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Ferrara F, Siligato R, Di Maria A, Scichilone L, Di Simone E, Bondanelli M, Storari A, De Giorgi A, Di Muzio M, Fabbian F. Food insecurity and kidney disease: a systematic review. Int Urol Nephrol 2024; 56:1035-1044. [PMID: 37679580 PMCID: PMC10853316 DOI: 10.1007/s11255-023-03777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The risk of developing and worsening chronic kidney disease (CKD) is associated with unhealthy dietary patterns. Food insecurity is defined by a limited or uncertain availability of nutritionally adequate and safe food; it is also associated with several chronic medical conditions. The aim of this systematic review is to investigate the current knowledge about the relationship between food insecurity and renal disease. METHODS We selected the pertinent publications by searching on the PubMed, Scopus, and the Web of Science databases, without any temporal limitations being imposed. The searching and selecting processes were carried out through pinpointed inclusion and exclusion criteria and in accordance with the Prisma statement. RESULTS Out of the 26,548 items that were first identified, only 9 studies were included in the systemic review. Eight out of the nine investigations were conducted in the US, and one was conducted in Iran. The studies evaluated the relationship between food insecurity and (i) kidney disease in children, (ii) kidney stones, (iii) CKD, (iv) cardiorenal syndrome, and (v) end stage renal disease (ESRD). In total, the different research groups enrolled 49,533 subjects, and food insecurity was reported to be a risk factor for hospitalization, kidney stones, CKD, ESRD, and mortality. CONCLUSIONS The relationship between food insecurity and renal disease has been underestimated. Food insecurity is a serious risk factor for health problems in both wealthy and poor populations; however, the true prevalence of the condition is unknown. Healthcare professionals need to take action to prevent the dramatic effect of food insecurity on CKD and on other chronic clinical conditions.
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Affiliation(s)
| | | | - Alessio Di Maria
- Renal Unit, University Hospital of Ferrara, 44124, Ferrara, Italy
| | - Laura Scichilone
- Renal Unit, University Hospital of Ferrara, 44124, Ferrara, Italy
| | - Emanuele Di Simone
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185, Rome , Italy
| | - Marta Bondanelli
- Department of Medical Sciences, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Alda Storari
- Renal Unit, University Hospital of Ferrara, 44124, Ferrara, Italy
- Department of Medical Sciences, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Alfredo De Giorgi
- Clinica Medica Unit, University Hospital of Ferrara, 44124, Ferrara, Italy
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185, Rome , Italy
| | - Fabio Fabbian
- Renal Unit, University Hospital of Ferrara, 44124, Ferrara, Italy.
- Department of Medical Sciences, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy.
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Di Maria A, Siligato R, Bondanelli M, Fabbian F. Venous Doppler flow patterns, venous congestion, heart disease and renal dysfunction: A complex liaison. World J Cardiol 2024; 16:5-9. [PMID: 38313388 PMCID: PMC10835472 DOI: 10.4330/wjc.v16.i1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/15/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
The World Journal of Cardiology published an article written by Kuwahara et al that we take the pleasure to comment on. We focused our attention on venous congestion. In intensive care settings, it is now widely accepted that venous congestion is an important clinical feature worthy of investigation. Evaluating venous Doppler profile abnormalities at multiple sites could suggest adequate treatment and monitor its efficacy. Renal dysfunction could trigger or worsen fluid overload in heart disease, and cardio-renal syndrome is a well-characterized spectrum of disorders describing the complex interactions between heart and kidney diseases. Fluid overload and venous congestion, including renal venous hypertension, are major determinants of acute and chronic renal dysfunction arising in heart disease. Organ congestion from venous hypertension could be involved in the development of organ injury in several clinical situations, such as critical diseases, congestive heart failure, and chronic kidney disease. Ultrasonography and abnormal Doppler flow patterns diagnose clinically significant systemic venous congestion. Cardiologists and nephrologists might use this valuable, non-invasive, bedside diagnostic tool to establish fluid status and guide clinical choices.
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Affiliation(s)
- Alessio Di Maria
- Specialized Medicines, Renal Unit, University Hospital St. Anna of Ferrara, Ferrara I-44124, Italy
| | - Rossella Siligato
- Specialized Medicines, Renal Unit, University Hospital St. Anna of Ferrara, Ferrara I-44124, Italy
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina I-98121, Italy
| | - Marta Bondanelli
- Department of Medical Sciences, University of Ferrara, Ferrara I-44124, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, University of Ferrara, Ferrara 44124, Italy.
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Heinze M, Lebherz L, Rimmele DL, Frese M, Jensen M, Barow E, Lettow I, Kriston L, Gerloff C, Härter M, Thomalla G. Higher comorbidity burden is associated with lower self-reported quality of life after stroke. Front Neurol 2022; 13:1023271. [DOI: 10.3389/fneur.2022.1023271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
IntroductionThis study assesses the association of comorbidity burden and polypharmacy with self-reported quality of life after stroke.Patients and methodsWe performed a post-hoc analysis of a prospective, single-center, observational study of outcome evaluation by patient-reported outcome measures in stroke clinical practice. Consecutive patients with acute ischemic stroke (AIS) were enrolled and self-reported health–related quality of life (HrQoL) was assessed 90 days after acute stroke using the Patient-reported Outcomes Measurement Information System 10-Question Short-Form (PROMIS-10). Comorbidities at baseline were assessed by the Charlson Comorbidity Index (CCI). Polypharmacy was defined as medication intake of ≥5 at baseline. We used linear regression analysis to study the association of CCI, polypharmacy and other clinical covariates with HrQoL after stroke.ResultsOf 781 patients (median age 76 years, 48.4% female) enrolled, 30.2% had a CCI Score ≥2, and 31.5% presented with polypharmacy. At follow up, 71 (9.1%) had died. In 409 (52.4%) reached for outcome evaluation, Global Physical Health T-Score was 43.8 ± 10 and Global Mental Health T-Score was 43.5 ± 8.76, indicating lower HrQoL than the average population. A CCI Score ≥2, higher NIHSS Score, female sex, dependency on others for dressing, toileting and mobility before index stroke, atrial fibrillation and hypertension were independent predictors of worse physical and mental health outcomes, while polypharmacy was not.ConclusionIn patients with AIS, high comorbidity burden and polypharmacy are frequent. Comorbidity burden at admission is independently associated with worse self-reported physical and mental health three months after stroke.
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Hao R, Qi X, Xia X, Wang L, Li X. Temporal trend of comorbidity and increasing impacts on mortality, length of stay, and hospital costs of first stroke in Tianjin, North of China. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:63. [PMID: 34583749 PMCID: PMC8477574 DOI: 10.1186/s12962-021-00316-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke patients have a high incidence of comorbidity. Previous studies have shown that comorbidity can impact on the short-term and long-term mortality after stroke. METHODS Our study aimed to explore the trend of comorbidity among patients with first stroke from 2010 to 2020, and the influence of comorbidity on admission mortality, length of stay and hospitalization costs. 5988 eligible patients were enrolled in our study, and divided into 4 comorbidity burden groups according to Charlson comorbidity index (CCI): none, moderate, severe, very severe. Survival analysis was expressed by Kaplan-Meier curve. Cox regression model was used to analyze the effect of comorbidity on 7-day and in-hospital mortality. Generalized linear model (GLM) was used to analyze the association between comorbidity and hospitalization days and cost. RESULTS Compared to patients without comorbidity, those with very severe comorbidity were more likely to be male (342, 57.7%), suffer from ischemic stroke (565, 95.3%), afford higher expense (Midian, 19339.3RMB, IQR13020.7-27485.9RMB), and have a higher in-hospital mortality (60, 10.1%). From 2010 to 2020, proportion of patients with severe and very severe comorbidity increased 12.9%. The heaviest comorbidity burden increased the risk of 7-day mortality (adjusted hazard ratio, 3.51, 95% CI 2.22-5.53) and in-hospital mortality (adjusted hazard ratio, 3.83, 95% CI 2.70-5.45). Patients with very severe comorbidity had a 12% longer LOS and extra 27% expense than those without comorbidity. CONCLUSIONS Comorbidity burden showed an increasing trend year in past eleven years. The heavy comorbidity burden increased in-hospital mortality, LOS, and hospitalization cost, especially in patients aged 55 years or more. The findings also provide some reference on improvement of health care reform policies and allocation of resources.
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Affiliation(s)
- Ruixiao Hao
- Department of Neurology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Tianjin, 300211, China
| | - Xuemei Qi
- Department of Neurology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Tianjin, 300211, China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Tianjin, 300211, China
| | - Lin Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Tianjin, 300211, China.
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De Giorgi A, Di Simone E, Cappadona R, Boari B, Savriè C, López-Soto PJ, Rodríguez-Borrego MA, Gallerani M, Manfredini R, Fabbian F. Validation and Comparison of a Modified Elixhauser Index for Predicting In-Hospital Mortality in Italian Internal Medicine Wards. Risk Manag Healthc Policy 2020; 13:443-451. [PMID: 32547275 PMCID: PMC7246324 DOI: 10.2147/rmhp.s247633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/07/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Burden of comorbidities appears to be related to clinical outcomes in hospitalized patients. Clinical stratification of admitted patients could be obtained calculating a comorbidity score, which represents the simplest way to identify the severity of patients' clinical conditions and a practical approach to assess prevalent comorbidities. Our aim was to validate a modified Elixhauser score for predicting in-hospital mortality (IHM) in internal medicine admissions and to compare it with a different one derived from clinical data previously used in a similar setting, having a good prognostic accuracy. Patients and Methods A single-center retrospective study enrolled all patients admitted to internal medicine department between January and June 2016. A modified Elixhauser score was calculated from chart review and administrative data; moreover, a second prognostic index was calculated from chart review only. Comorbidity scores were compared using c-statistic. Results We analyzed 1614 individuals without selecting the reason for admission, 224 (13.9%) died during hospital stay. Deceased subjects were older (83.3±9.1 vs 78.4±13.5 years; p<0.001) and had higher burden of comorbidities. The modified Elixhauser score calculated by administrative data and by chart review and the comparator one was 18.13±9.36 vs 24.43±11.27 vs 7.63±3.3, respectively, and the c-statistic was 0.758 (95% CI 0.727-0.790), 0.811 (95% CI 0.782-0.840) and 0.740 (95% CI 0.709-0.771), respectively. Conclusion The new modified Elixhauser score showed a similar performance to a previous clinical prognostic index when it was calculated using administrative data; however, its performance improved if calculation was based on chart review.
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Affiliation(s)
- Alfredo De Giorgi
- Department of Internal Medicine, University Hospital St. Anna, Ferrara, Italy
| | - Emanuele Di Simone
- Department of Internal Medicine, University Hospital St. Anna, Ferrara, Italy
| | - Rosaria Cappadona
- Department of Medical Sciences, Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - Benedetta Boari
- Department of Internal Medicine, University Hospital St. Anna, Ferrara, Italy
| | - Caterina Savriè
- Department of Internal Medicine, University Hospital St. Anna, Ferrara, Italy
| | - Pablo J López-Soto
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC)/University of Córdoba, Córdoba, Spain
| | - María A Rodríguez-Borrego
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC)/University of Córdoba, Córdoba, Spain
| | - Massimo Gallerani
- Department of Internal Medicine, University Hospital St. Anna, Ferrara, Italy
| | - Roberto Manfredini
- Department of Medical Sciences, Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
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Wang Y, Qin W, Hu W. An analysis of the risk of perioperative ischemic stroke in patients undergoing non-cardiovascular and non-neurological surgeries. Neurol Res 2020; 42:55-61. [PMID: 31903867 DOI: 10.1080/01616412.2019.1709140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objectives: This study aimed to assess the preoperative risk factor for perioperative ischemic stroke (PIS) in patients undergoing non-cardiovascular and non-neurological surgeries.Methods: Patients were retrospectively enrolled and grouped into two groups at a ratio of 1:2 according to their PIS status, i.e. patients with PIS in disease group, and patients without PIS in control group. Univariate analysis and multivariate logistic regression analysis were performed on admission laboratory test indices and preoperative risk factors for stroke. The pooled cohort equation (PCE), Essen Stroke Risk Score (ESRS), and Stroke Prognostic Instrument II (SPI-II) were used to separately assess the risk of stroke in patients with or without a history of stroke.Results: There were significant differences between the two groups in the levels of high-density lipoprotein cholesterol (HDL-C), prealbumin, renal insufficiency, dyslipidemia, coronary heart disease, anemia, and hemoglobin; the incidence of electrolyte disturbance; and previous histories of smoking, drinking, and stroke. Multivariate logistic regression analysis showed that renal insufficiency, histories of smoking and stroke, and decreased HDL-C can increase the risk of PIS. There were no significant differences between the disease group and the control group in ESRS or SPI-II score in patients with stroke history. There was a significant difference between the two groups in the risk of PIS evaluated by PCE in patients without stroke history.Conclusions: History of stroke and smoking, renal insufficiency, and low HDL-C are independent risk factors for PIS. It is feasible to assess the risk of stroke in preoperative patients using PCE in clinical practice.
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Affiliation(s)
- Yun Wang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wei Qin
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Acute Kidney Injury and In-Hospital Mortality: A Retrospective Analysis of a Nationwide Administrative Database of Elderly Subjects in Italy. J Clin Med 2019; 8:jcm8091371. [PMID: 31480750 PMCID: PMC6781256 DOI: 10.3390/jcm8091371] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
Background: The aim of this study was to investigate the association between acute kidney injury (AKI) and in-hospital mortality (IHM) in a large nationwide cohort of elderly subjects in Italy. Methods: We analyzed the hospitalization data of all patients aged ≥65 years, who were discharged with a diagnosis of AKI, which was identified by the presence of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), and extracted from the Italian Health Ministry database (January 2000 to December 2015). Data regarding age, gender, dialysis treatment, and comorbidity, including the development of sepsis, were also collected. Results: We evaluated 760,664 hospitalizations, the mean age was 80.5 ± 7.8 years, males represented 52.2% of the population, and 9% underwent dialysis treatment. IHM was 27.7% (210,661 admissions): Deceased patients were more likely to be older, undergoing dialysis treatment, and to be sicker than the survivors. The population was classified on the basis of tertiles of comorbidity score (the first group 7.48 ± 1.99, the second 13.67 ± 2,04, and third 22.12 ± 4.13). IHM was higher in the third tertile, whilst dialysis-dependent AKI was highest in the first. Dialysis-dependent AKI was associated with an odds ratios (OR) of 2.721; 95% confidence interval (CI) 2.676–2.766; p < 0.001, development of sepsis was associated with an OR of 1.990; 95% CI 1.948–2.033; p < 0.001, the second tertile of comorbidity was associated with an OR of 1.750; 95% CI 1.726–1.774; p < 0.001, and the third tertile of comorbidity was associated with an OR of 2.522; 95% CI 2.486–2.559; p < 0.001. Conclusions: In elderly subjects with AKI discharge codes, IHM is a frequent complication affecting more than a quarter of the investigated population. The increasing burden of comorbidity, dialysis-dependent AKI, and sepsis are the major risk factors.
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Fabbian F, Verzola A, Napoli N, De Giorgi A, Comai G, La Manna G, Gallerani M, Manfredini R, Rodríguez-Borrego MA, López-Soto PJ. Impact of hospital admissions subsequent to renal transplantation on Italian regional resources: a retrospective study in the Italian region of Emilia-Romagna. MINERVA UROL NEFROL 2019; 71:612-618. [PMID: 30654602 DOI: 10.23736/s0393-2249.19.03280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aim of this retrospective study was to investigate costs and resource consuming, expressed by diagnosis related groups (DRG), related only to hospitalizations of renal transplant recipients (RTRs) for all causes in the Region Emilia Romagna (RER) in Italy. METHODS We included all hospital admissions of RTRs (International Classification of Diseases 9th Revision, Clinical Modification [ICD-9-CM] code V420) between 2001 and 2015. We calculated number of admissions, RTRs and inhabitants of RER for each year, mean age, length of stay (LOS) in the hospital as total number of days, mean and median days, mean value of DRG and costs of admissions during the 15-year period of the study. RESULTS RTRs admitted in the 15 years study period were 9,197 and mean age 56.6±1.6 years. Admissions were 14,558, and mean rate of admitted RTRs (*100,000) was 14.21. Total, mean and median LOS were 122,966, 8.7 and 6 days, respectively. Total costs of admissions during the study period were €72,717,232 with mean DRG values of €3,409. Number of admissions and total number of days required for RTRs as well as mean age of admitted patients increased from 2001 to 2015, however mean and median LOS remained stable. CONCLUSIONS Costs due to admissions of RTRs appeared to gradually increase in the long term probably due to the increasing number of admissions and increasing mean age of admitted RTRs.
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Affiliation(s)
- Fabio Fabbian
- Clinica Medica Unit, Department of Medical Sciences, Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy -
| | - Adriano Verzola
- Management Planning and Control Service, Sant'Anna University Hospital, Ferrara, Italy
| | - Nicola Napoli
- Management Planning and Control Service, Sant'Anna University Hospital, Ferrara, Italy
| | - Alfredo De Giorgi
- Department of Internal Medicine, Sant'Anna University Hospital, Ferrara, Italy
| | - Giorgia Comai
- Unit of Nephrology, Dialysis and Renal Transplant, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Unit of Nephrology, Dialysis and Renal Transplant, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Massimo Gallerani
- Department of Internal Medicine, Sant'Anna University Hospital, Ferrara, Italy
| | - Roberto Manfredini
- Clinica Medica Unit, Department of Medical Sciences, Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - María A Rodríguez-Borrego
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Pablo J López-Soto
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
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Ding WY, Lip GYH. Does Renal Function Predict Short- and Medium-Term Mortality and Hospital Readmissions in Poststroke Patients? Stroke 2018; 49:2812-2813. [PMID: 30571451 DOI: 10.1161/strokeaha.118.023723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wern Yew Ding
- From the Liverpool Centre for Cardiovascular Science, University of Liverpool, United Kingdom (W.Y.D., G.Y.H.L.).,Liverpool Heart and Chest Hospital, United Kingdom (W.Y.D., G.Y.H.L.)
| | - Gregory Y H Lip
- From the Liverpool Centre for Cardiovascular Science, University of Liverpool, United Kingdom (W.Y.D., G.Y.H.L.).,Liverpool Heart and Chest Hospital, United Kingdom (W.Y.D., G.Y.H.L.).,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
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Fabbian F, De Giorgi A, Boari B, Misurati E, Gallerani M, Cappadona R, Cultrera R, Manfredini R, Rodrìguez Borrego MA, Lopez-Soto PJ. Infections and internal medicine patients: Could a comorbidity score predict in-hospital mortality? Medicine (Baltimore) 2018; 97:e12818. [PMID: 30334978 PMCID: PMC6211916 DOI: 10.1097/md.0000000000012818] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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
Infectious diseases (ID) are frequently cause of internal medicine wards (IMW) admission. We aimed to evaluate risk factors for in-hospital mortality (IHM) in IMW patients with ID, and to test the usefulness of a comorbidity score (CS).This study included ID hospital admissions between January 2013, and December 2016, recorded in the database of the local hospital. ICD-9-CM codes were selected to identify infections, development of sepsis, and to calculate a CS.We analyzed 12,173 records, (age 64.8 ± 25.1 years, females 66.2%, sepsis 9.3%). Deceased subjects (1545, 12.7%) were older, had higher percentage of sepsis, pulmonary infections, and endocarditis. Mean value of CS was also significantly higher. At multivariate analysis, the odds ratio (OR) for sepsis (OR 5.961), endocarditis (OR 4.247), pulmonary infections (OR 1.905), other sites of infection (OR 1.671), and urinary tracts infections (OR 0.548), were independently associated with IHM. The CS (OR 1.070 per unit of increasing score), was independently associated with IHM as well. The calculated weighted risk, obtained by multiplying 1.070 for the mean score value in deceased patients, was 19.367. Receiver operating characteristic (ROC) analysis showed that CS and development of sepsis were significant predictors for IHM (area under the curve, AUC: 0.724 and 0.670, respectively).Careful evaluation of comorbidity in internal medicine patients is nowadays matter of extreme importance in IMW patients hospitalized for ID, being IHM related to severity of disease, type and site of infection, and also to concomitant comorbidities. In these patients, a careful evaluation of CS should represent a fundamental step in the disease management.
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Affiliation(s)
- Fabio Fabbian
- Clinica Medica Unit, Department of Medical Sciences, University of Ferrara
- Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba & Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Alfredo De Giorgi
- Clinica Medica Unit, Department of Medical Sciences, University of Ferrara
| | - Benedetta Boari
- Clinica Medica Unit, Department of Medical Sciences, University of Ferrara
| | - Elisa Misurati
- Clinica Medica Unit, Department of Medical Sciences, University of Ferrara
| | - Massimo Gallerani
- First Internal Medicine Unit, Department of Internal Medicine, General Hospital of Ferrara
| | - Rosaria Cappadona
- Obstetrics and Gynecology Unit, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara
| | - Rosario Cultrera
- Infectious Diseases University Unit, Department of Medical Sciences, University of Ferrara, Italy
| | - Roberto Manfredini
- Clinica Medica Unit, Department of Medical Sciences, University of Ferrara
- Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba & Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Maria A. Rodrìguez Borrego
- Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba & Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Pablo J. Lopez-Soto
- Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba & Hospital Universitario Reina Sofía, Córdoba, Spain
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Manfredini R, Fabbian F, De Giorgi A, Cappadona R, Zucchi B, Storari A, Rodriguez Borrego MA, Carmona Torres JM, Lopez Soto PJ. Takotsubo syndrome and dialysis: an uncommon association? J Int Med Res 2018; 46:4399-4406. [PMID: 30178683 PMCID: PMC6259368 DOI: 10.1177/0300060518794249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
This review was performed to investigate the association between treatment with dialysis and Takotsubo syndrome in patients with end-stage renal disease. We systematically explored the PubMed database using the search terms "Takotsubo cardiomyopathy" and/or "stress-induced cardiomyopathy" and/or "Takotsubo syndrome" in combination with "dialysis" and "uremia." Of 3630 articles found, 8 articles reporting 10 cases were selected for analysis. Most patients were women, and their age ranged from 51 to 84 years. Diabetes mellitus and hypertension were diagnosed in 40% of patients, and glomerular disease was diagnosed in 30%. One only patient was treated with peritoneal dialysis; all others were treated with hemodialysis. The outcome was unfavorable in only one patient. An association between Takotsubo syndrome and dialysis is uncommon, but not negligible, and comorbidities play a major role in determining the clinical outcome.
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Affiliation(s)
- Roberto Manfredini
- 1 Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Italy.,2 Azienda Ospedaliera-Universitaria, Ferrara, Italy.,3 Instituto Maimonides de Investigacion Biomedica de Cordoba (IMIBIC), University of Cordoba, Spain
| | - Fabio Fabbian
- 1 Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Italy.,2 Azienda Ospedaliera-Universitaria, Ferrara, Italy.,3 Instituto Maimonides de Investigacion Biomedica de Cordoba (IMIBIC), University of Cordoba, Spain
| | | | - Rosaria Cappadona
- 1 Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Italy
| | - Beatrice Zucchi
- 1 Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Italy
| | - Alda Storari
- 2 Azienda Ospedaliera-Universitaria, Ferrara, Italy
| | | | | | - Pablo Jesus Lopez Soto
- 3 Instituto Maimonides de Investigacion Biomedica de Cordoba (IMIBIC), University of Cordoba, Spain
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Usui T, Hanafusa N, Yasunaga H, Nangaku M. Association of dialysis with in-hospital disability progression and mortality in community-onset stroke. Nephrology (Carlton) 2018; 24:737-743. [PMID: 29468787 DOI: 10.1111/nep.13242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2018] [Indexed: 12/01/2022]
Abstract
AIM End-stage renal disease is associated with increased risk of cerebrovascular disease, but the effect on post-stroke clinical outcomes has not been thoroughly investigated. METHODS Using the Japanese Diagnosis Procedure Combination database, which includes administrative claims and discharge abstract data, we examined the association between risk factors including dialysis therapy and in-hospital disability progression or mortality in patients with community-onset stroke. We extracted data of patients aged ≥ 20 years old who were admitted to the hospital within 3 days after onset of stroke between July 2010 and March 2013. The disability level was divided into modified Rankin Scale (mRS) 0-1, 2-3, 4-5, and 6 (death). Disability progression was defined as an increase in disability level. Odds ratios for in-hospital disability progression and mortality were calculated using logistic regression models. RESULTS Of 435 403 patients, 7562 (1.7%) received dialysis therapy. The median length of stay was 21 and 20 days for patients with and without dialysis, respectively. During the hospital stay, disability progressed in 100 402 (23.1%) patients and 45 919 (10.5%) died. Patients on dialysis had a higher prevalence of disability progression (26.8%) and mortality (13.1%) compared to those without dialysis (23.0% and 10.5%, respectively). Dialysis was associated with an increased risk of in-hospital disability progression (odds ratio, 1.56; 95% confidence interval, 1.47-1.66) and mortality (odds ratio 1.70; 95% confidence interval, 1.57-1.84). These risks were comparable among subtypes of stroke. CONCLUSIONS Dialysis was associated with an increased risk of in-hospital disability progression and mortality among patients with community-onset stroke, regardless of stroke subtype.
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Affiliation(s)
- Tomoko Usui
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Norio Hanafusa
- Department of Blood Purification, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo School of Medicine, Tokyo, Japan
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Fabbian F, De Giorgi A, Maietti E, Gallerani M, Pala M, Cappadona R, Manfredini R, Fedeli U. A modified Elixhauser score for predicting in-hospital mortality in internal medicine admissions. Eur J Intern Med 2017; 40:37-42. [PMID: 28187963 DOI: 10.1016/j.ejim.2017.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND In-hospital mortality (IHM) is an indicator of the quality of care provided. The two most widely used scores for predicting IHM by International Classification of Diseases (ICD) codes are the Elixhauser (EI) and the Charlson Comorbidity indexes. Our aim was to obtain new measures based on internal medicine ICD codes for the original EI, to detect risk for IHM. MATERIAL AND METHODS This single-center retrospective study included hospital admissions for any cause in the department of internal medicine between January 1, 2000, and December 31, 2013, recorded in the hospital database. The EI was calculated for evaluation of comorbidity, then we added age, gender and diagnosis of ischemic heart disease. IHM was our outcome. Only predictors positively associated with IHM were taken into consideration and the Sullivan's method was applied in order to modify the parameter estimates of the regression model into an index. RESULTS We analyzed 75,586 admissions (53.4% females) and mean age was 72.7±16.3years. IHM was 7.9% and mean score was 12.1±7.6. The points assigned to each condition ranged from 0 to 16, and the possible range of the score varied between 0 and 89. In our population the score ranged from 0 to 54, and it was higher in the deceased group. Receiver operating characteristic curve of the new score was 0.721 (95% CI 0.714-0.727, p<0.001). CONCLUSIONS In order to make prognostic assessment, the use of a score could be of help in targeting interventions in older adults, identifying subjects at high risk for IHM.
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Affiliation(s)
- Fabio Fabbian
- Department of Medical Sciences, Clinica Medica Unit, University of Ferrara, Italy.
| | - Alfredo De Giorgi
- Department of Medical Sciences, Clinica Medica Unit, University of Ferrara, Italy
| | - Elisa Maietti
- Center for Clinical Epidemiology, University of Ferrara, Ferrara, Italy
| | | | - Marco Pala
- Department of Internal Medicine, Hospital of Ferrara, Italy
| | - Rosaria Cappadona
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Roberto Manfredini
- Department of Medical Sciences, Clinica Medica Unit, University of Ferrara, Italy
| | - Ugo Fedeli
- SER - Epidemiological Department, Veneto Region, Padua, Italy
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Fedeli U, De Giorgi A, Gennaro N, Ferroni E, Gallerani M, Mikhailidis DP, Manfredini R, Fabbian F. Lung and kidney: a dangerous liaison? A population-based cohort study in COPD patients in Italy. Int J Chron Obstruct Pulmon Dis 2017; 12:443-450. [PMID: 28184156 PMCID: PMC5291454 DOI: 10.2147/copd.s119390] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background COPD is among the major causes of death, and it is associated with several comorbid conditions. Chronic kidney disease (CKD) is frequently diagnosed in older people living in Western societies and could impact COPD patients’ mortality. We evaluated the relationship between burden of comorbidities, CKD, and mortality in a population-based cohort of patients discharged with a diagnosis of COPD. Methods A longitudinal cohort study was conducted evaluating 27,272 COPD patients. Recruitment of COPD subjects and identification of CKD and other comorbidities summarized by the Charlson comorbidity index (CCI) were based on claims data coded according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). Severity of COPD was classified by hospital diagnosis or exemption from medical charges due to respiratory failure or previous hospitalizations for COPD. The impact of comorbidities on survival was assessed by Cox regression. Results Less than 40% of patients were still alive at the end of a median follow-up of 37 months (17 months for patients who died and 56 months for those alive at the end of follow-up). After adjustment for age, gender, and severity score of COPD, CKD (hazard ratio =1.36, 95% confidence interval 1.30–1.42) independently from comorbidities summarized by the CCI was a significant risk factor for mortality. Conclusion In spite of limitations due to the use of claims data, long-term survival of COPD patients was heavily affected by the presence of CKD and other comorbidities.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Veneto Region
| | - Alfredo De Giorgi
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara
| | | | | | - Massimo Gallerani
- Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), University College London Medical School, London, UK
| | - Roberto Manfredini
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara
| | - Fabio Fabbian
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara
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El Husseini N, Fonarow GC, Smith EE, Ju C, Schwamm LH, Hernandez AF, Schulte PJ, Xian Y, Goldstein LB. Renal Dysfunction Is Associated With Poststroke Discharge Disposition and In-Hospital Mortality: Findings From Get With The Guidelines-Stroke. Stroke 2016; 48:327-334. [PMID: 28034963 DOI: 10.1161/strokeaha.116.014601] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/13/2016] [Accepted: 11/23/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Kidney disease is a frequent comorbidity in patients presenting with acute ischemic stroke. We evaluated whether the estimated glomerular filtration rate (eGFR) on admission is associated with poststroke in-hospital mortality or discharge disposition. METHODS In this cohort study, data from ischemic stroke patients in Get With The Guidelines-Stroke linked to fee-for-service Medicare data were analyzed. The Modification of Diet in Renal Disease study equation was used to calculate the eGFR (mL/min/1.73 m2). Dialysis was identified by International Classification of Diseases, Ninth Revision codes. Adjusted multivariable Cox proportional hazards models were used to determine the independent associations of eGFR with discharge disposition and in-hospital mortality. Adjusted individual models also examined whether the association of clinical and demographic factors with outcomes varied by eGFR level. RESULTS Of 232 236 patients, 47.3% had an eGFR ≥60, 26.6% an eGFR 45 to 59, 16.8% an eGFR 30 to 44, 5.6% an eGFR 15 to 29, 0.7% an eGFR<15 without dialysis, and 2.8% were receiving dialysis. Of the total cohort, 11.8% died during the hospitalization or were discharged to hospice, and 38.6% were discharged home. After adjusting for other relevant variables, renal dysfunction was independently associated with an increased risk of in-hospital mortality that was highest among those with eGFR <15 without dialysis (odds ratio, 2.52; 95% confidence interval, 2.07-3.07). An eGFR 15 to 29 (odds ratio, 0.82; 95% confidence interval, 0.78-0.87), eGFR <15 (odds ratio, 0.72; 95% confidence interval, 0.61-0.86), and dialysis (odds ratio, 0.86; 95% confidence interval, 0.79-0.94) remained associated with lower odds of being discharged home. In addition, the associations of several clinical and demographic factors with outcomes varied by eGFR level. CONCLUSIONS eGFR on admission is an important predictor of poststroke short-term outcomes.
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Affiliation(s)
- Nada El Husseini
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.).
| | - Gregg C Fonarow
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Eric E Smith
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Christine Ju
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Lee H Schwamm
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Adrian F Hernandez
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Phillip J Schulte
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Ying Xian
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Larry B Goldstein
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
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Fabbian F, De Giorgi A, Manfredini F, Lamberti N, Forcellini S, Storari A, Todeschini P, Gallerani M, La Manna G, Mikhailidis DP, Manfredini R. Impact of comorbidity on outcome in kidney transplant recipients: a retrospective study in Italy. Intern Emerg Med 2016; 11:825-32. [PMID: 27003820 DOI: 10.1007/s11739-016-1438-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/09/2016] [Indexed: 01/06/2023]
Abstract
The aim of this study was to relate in-hospital mortality (IHM), cardiovascular events (CVEs) and non-immunologic comorbidity evaluated on the basis of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codification, in Italian kidney transplant recipients (KTRs). We evaluated IHM and admissions due to CVEs between 2000 and 2013 recorded in the database of the region Emilia Romagna. The Elixhauser score was calculated for evaluation of non-immunologic comorbidity. Three main outcomes (i.e. IHM, admission due to major CVEs and combined outcome) were the dependent variables of the multivariate models, while age, gender and Elixhauser score were the independent ones. During the examined period, a total of 9063 admissions in 3648 KTRs were recorded; 1945 patients were males (53.3 %) and 1703 females (46.7 %) and the mean age was 52.9 ± 13.1 years. The non-immunological impaired status of the KTRs, examined by the Elixhauser score, was 3.88 ± 4.29. During the 14-year follow-up period, IHM for any cause was 3.2 % (n = 117), and admissions due to CVEs were 527 (5.8 %). Age and comorbidity were independently associated with CVEs, IHM and the combined outcome. Male gender was independently associated with IHM and combined outcome, but not with CVEs. Evaluation of non-immunological comorbidity is important in KTRs and identification of high-risk patients for major clinical events could improve outcome. Moreover, comorbidity could be even more important in chronic kidney disease patients who are waiting for a kidney transplant.
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Affiliation(s)
- Fabio Fabbian
- Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy.
| | - Alfredo De Giorgi
- Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy
| | - Fabio Manfredini
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Silvia Forcellini
- Nephrology Unit, Department of Specialistic Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Alda Storari
- Nephrology Unit, Department of Specialistic Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Paola Todeschini
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Massimo Gallerani
- Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Gaetano La Manna
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), University College London (UCL) Medical School, London, UK
| | - Roberto Manfredini
- Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy
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Manfredini R, Gallerani M, Giorgi AD, Boari B, Lamberti N, Manfredini F, Storari A, Manna GL, Fabbian F. Lack of a “Weekend Effect” for Renal Transplant Recipients. Angiology 2016; 68:366-373. [DOI: 10.1177/0003319716660245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The “weekend (WE) effect” defines the association between WE hospital admissions and higher rate of mortality. The aim of this study was to evaluate the relationship between WE effect and renal transplant recipients (RTRs) using the database of the Emilia-Romagna region (ERR), Italy. We included ERR admissions of RTRs ( International Classification of Diseases, Ninth Revision, Clinical Modification [ ICD-9-CM] code V420) between 2000 and 2013. In-hospital mortality, admissions due to cardiovascular events (CVEs), and the Elixhauser score were evaluated on the basis of ICD-9-CM codification. Out of 9063 hospital admissions related to 3648 RTRs (mean age 53 ± 13 years, 62.9% male), 1491 (16.5%) were recorded during the WE. During the follow-up period, 1581 (17.4%) patients deceased and 366 (4%) had CVEs. Length of hospital stay (LOS) was 9.7 ± 12.1 days. Logistic regression analysis showed that only LOS was independently associated with WE admissions (odds ratio: 1594, confidence interval: 1.385-1.833; P < .001). Renal transplant recipients are not exposed to higher risk of adverse outcome during WE admissions. However, WE admissions were characterized by an increased duration of hospitalization.
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Affiliation(s)
- Roberto Manfredini
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
| | - Massimo Gallerani
- Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Alfredo De Giorgi
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
| | - Benedetta Boari
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Fabio Manfredini
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Alda Storari
- Department of Specialistic Medicine, Nephrology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Gaetano La Manna
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
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Impact of renal dysfunction on in-hospital mortality of patients with severe chronic obstructive pulmonary disease: a single-center Italian study. Int Urol Nephrol 2016; 48:1121-7. [PMID: 27020445 DOI: 10.1007/s11255-016-1272-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 03/13/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND We conducted a study, based on discharge hospital sheets [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)], in order to evaluate the relationship between chronic kidney disease (CKD), acute kidney injury (AKI), multi-morbidity, and in-hospital mortality (IHM). METHODS This study included all hospital admissions for chronic obstructive pulmonary disease (COPD) exacerbations between January 1, 2000, and December 31, 2013, recorded in the database of the University Hospital St. Anna of Ferrara. Age, sex, and diagnosis of CKD and AKI were collected, and Charlson comorbidity index (CCI) was calculated by ICD-9-CM codes. IHM was our main outcome. RESULTS We analyzed 7073 subjects with COPD exacerbation; they were more frequently male (56.9 vs 43.1 %), and mean age was 76.7 ± 9.8 years. Diagnosis of CKD was present in 771 patients (10.9 %), while AKI was diagnosed in 354 cases (5 %). A total of 554 patients (7.8 %) died during hospitalization, and LOS was 10.3 ± 11.2 days (median 8 days); the CCI corrected for CKD was 2.30 ± 1.65. Univariate analysis showed that IHM group had higher age (81.2 ± 7.9 vs 76.3 ± 9.9 years, p < 0.001), CCI (2.61 ± 2.21 vs 2.28 ± 1.62, p = 0.001), and LOS (11.1 ± 15.1 vs 10.3 ± 10.8 days, p = 0.001) and developed AKI more frequently (16.6 vs 4 %, p < 0.001) than survivors. Multivariate logistic regression analysis showed an independent association of IHM with age (OR 1.063; 95 % CI 1.050-1.075, p < 0.001), male sex (OR 1.229; 95 % CI 1.016-1.486, p = 0.033), logCCI (OR 2.051; 95 % CI 1.419-2.964, p < 0.001), and AKI (OR 3.849; 95 % CI 2.874-5.155, p < 0.001). CONCLUSIONS Acute kidney injury (AKI) represents a very important predictive factor of IHM in male older adult with multi-morbidity admitted because of COPD exacerbations.
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19
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Fabbian F, De Giorgi A, Forcellini S, Ricciardelli MA. Are nephrologists involving all physicians for management of sudden cardiac arrest in chronic kidney disease patients? Int Urol Nephrol 2015; 47:1439-40. [DOI: 10.1007/s11255-015-1050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022]
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20
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Fabbian F, De Giorgi A, Monesi M, Pala M, Tiseo R, Forcellini S, Storari A, Graziani R, Volpi R, Mikhailidis DP, Manfredini R. A possible relationship between renal impairment and complications development in type 2 diabetes mellitus: a prospective, observational study in Italy. J Diabetes Complications 2015; 29:771-5. [PMID: 26025698 DOI: 10.1016/j.jdiacomp.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/26/2015] [Accepted: 05/06/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND We investigated the relationship between complications development and estimated glomerular filtration rate (eGFR), in a cohort of type 2 diabetes mellitus (T2DM) outpatients. METHODS This observational study considered 1284 T2DM outpatients, who had been followed-up for 4.5 ± 1.6 years. eGFR was estimated using Chronic Kidney Disease Epidemiology Collaboration equation. The independent relationship between development of complications and clinical data was evaluated, and hazard ratio (HR) by Cox regression analysis calculated. RESULTS Mean age of the population was 66.8 ± 10.4 years; mean serum creatinine and eGFR were 1.05 ± 0.36 mg/dl and 71.6 ± 21.6 ml/min/1.73 m(2), respectively. Complications including death (14.2% of the whole population) were recorded in 504 subjects (39.3%). Patients with complications were older and more frequently male with history of hypertension, coronary heart disease, congestive heart disease, retinopathy, nephropathy and had higher levels of glycated hemoglobin. At Cox regression analysis, eGFR was the major risk factor for development of complications, and the HR increased according with lower eGFR (HR 1.53 and 1.86, for eGFR<45 and<30 ml/min/1.73 m(2), respectively). CONCLUSIONS In our cohort of T2DM outpatients, a reduced eGFR was associated with an increased risk of complications development.
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Affiliation(s)
- Fabio Fabbian
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara.
| | - Alfredo De Giorgi
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
| | - Marcello Monesi
- Diabetes and Clinical Nutrition, University Hospital St. Anna, Ferrara
| | - Marco Pala
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
| | - Ruana Tiseo
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
| | | | - Alda Storari
- Nephrology and Dialysis, University Hospital St. Anna, Ferrara
| | - Roberto Graziani
- Diabetes and Clinical Nutrition, University Hospital St. Anna, Ferrara
| | - Riccardo Volpi
- Department of Internal Medicine and Biomedical Science, University of Parma, Parma
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), University College London Medical School, University College London (UCL), London, UK
| | - Roberto Manfredini
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
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Chao TF, Chen SA. Risk of Ischemic Stroke and Stroke Prevention in Patients with Atrial Fibrillation and Renal Dysfunction. J Atr Fibrillation 2015; 8:1196. [PMID: 27957171 DOI: 10.4022/jafib.1196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/07/2015] [Accepted: 06/25/2015] [Indexed: 12/31/2022]
Abstract
Chronic kidney disease (CKD) has been identified as an important risk factor for new-onset atrial fibrillation (AF) and would significantly increase the risk of AF-related strokes. Stroke prevention in AF patients with CKD is a big challenge, especially for patients with end-stage renal disease (ESRD) undergoing long-term dialysis. In addition to an increase risk of stroke, renal dysfunction was also associated with a higher risk of hemorrhage due to dysregulation of coagulation and uremia-mediated platelet dysfunction. Therefore, the net clinical benefit balancing stroke risk reduction and increased risk of bleeding should be weighed carefully before initiating oral anti-coagulants for ESRD patients. Several studies investigating whether warfarin should be used for stroke prevention in AF patients with ESRD have been published and showed inconsistent results. Since none of these studies was a prospective and randomized trial, the best strategy for stroke prevention in AF patients with ESRD undergoing dialysis remained unknown and more data are necessary to answer this issue.
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Affiliation(s)
- Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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Fabbian F. Impact of Glomerular Filtration Rate on Intravenous Thrombolytic Therapy in Acute Ischemic Stroke: A Retrospective Study from a Single Italian Center. ACTA ACUST UNITED AC 2015. [DOI: 10.17352/acn.000001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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