-induced coagulopathy significantly increased in those with ≥20% TBSA; p = .048 at 20-29% TBSA, p = .0005 at 30-39% TBSA, and p < .0001 for 40% TBSA and above. Age played a significant factor with average age for those with burn-induced coagulopathy 59 ± 21.5 years and 46 ± 21.8 for those without (p < .0001). After matching for age, TBSA, and demographics, the risk of 28 day-mortality was higher in those with burn-induced coagulopathy compared to those without (risk difference 20.9%, p < .0001) and the odd ratio with 95% CI is 4.45 (3.399-5.825). Investigation of conditions associated with burn-induced coagulopathy showed the effect of heart diseases to be significant; 53% of patients with burn-induced coagulopathy had hypertension (p < .0001). Burn-induced coagulopathy increases with %TBSA burned. The information gained firmly reflects a link between %TBSA and burn-induced coagulopathy, which could be useful in prognosis and treatment decisions.
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Affiliation(s)
- Kendall Wermine
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Juquan Song
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Sunny Gotewal
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Lyndon Huang
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Kassandra Corona
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Shelby Bagby
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Elvia Villarreal
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Shivan Chokshi
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Tsola Efejuku
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Jasmine Chaij
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Alejandro Joglar
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Nicholas J. Iglesias
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Phillip Keys
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Giovanna De La Tejera
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Georgiy Golovko
- Department of Pharmacology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Steven E. Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
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Smith S, Seoane J, Emerson L, Rainey A, Smith HG. Relationship Between Preexisting Functional Mobility Impairments and Burn Treatment Outcomes. J Burn Care Res 2023; 44:70-74. [PMID: 35660915 DOI: 10.1093/jbcr/irac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Indexed: 01/11/2023]
Abstract
Burn severity is determined by total body surface area affected, temperature of source, and duration of exposure. Patients with impaired mobility are less capable of avoiding hazards and escaping traumatic injuries. Additionally, patients with impaired mobility frequently suffer from other comorbid conditions and have specialized needs, which can complicate their acute treatment. This study was a retrospective electronic medical records review of all adult patients, aged 18 years and older with a preexisting mobility impairment, admitted as inpatients to a single burn center for treatment of burn-related injuries from January 1, 2009, to December 31, 2019. The 10-year review of 1520 adult burn admissions meeting the initial criteria of inpatient admission and burn injury revealed 174 patients with documentation supporting preexisting functional mobility impairment (11%). Surprisingly, patients' overall lengths of stays were consistent with all burn populations at 0.81 days per % TBSA, with the average length of stay being 6.7 days. The demographic data were consistent with national burn registry data as male, Caucasian, and older, with mean age of 61.1 years. Demographic data and details of hospital course focusing on treatment, complications, and outcomes were extracted and analyzed. There is a paucity of literature describing the needs of this unique burn population. Burn-injured patients with preexisting mobility impairments suffer from similar mechanisms of injury. By identifying attributes unique to this population, we hope to develop specialized prevention education and treatment protocols.
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Affiliation(s)
- Susan Smith
- Warden Burn Center, Orlando Health, Orlando, FL, USA
| | | | - Lisa Emerson
- Department of Microbiology and Cell Science, University of Florida, Gainesville, FL, USA
| | - Andrew Rainey
- Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA
| | - Howard G Smith
- Director of Burn Surgery, Warden Burn Center, Orlando Health, Orlando, FL, USA
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A Maddah S. Relationship between intraoperative administration of ketamine and posttraumatic stress disorder in burn patients: An important yet challenging issue. Burns 2022; 49:985-986. [PMID: 36759217 DOI: 10.1016/j.burns.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Seyedmahrokh A Maddah
- Department of Anesthesiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
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Tardif I, Guénette L, Zongo A, Demers É, Lunghi C. Depression and the risk of hospitalization in type 2 diabetes patients: A nested case-control study accounting for non-persistence to antidiabetic treatment. DIABETES & METABOLISM 2022; 48:101334. [PMID: 35231612 DOI: 10.1016/j.diabet.2022.101334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/29/2022] [Accepted: 02/12/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Depression is one of the most common comorbidities of type 2 diabetes. The relationship between these two diseases seems to be bidirectional. Both conditions separately lead to significant morbidity and mortality, including hospitalization. Moreover, depression is associated with non-persistence with antidiabetic drugs. OBJECTIVES To measure the effect of depression on morbidity and particularly on all-cause, diabetes-related, cardiovascular-related and major cardiovascular events-related hospitalization, adjusting for non-persistence to antidiabetic drugs and other confounders. METHODS We performed a nested case-control study within a cohort of type 2 diabetic individuals initiating antidiabetic drugs. Using the health administrative data of the province of Quebec, Canada, we identified all-cause, diabetes-related, cardiovascular-related and major cardiovascular hospitalizations during a maximum follow-up of eight years after the initiation of antidiabetic drug treatment. A density sampling method matched all cases with up to 10 controls by age, sex, and the Elixhauser comorbidity index. The effect of depression on hospitalization was estimated using conditional logistic regressions adjusting for non-persistence to antidiabetic drug treatment and other variables. RESULTS We identified 41,550 all-cause hospitalized cases, of which 34,437 were related to cardiovascular (CV) diseases, 29,584 to diabetes, and 13,867 to major CV events. Depression was diagnosed in 2.51% of all-cause hospitalizations and 1.16% of matched controls. 69.11% of cases and 72.59% of controls were on metformin monotherapy. The majority (71.62% vs 75.02%, respectively) stayed on metformin monotherapy without adding or switching drugs during follow-up. Non-persistence was at similar rates (about 30%) in both groups. In the multivariable analyses, depression was associated with an increased risk for all-cause hospitalizations, with odds ratios (ORs) ranging from 2.21 (95% CI: 2.07-2.37) to 1.32 (95% CI: 1.22-1.44) according to the model adjustment (from the univariate to the fully adhjusted). CONCLUSION Depression increased the risk of all-cause hospitalizations among patients treated for diabetes, even after accounting for non-persistence and other potentially confounding factors. These results stress the impact of depression on diabetic patients' use of health care resources.
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Affiliation(s)
- Isabelle Tardif
- Faculty of Medicine, 1050 avenue de la Médecine, Université Laval, Quebec City, QC, Canada
| | - Line Guénette
- Faculty of Pharmacy, 1050 avenue de la Médecine, Université Laval, Quebec City, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec-Université Laval, 1050 chemin Ste-Foy, Quebec City, QC, Canada
| | - Arsène Zongo
- Faculty of Pharmacy, 1050 avenue de la Médecine, Université Laval, Quebec City, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec-Université Laval, 1050 chemin Ste-Foy, Quebec City, QC, Canada
| | - Éric Demers
- Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec-Université Laval, 1050 chemin Ste-Foy, Quebec City, QC, Canada
| | - Carlotta Lunghi
- Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec-Université Laval, 1050 chemin Ste-Foy, Quebec City, QC, Canada; Department of Health Sciences, Université du Québec à Rimouski, 1595 boulevard Alphonse-Desjardins, Lévis, QC, Canada.
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Coutris N, Gawaziuk JP, Magnusson S, Logsetty S. Malnutrition in Burns: A prospective, single center study. J Burn Care Res 2021; 43:592-595. [PMID: 34653246 DOI: 10.1093/jbcr/irab186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The hypermetabolic response from burn injury is the highest of the critically ill patient population. When coupled with the hypermetabolic response, preexisting malnutrition may increase the hospital resources used. The goal of this study was to evaluate the rate of malnutrition in burn patients and the associated hospital resource utilization.We collected prospective data on burn patients ≥ 18 years with a burn ≥ 10% TBSA admitted to a regional burn center. Demographics, %TBSA, co-morbidities, length of stay (LOS) and standardized LOS (LOS/%TBSA) were evaluated on 49 patients. A multivariable regression model was constructed. Nutrition assessment was completed within 24-48 hours of admission including an SGA (Subjective Global Assessment) classification. SGA A (well-nourished) was compared to SGA B and C (malnourished). Fourteen patients (28.6%) in this study were malnourished. Malnourished patients were not statistically different with respect to median age (50 versus 39; p = 0.08] and BMI (22.9 versus 26.5; p = 0.08) compared to the well-nourished group. However, malnourished patients had significantly longer median LOS (21.0 versus 11.0 days, p = 0.01) and LOS/%TBSA (1.69 versus 0.83, p = 0.001) than the well-nourished group. Being malnourished was a significant independent predictor of above median LOS/%TBSA (p=0.027) with an odds ratio (OR) of 5.61 (95% C.I. 1.215-25.890).The rate of malnutrition is important given the high metabolic demands of these patients. Malnutrition increased the resource requirements via higher standardized LOS. This underscores the importance of completing SGA on admission to identify malnutrition early on to optimize nutrition intervention during the patients' hospital stay.
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Affiliation(s)
- Nancy Coutris
- Department of Nutrition and Food Services, Health Sciences Centre, Winnipeg, Manitoba Canada.,Manitoba Firefighters' Burn Unit, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Justin Peter Gawaziuk
- Manitoba Firefighters' Burn Unit, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Saul Magnusson
- Manitoba Firefighters' Burn Unit, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Sarvesh Logsetty
- Department of Nutrition and Food Services, Health Sciences Centre, Winnipeg, Manitoba Canada.,Manitoba Firefighters' Burn Unit, Health Sciences Centre, Winnipeg, Manitoba, Canada.,Departments of Surgery and Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Pinatti de Moraes S, Marcolan J. Depressive symptoms in individuals with burns: A Brazilian study. INDIAN JOURNAL OF BURNS 2021. [DOI: 10.4103/ijb.ijb_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Choi C, Barajas-Ochoa A, Uppuluri A, Ro G, Hashemipour R, Jiang Y, Nasir U, Ahlawat S. The impact of bariatric surgery on in-patient clinical outcomes among patients with autoimmune hepatitis. Medicine (Baltimore) 2020; 99:e22446. [PMID: 33080679 PMCID: PMC7572015 DOI: 10.1097/md.0000000000022446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Autoimmune hepatitis (AIH) is a form of liver inflammation in which immune cells target hepatocytes, inducing chronic inflammatory states. Bariatric surgery (BS) was shown to reduce inflammation in severely obese patients. We hypothesize that obese patients with AIH and BS have lower prevalence of liver-related complications and in-patient mortality compared to those without BS.The National Inpatient Sample from 2007 to 2013 was queried for hospitalizations of adults over 18 years of age with a diagnosis of AIH. Of those, hospitalizations with BS were selected as cases and those with morbid obesity as controls. Case-control 1:2 matching was done based on sex, age, race, and comorbidities. Primary outcomes were prevalence of liver-related complications and in-patient mortality. Independent risk factors of in-patient clinical outcomes were identified using multivariate regression analysis.From 137,834 hospitalizations with a diagnosis of AIH, 688 with BS were selected as cases, and 1295 were matched as controls. The prevalence of ascites was higher in the BS group compared to the control (odds ratio 1.73, 95% confidence interval (CI) 1.27-2.36). The prevalence of cirrhosis (36.8% vs 33.2%), portal hypertension (7.4% vs 10.0%), hepatic encephalopathy (10.6% vs 8.7%), and varices and variceal bleeding (3.9% vs 5.5%) was not statistically different from case controls, (P > .05).BS was an independent risk factor for ascites (adjusted odds ratio (aOR) 1.87; 95% CI 1.36-2.56) and hepatic encephalopathy (aOR 1.42; 95% CI 1.03-1.97) but was an independent protective factor against in-patient mortality (aOR 0.21, 95% CI 0.08-0.55) once adjusted for age, sex, race, and comorbidities.
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Affiliation(s)
| | | | | | - Grace Ro
- Rutgers New Jersey Medical School
| | - Reza Hashemipour
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Yi Jiang
- Internal Medicine, Rutgers New Jersey Medical School
| | - Umair Nasir
- Internal Medicine, Rutgers New Jersey Medical School
| | - Sushil Ahlawat
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ, USA
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