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Shaikh N, Mohammed A, Seddiq M, Kidwai S, Shahzad D, Mahmoud MM. The Effect of the Charlson Comorbidity Index On In-Hospital Complications, Hospital Length of Stay, Mortality, and Readmissions Among Patients Hospitalized for Acute Stroke. Cureus 2024; 16:e60112. [PMID: 38864047 PMCID: PMC11164611 DOI: 10.7759/cureus.60112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 06/13/2024] Open
Abstract
Aim A notable number of people who develop stroke have comorbid medical conditions. The aim of this study is to evaluate the use of the Charlson Comorbidity Index (CCI) to predict in-hospital complications, mortality, length of stay, and readmission rates in stroke patients. Method It is a retrospective study that analyzed patients who were admitted for stroke in a six-month time duration. Stroke was classified into ischemic, hemorrhagic, or undetermined; hospital complications were classified into medical or neurological. Data regarding comorbidities, complications, length of stay, mortality, and readmissions were documented. Comorbidities were then classified by the CCI and split into four categories: zero, mild (1-2), moderate (3-4) and severe (5+). The data was analyzed using SPSS (IBM, Inc., Armonk, US). Results Four hundred and seventy-three adults aged above 18 were hospitalized for acute stroke. There was no correlation between the severity of the CCI score and mortality. Patients with ischemic stroke had a higher CCI correlated with readmission rate (p=0.026) and hospital complications (p=0.054). The two groups with the highest intensive care unit admission rate were mild, followed by the severe group (p=0.001). Our study also revealed that the patients with severe CCI scores had an increased readmission rate (p=0.001). Conclusion There is a correlation between a high CCI score and readmission rate, as well as CCI score with hospital complications in ischemic stroke. Further prospective studies of a longer duration can be undertaken to find further associations with the potential for this score to be used as a predictor in patients hospitalized for stroke.
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Affiliation(s)
- Niaz Shaikh
- Internal Medicine, Rashid Hospital, Dubai, ARE
| | - Asna Mohammed
- Internal Medicine, Rashid Hospital, Dubai, ARE
- Internal Medicine, Hackensack University Medical Center, Hackensack, USA
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Lee SW, Elsakr C, Holt J, Ayutyanont N. Characteristics and Hospital Outcomes of 1403 Patients Hospitalized at Community Hospitals With Ankylosing Spondylitis. HCA HEALTHCARE JOURNAL OF MEDICINE 2024; 5:11-18. [PMID: 38560394 PMCID: PMC10939093 DOI: 10.36518/2689-0216.1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background In this study, we aimed to assess the hospital course, outcomes after hospitalization, and predictors of outcomes in patients with ankylosing spondylitis (AS). Methods We included 1403 patients with AS between 2016 and 2021 who were identified using International Classification of Disease (ICD) codes from a large for-profit healthcare system database. Demographics and clinical characteristics were compared between those who had a favorable outcome, defined as being discharged to home without readmission within 3 months of discharge, versus those who had an unfavorable outcome. A stepwise logistic regression was used to identify demographic and clinical characteristics associated with home discharge and readmission. Results The mean age for all AS patients was 56.06 ± 17.01 years, which was younger in the favorable outcome group, and 82.47% of patients were discharged to home after the average length of stay of 3.72 ± 4.09 days, also shorter in the favorable outcome group. Of 1403 patients, 37.56% were readmitted within 3 months of discharge, at a lower rate in the group with home discharge. Opioids were the most commonly used medication during hospitalization (67.07%), prescribed at a lower rate in the favorable outcome group. Medical coverage by Medicare and Medicaid, fall at admission, hospital-acquired anemia, steroid, acetaminophen, muscle relaxant use, and an increased dose of morphine milligram equivalent at discharge were significantly associated with decreased odds of home discharge. Surgical procedures during admission, gastrointestinal complications, discharge to inpatient rehabilitation units, and use of benzodiazepine were associated with an increased risk of readmission within 3 months. Conclusion Recognizing factors that put patients with AS at risk of unfavorable outcomes is useful information to improve patient care during hospitalization.
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Obaitan I, Wehbe H, Easler JJ, Stethen JT, Mahendraker N, Tong Y, Vargas A, Dewitt JM, Bick BL, Fogel E, Gutta A, Sherman S, Watkins J, Gromski M, Saleem N, Zyromski N, Al-Haddad MA. Factors predictive of hospital length of stay in patients with an index episode of acute necrotizing pancreatitis. Pancreatology 2024; 24:32-40. [PMID: 37996268 DOI: 10.1016/j.pan.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/28/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Acute necrotizing pancreatitis (ANP) complicates 15 % of acute pancreatitis cases and is associated with prolonged length of stay (LOS). There are limited studies exploring potential predictors. METHODS We carried out a retrospective study of all consecutive patients presenting to a large referral healthcare system with ANP. Patients younger than 18 years of age, without confirmed glandular necrosis and with in-hospital mortality were excluded. Poisson regression was carried out to identify potential predictors of prolonged hospital stay. RESULTS One hundred and sixty-two patients hospitalized between December 2016 and June 2020 were included. The median LOS was 12 days (range: 1-155 days). On multivariate analysis, organ dysfunction at presentation (Incidence rate ratio (IRR) 1.21, p = 0.01) or during admission (IRR 1.32, p = 0.001), Charlson Comorbidity Index scores (IRR 1.1 per CCI point, p < 0.001), known chronic pancreatitis (IRR 1.19, p = 0.03), concurrent (non-pancreas related) infections (IRR 1.13, p = 0.04), need for enteral tube placement (IRR 3.42, p < 0.001) and in-hospital interventions (IRR 1.48-2.85 depending on intervention, p < 0.001) were associated with increased LOS. For patients in the cohort to whom this applied, delayed hospital transfers (IRR 1.02, p < 0.001) and delayed start of enteral feeds (IRR 1.01, p = 0.017) contributed to increased overall LOS. CONCLUSION We demonstrate that multiple factors including delayed transfers to hospitals with pancreaticobiliary expertise lead to increased length of hospitalization. We suggest various strategies that can be considered to target those gaps and may have a favorable effect on LOS.
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Affiliation(s)
- Itegbemie Obaitan
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hisham Wehbe
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeffrey J Easler
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joseph T Stethen
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Neetu Mahendraker
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yan Tong
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alejandra Vargas
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - John M Dewitt
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin L Bick
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Evan Fogel
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Aditya Gutta
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stuart Sherman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James Watkins
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nasir Saleem
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mohammad A Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Lee SW, Werner B, Anireddy S, Ayutyanont N. Characteristics, Outcomes, and Its Associated Factors Among Patients Hospitalized With Mild Traumatic Brain Injuries. Am J Phys Med Rehabil 2024; 103:47-52. [PMID: 37549368 DOI: 10.1097/phm.0000000000002298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVE The aim of the study is to investigate the characteristics and hospital outcomes of patients with mild traumatic brain injuries. DESIGN A total of 1940 patients with mild traumatic brain injuries from seven community hospitals between 2017 and 2019 were identified using International Classification of Disease codes and an documented initial Glasgow Coma Scale score of 13-15. A stepwise logistic regression was used to identify demographics and clinical characteristics associated with in-hospital mortality and home discharge. RESULTS The median age was 69 yrs old with 66.6% associated with falls at admission. Subdural hemorrhage was the most common brain lesion and more common in the group with falls. Increased age, male sex, epidural hemorrhage, presence of hemiplegia, paraplegia, renal disease, cancer, hospital-acquired sepsis, anemia, and use of direct vasodilator were associated with increased odds of in-hospital mortality. Increased age, medical coverage by Medicare, cerebral edema, lower initial Glasgow Coma Scale, length of stay, comorbidity of acute myocardiac infarction, and use of thiamine and opioids were associated with decreased likelihood of discharge to home. CONCLUSIONS Recognizing characteristics of hospitalized patients with mild traumatic brain injuries and their association with increased in-hospital mortality and nonhome discharge can be useful for improving care of this vulnerable population.
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Affiliation(s)
- Se Won Lee
- From the Sunrise Health GME Consortium, MountainView Hospital, HCA Healthcare, Las Vegas, Nevada
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Kim HC, Lee HJ, Kim YT, Jang BC. Risk of Neurodegenerative Diseases in Elderly Koreans with an Initial Diagnosis of Type 2 Diabetes: A Nationwide Retrospective Cohort Study. J Diabetes Res 2023; 2023:7887792. [PMID: 38020200 PMCID: PMC10651337 DOI: 10.1155/2023/7887792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/30/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Type 2 diabetes (T2D) and neurodegenerative diseases (NDs) are common among elderly individuals. Growing evidence has indicated a strong link between T2D and NDs, such as Alzheimer's disease. However, previous studies have limitations in exploring the epidemiological relationship among these diseases as a group of NDs rather than as a specific type of ND. We aimed to investigate the risk of NDs in elderly Koreans who were first diagnosed with T2D and determine the association between T2D and NDs. We conducted a retrospective longitudinal cohort study of patients with who were initially diagnosed with T2D using the Korean National Health Information Database. The study participants were categorized into a T2D group (n = 155,459) and a control group (n = 155,459), aged 60-84 years, that were matched for age, sex, and comorbidities. We followed the participants for 10 years to investigate the incidence of NDs. The Cox proportional hazards regression model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for NDs. The numbers of patients diagnosed with ND at the end of follow-up were as follows: 51,096/155,459 (32.9%) in the T2D group and 44,673/155,459 (28.7%) in the control group (χ2 = 622.53, p < 0.001). The incidences of NDs in the T2D and control groups were 44.68 (95% CI: 44.29, 45.07) and 36.89 (95% CI: 36.55, 37.24) cases per 1,000 person-years at risk, respectively. The overall incidence of NDs was higher in the T2D group than that in the control group (HR: 1.23, 95% CI: 1.22, 1.25, p < 0.001). This study revealed a higher incidence of NDs in elderly Koreans who were initially diagnosed with T2D. This suggests that T2D is a risk factor for NDs in elderly Koreans.
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Affiliation(s)
- Hee-Cheol Kim
- Department of Psychiatry, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
- Brain Research Institute, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Ho-Jun Lee
- Department of Psychiatry, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Yang-Tae Kim
- Department of Psychiatry, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Byeong-Churl Jang
- Department of Molecular Medicine, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
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Lee SW, Werner B, Holt J, Lohia A, Ayutyanont N, York H. Clinical characteristics, hospital course, and disposition of patients with nontraumatic spinal cord injury in a large private health care system in the United States. J Spinal Cord Med 2023; 46:900-909. [PMID: 35532310 PMCID: PMC10653757 DOI: 10.1080/10790268.2022.2069533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To evaluate the clinical characteristics, hospital courses, outcomes after hospitalization, and factors associated with outcomes in patients with nontraumatic spinal cord injuries (NTSCI). DESIGN Retrospective analysis. SETTING A large for-profit United States health care system. PARTICIPANTS 2807 inpatients with NTSCI between 2014 and 2020 were identified using International Classification of Disease codes. MAIN OUTCOME MEASURE Demographic, clinical characteristics, hospital course, and disposition data collected from electronic health record. RESULTS The mean age was 57.91 ± 16.41 years with 69.83% being male. Incomplete cervical level injury was the most common injury type, spinal stenosis was the most common diagnostic etiology and central cord syndrome was the most common clinical syndrome. The average length of stay was 9.52 ± 15.8 days, with the subgroup of 1308 (46.6%) patients who were discharged home demonstrating a shorter length of stay (6.42 ± 10.24 days). Falls were the most common hospital-acquired complication (n = 424, 15.11%) and 83 patients deceased. There were increased odds of non-home discharge among patients with the following characteristics: older age, Medicare insurance, non-black racial minority, increased Charlson Comorbidity Index (CCI), intensive care unit (ICU) stay, use of steroid or anticoagulant medications, and hospital-acquired pulmonary complications. Increased in-hospital mortality was observed in those with Medicaid insurance, ICU stay, increased CCI, diagnosis of degenerative spine disease, other unspecified level of injury, and hospital-acquired pulmonary complications. CONCLUSIONS NTSCI in this sample were predominantly incomplete cervical central SCIs. Increased CCI, ICU stay, and hospital-acquired pulmonary complications were associated with poorer outcomes after acute care hospitalization among patients with NTSCI.
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Affiliation(s)
- Se Won Lee
- Department of Physical Medicine and Rehabilitation, Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada, USA
| | - Bryan Werner
- Department of Physical Medicine and Rehabilitation, Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada, USA
| | - Jonathan Holt
- Department of Physical Medicine and Rehabilitation, Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada, USA
| | - Akash Lohia
- Department of Physical Medicine and Rehabilitation, Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada, USA
| | - Napatkamon Ayutyanont
- Clinical Research Department, Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada, USA
| | - Henry York
- Department of Physical Medicine and Rehabilitation, VA San Diego Healthcare System, San Diego, California, USA
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Scala A, Trunfio TA, Improta G. Classification and regression model to manage the hospitalization for laparoscopic cholecystectomy. Sci Rep 2023; 13:14700. [PMID: 37679406 PMCID: PMC10485042 DOI: 10.1038/s41598-023-41597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
Gallstone disease (GD) is one of the most common morbidities in the world. Laparoscopic Cholecystectomy (LC) is currently the gold standard, performed in about 96% of cases. The most affected groups are the elderly, who generally have higher pre- and post-operative morbidity and mortality rates and longer Length of Stay (LOS). For this reason, several indicators have been defined to improve quality and efficiency and contain costs. In this study, data from patients who underwent LC at the "San Giovanni di Dio e Ruggi d'Aragona" University Hospital of Salerno in the years 2010-2020 were processed using a Multiple Linear Regression (MLR) model and Classification algorithms in order to identify the variables that most influence LOS. The results of the 2352 patients analyzed showed that pre-operative LOS and Age were the independent variables that most affected LOS. In particular, MLR model had a R2 value equal to 0.537 and the best classification algorithm, Decision Tree, had an accuracy greater than 83%. In conclusion, both the MLR model and the classification algorithms produced significant results that could provide important support in the management of this healthcare process.
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Affiliation(s)
- Arianna Scala
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Teresa Angela Trunfio
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Giovanni Improta
- Department of Public Health, University of Naples "Federico II", Naples, Italy
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples "Federico II", Naples, Italy
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Chia S, Xia J, Kwan YH, Lim ZY, Tan CS, Low SG, Xu B, Loo YX, Kong LY, Koh CW, Towle RM, Lim SF, Yoon S, Seah SSY, Low LL. Evaluating the association of COVID-19 restrictions on discharge planning and post-discharge outcomes in the community hospital and Singapore regional health system. FRONTIERS IN HEALTH SERVICES 2023; 3:1147698. [PMID: 37744642 PMCID: PMC10513784 DOI: 10.3389/frhs.2023.1147698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
Objectives The COVID-19 is a global health issue with widespread impact around the world, and many countries initiated lockdowns as part of their preventive measures. We aim to quantify the duration of delay in discharge to community from Community Hospitals, as well as quantify adverse patient outcomes post discharge pre and during lockdown period. Design and methods We conducted a before-after study comparing the length of stay in Community Hospitals, unscheduled readmissions or Emergency Department attendance, patients' quality of life using EQ5D-5l, number and severity of falls, in patients admitted and discharged before and during lockdown period. Results The average length of stay in the lockdown group (27.77 days) were significantly longer than that of the pre-lockdown group (23.76 days), p = 0.003. There were similar proportions of patients with self-reported falls post discharge between both groups. Patients in the pre-lockdown group had slightly better EQ-5D-5l Index score at 0.55, compared to the lockdown study group at 0.49. Half of the patients in both groups were referred to Community Care Services on discharge. Conclusion Our study would help in developing a future systematic preparedness guideline and contingency plans in times of disease outbreak and other similar public health emergencies.
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Affiliation(s)
- Shermain Chia
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
| | - Jiawen Xia
- Research and Translational Innovation Office, Singhealth Community Hospitals, Singapore, Singapore
| | - Yu Heng Kwan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Zhui Ying Lim
- Population Health & Integrated Care Office, Singapore General Hospital, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sher Guan Low
- Post-Acute and Continuing Care, Sengkang Community Hospital, Singapore, Singapore
| | - Bangyu Xu
- Post-Acute and Continuing Care, Sengkang Community Hospital, Singapore, Singapore
| | - Yu Xian Loo
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
| | - Lai Yee Kong
- Medical Social Services, Sengkang Community Hospital, Singapore, Singapore
| | - Chee Wai Koh
- Medical Social Services, Outram Community Hospital, Singapore, Singapore
| | - Rachel Marie Towle
- Specialty Nursing, Population Health & Integrated Care Office, Regional Health System, Singapore, Singapore
| | - Su Fee Lim
- Regional Health System Community Nursing, Population Health & Integrated Care Office, Singapore General Hospital, Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Sharna Si Ying Seah
- Research and Translational Innovation Office, Singhealth Community Hospitals, Singapore, Singapore
| | - Lian Leng Low
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
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Clements NA, Gaskins JT, Martin RCG. Predictive Ability of Comorbidity Indices for Surgical Morbidity and Mortality: a Systematic Review and Meta-analysis. J Gastrointest Surg 2023; 27:1971-1987. [PMID: 37430092 DOI: 10.1007/s11605-023-05743-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Several contemporary risk stratification tools are now being used since the development of the Charlson Comorbidity Index (CCI) in 1987. The purpose of this systematic review and meta-analysis was to compare the utility of commonly used co-morbidity indices in predicting surgical outcomes. METHODS A comprehensive review was performed to identify studies reporting an association between a pre-operative co-morbidity measurement and an outcome (30-day/in-hospital morbidity/mortality, 90-day morbidity/mortality, and severe complications). Meta-analysis was performed on the pooled data. RESULTS A total of 111 included studies were included with a total cohort size 25,011,834 patients. The studies reporting the 5-item Modified Frailty Index (mFI-5) demonstrated a statistical association with an increase in the odds of in-hospital/30-day mortality (OR:1.97,95%CI: 1.55-2.49, p < 0.01). The pooled CCI results demonstrated an increase in the odds for in-hospital/30-day mortality (OR:1.44,95%CI: 1.27-1.64, p < 0.01). Pooled results for co-morbidity indices utilizing a scale-based continuous predictor were significantly associated with an increase in the odds of in-hospital/30-day morbidity (OR:1.32, 95% CI: 1.20-1.46, p < 0.01). On pooled analysis, the categorical results showed a higher odd for in-hospital/30-day morbidity (OR:1.74,95% CI: 1.50-2.02, p < 0.01). The mFI-5 was significantly associated with severe complications (Clavien-Dindo ≥ III) (OR:3.31,95% CI:1.13-9.67, p < 0.04). Pooled results for CCI showed a positive trend toward severe complications but were not significant. CONCLUSION The contemporary frailty-based index, mFI-5, outperformed the CCI in predicting short-term mortality and severe complications post-surgically. Risk stratification instruments that include a measure of frailty may be more predictive of surgical outcomes compared to traditional indices like the CCI.
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Affiliation(s)
- Noah A Clements
- The Hiram C. Polk, Jr., MD Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA
| | - Jeremy T Gaskins
- The Hiram C. Polk, Jr., MD Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA
| | - Robert C G Martin
- The Hiram C. Polk, Jr., MD Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA.
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Ye M, Kahana E, Deimling G, Perzynski A, Stange K. Beyond the treatment: The role of race, sex, and education in health trajectories between cancer survivors and noncancer older adults. J Geriatr Oncol 2023; 14:101532. [PMID: 37229884 PMCID: PMC10330899 DOI: 10.1016/j.jgo.2023.101532] [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: 12/29/2022] [Revised: 02/21/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The number of older, long-term cancer survivors is increasing. However, little is known about how cancer and aging affect the health trajectories of older adults differently. In addition, the impact of race, sex, and education on the processes of aging and the cancer experience needs further investigation. The current study aims to address this knowledge gap by combining two National Cancer Institute (NIC)-funded longitudinal studies conducted in Cleveland from 1998 to 2010. MATERIALS AND METHODS The unique cross-sequential design facilitates a comparison between the health changes in long-term (five years +) older cancer survivors (breast, prostate, and colorectal cancer) and demographically matched older adults without a history of cancer in the same geographic area within the same period. The study also captured comprehensive information on how socioeconomic status interacts with cancer and aging over time. General linear models were employed in the data analysis. RESULTS The findings showed that early cancer experience did not affect long-term cancer survivors' health status in later life. Conversely, comorbidities, being an African American, being female, and having education less than a college degree significantly decreased the health trajectory in later life for all older adults. Moreover, compared to other groups, older African American cancer survivors reported a dramatic decrease in self-reported health after controlling for other conditions. DISCUSSION Study findings can inform public policy and social services to offer comprehensive treatment plans and help individuals overcome their diseases and lead longer and healthier lives.
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Affiliation(s)
- Minzhi Ye
- Kent State University The School of Lifespan Development and Educational Science, 111E, Nixson Hall, 1225 Theatre Drive, Kent, OH 44243, USA.
| | - Eva Kahana
- Case Western Reserve University Department of Sociology, Rm 226, Mather Memorial Building, 11220 Bellflower Rd, Cleveland, OH 44106, USA
| | - Gary Deimling
- Case Western Reserve University Department of Sociology, Rm 226, Mather Memorial Building, 11220 Bellflower Rd, Cleveland, OH 44106, USA
| | - Adam Perzynski
- The MetroHealth System Population Health Research Institute, 2500 Metrohealth Dr., Rammelkamp, Bldg., 2nd Floor, Cleveland, OH 44109, USA
| | - Kurt Stange
- Case Western Reserve University Center for Community Health Integration, School of Medicine 10900 Euclid Ave. Cleveland, OH 44106, USA
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Griffin O, Li T, Beveridge A, Ní Chróinín D. Higher levels of multimorbidity are associated with increased risk of readmission for older people during post-acute transitional care. Eur Geriatr Med 2023:10.1007/s41999-023-00770-5. [PMID: 37010792 DOI: 10.1007/s41999-023-00770-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/08/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Older patients are at high risk for poor outcomes after an acute hospital admission. The Transitional Aged Care Programme (TACP) was established by the Australian government to provide a short-term care service aiming to optimise functional independence following hospital discharge. We aim to investigate the association between multimorbidity and readmission amongst patients on TACP. METHODS Retrospective cohort study of all TACP patients over 12 months. Multimorbidity was defined using the Charlson Comorbidity Index (CCI), and prolonged TACP (pTACP) as TACP ≥ 8 weeks. RESULTS Amongst 227 TACP patients, the mean age was 83.3 ± 8.0 years, and 142 (62.6%) were females. The median length-of-stay on TACP was 8 weeks (IQR 5-9.67), and median CCI 7 (IQR 6-8). 21.6% were readmitted to hospital. Amongst the remainder, 26.9% remained at home independently, 49.3% remained home with supports; < 1% were transferred to a residential facility (0.9%) or died (0.9%). Hospital readmission rates increased with multimorbidity (OR 1.37 per unit increase in CCI, 95% CI 1.18-1.60, p < 0.001). On multivariable logistic regression analysis, including polypharmacy, CCI, and living alone, CCI remained independently associated with 30-day readmission (aOR 1.43, 95% CI 1.22-1.68, p < 0.001). CONCLUSIONS CCI is independently associated with a 30-day hospital readmission in TACP cohort. Identifying vulnerability to readmission, such as multimorbidity, may allow future exploration of targeted interventions.
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Affiliation(s)
- Ornagh Griffin
- Department of Geriatric Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Tracy Li
- Department of Geriatric Medicine, Liverpool Hospital, Corner of Elizabeth and Goulburn St, Liverpool, NSW, Australia.
- South Western Sydney Clinical School, UNSW Sydney, Sydney, NSW, Australia.
| | - Alexander Beveridge
- Department of Geriatric Medicine, St Vincent's Hospital, Sydney, NSW, Australia
- St. Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, Corner of Elizabeth and Goulburn St, Liverpool, NSW, Australia
- South Western Sydney Clinical School, UNSW Sydney, Sydney, NSW, Australia
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12
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Lee SW, Ma D, Davoodian A, Ayutyanont N, Werner B. COVID-19 vaccination decreased COVID-19 hospital length of stay, in-hospital death, and increased home discharge. Prev Med Rep 2023; 32:102152. [PMID: 36811076 PMCID: PMC9933576 DOI: 10.1016/j.pmedr.2023.102152] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/16/2022] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
COVID-19 vaccination impact on hospital outcome metrics among patients hospitalized with COVID-19 is not well known. We evaluated if covid-19 vaccination was associated with better hospital outcomes such as in-hospital mortality, overall length of stay, and home discharge. This retrospective study analyzed data from the electronic health records of 29,732 patients admitted with COVID-19 with or without vaccination (21,525 unvaccinated and 8207 vaccinated) from January to December 2021. The association of COVID-19 vaccination status with overall length of hospitalization, in-hospital mortality rate, home discharge after hospitalization was investigated using a multivariate logistic regression and a generalized linear model. The mean age of all groups was 58.16 ± 17.39 years. The unvaccinated group was younger (54.95 ± 16.75) and had less comorbidities compared to the vaccinated group. Patients that had received COVID-19 vaccination exhibited decreased in-hospital mortality (OR 0.666, 95 % CI 0.580-0.764), decreased length of stay (-2.13 days, CI 2.73-1.55 days), and increased rate of home discharge (OR 1.168, CI 1.037-1.315). Older age and cerebrovascular accident diagnosis at admission demonstrated a negative effect on hospital outcomes with decreased home discharge (OR 0.950 per 1 year, CI 0.946-0.953 and OR 0.415, CI 0.202-0.854) and increased inhospital mortality (OR 1.04 per 1 year, CI 1.036-1.045 and OR 3.005, CI 1.961-4.604). This study shows the additional positive impact of COVID-19 vaccination has not just on in-hospital mortality but also in reducing overall length of stay and improved hospital outcome metrics including increasing likelihood of home discharge after hospitalization.
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Affiliation(s)
- Se Won Lee
- Corresponding authors at: Sunrise Health GME Consortium, Mt. View Medical Center, HCA Healthcare, 2880 N Tenaya Way, 2nd floor, Las Vegas, NV, United States
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13
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Barow E, Probst AC, Pinnschmidt H, Heinze M, Jensen M, Rimmele DL, Flottmann F, Broocks G, Fiehler J, Gerloff C, Thomalla G. Effect of Comorbidity Burden and Polypharmacy on Poor Functional Outcome in Acute Ischemic Stroke. Clin Neuroradiol 2023; 33:147-154. [PMID: 35831611 PMCID: PMC10014774 DOI: 10.1007/s00062-022-01193-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/22/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Comorbidities and polypharmacy are risk factors for worse outcome in stroke. However, comorbidities and polypharmacy are mostly studied separately with various approaches to assess them. We aimed to analyze the impact of comorbidity burden and polypharmacy on functional outcome in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). METHODS Acute ischemic stroke patients with large vessel occlusion (LVO) treated with MT from a prospective observational study were analyzed. Relevant comorbidity burden was defined as a Charlson Comorbidity Index (CCI) score ≥ 2, polypharmacy as the intake of ≥ 5 medications at time of stroke onset. Favorable outcome was a score of 0-2 on the modified Rankin scale at 90 days after stroke. The effect of comorbidity burden and polypharmacy on favorable outcome was studied via multivariable regression analysis. RESULTS Of 903 patients enrolled, 703 AIS patients (mean age 73.4 years, 54.9% female) with anterior circulation LVO were included. A CCI ≥ 2 was present in 226 (32.1%) patients, polypharmacy in 315 (44.8%) patients. Favorable outcome was less frequently achieved in patients with a CCI ≥ 2 (47, 20.8% vs. 172, 36.1%, p < 0.001), and in patients with polypharmacy (69, 21.9% vs. 150, 38.7%, p < 0.001). In multivariable regression analysis including clinical covariates, a CCI ≥ 2 was associated with lower odds of favorable outcome (odds ratio, OR 0.52, 95% confidence interval, 95% CI 0.33-0.82, p = 0.005), while polypharmacy was not (OR 0.81, 95% CI 0.52-1.27, p = 0.362). CONCLUSION Relevant comorbidity burden and polypharmacy are common in AIS patients with LVO, with comorbidity burden being a risk factor for poor outcome.
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Affiliation(s)
- Ewgenia Barow
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Ann-Cathrin Probst
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Hans Pinnschmidt
- Institut für Medizinische Biometrie und Epidemiologie, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Heinze
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - David Leander Rimmele
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Zhang X, Wang X, Wang M, Gu J, Guo H, Yang Y, Liu J, Li Q. Effect of comorbidity assessed by the Charlson Comorbidity Index on the length of stay, costs, and mortality among colorectal cancer patients undergoing colorectal surgery. Curr Med Res Opin 2023; 39:187-195. [PMID: 36269069 DOI: 10.1080/03007995.2022.2139053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Charlson Comorbidity Index (CCI) is a good predictor for hospitalization cost and mortality among patients with chronic disease. However, the impact of CCI on patients after colorectal cancer surgery is unclear. This study aims to investigate the influence of comorbidity assessed by CCI on length of stay, hospitalization costs, and in-hospital mortality in patients with colorectal cancer (CRC) who underwent surgical resection. METHODS This historical cohort study collected 10,271 adult inpatients for CRC undergoing resection surgery in 33 tertiary hospitals between January 2018 and December 2019. All patients were categorized by the CCI score into four classes: 0, 1,2, and ≥3. Linear regression was used for outcome indicators as continuous variables and logical regression for categorical variables. EmpowerStats software and R were used for data analysis. RESULTS Of all 10,271 CRC patients, 51.72% had at least one comorbidity. Prevalence of metastatic solid tumor (19.68%, except colorectal cancer) and diabetes without complication (15.01%) were the major comorbidities. The highest average cost of hospitalization (86,761.88 CNY), length of stay (18.13 days), and in-hospital mortality (0.89%) were observed in patients with CCI score ≥3 compared to lower CCI scores (p < .001). Multivariate regression analysis showed that the CCI score was associated with hospitalization costs (β, 7340.46 [95% confidence interval (CI) (5710.06-8970.86)], p < .001), length of stay (β, 1.91[95%CI (1.52-2.30)], p < .001), and in-hospital mortality(odds ratio (OR),16.83[95%CI (2.23-126.88)], p = .0062) after adjusted basic clinical characteristics, especially when CCI score ≥3. Notably, the most specific complication associated with hospitalization costs and length of stay was metastatic solid tumor, while the most notable mortality-specific comorbidity was moderate or severe renal disease. CONCLUSION The research work has discovered a strong link between CCI and clinical plus economic outcomes in patients with CRC who underwent surgical resection.
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Affiliation(s)
- Xuexue Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Xujie Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Miaoran Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiyu Gu
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Huijun Guo
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yufei Yang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jian Liu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiuyan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Nelson MLA, Singh H, Nie J, MacDonald S, Bayley M, Fortin C, Upshur R. Comparing stroke rehabilitation inpatients and clinical trials eligibility criteria: A secondary chart review analysis revealing that most patients could have been excluded from rehabilitation trials based on comorbidity status. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231211668. [PMID: 37927973 PMCID: PMC10624005 DOI: 10.1177/26335565231211668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
Background The generalizability of treatments examined in rehabilitation randomized controls trials (RCTs) partly depend on the similarity between trial subjects and a stroke rehabilitation inpatient population. The aim of this study was to determine the proportion of stroke rehabilitation inpatients that would have been eligible or ineligible to participate in published stroke RCTs. Methods This was a secondary analysis of chart review data collected as part of an independent quality improvement initiative. Data pertaining to the characteristics of stroke rehabilitation inpatients (e.g. age, cognitive impairment, previous stroke, comorbidities) were extracted from the medical charts of patients consecutively admitted to an inpatient stroke rehabilitation unit at a large urban rehabilitation hospital in Canada. Using the exclusion criteria categories of stroke RCTs identified from a systematic scoping review of 428 RCTs, we identified how many stroke rehabilitation inpatients would have been eligible or ineligible to participate in stroke RCTs based on their age, cognitive impairment, previous stroke and presence of comorbidities. Results In total, 110 stroke rehabilitation inpatients were included. Twenty-four percent of patients were 80 years of age or older, 84.5% had queries or concerns regarding patient cognitive abilities, 28.0% had a previous stroke, and 31.8% had a severe stroke. Stroke rehabilitation inpatients had six comorbidities on average. Based on these factors, most stroke rehabilitation inpatients could have been excluded from stroke RCTs, with cognitive impairment the most common RCT exclusion criteria. Conclusions Changes to the design of RCTs would support the development of clinical practice guidelines that reflect stroke rehabilitation inpatient characteristics, enhancing equity, diversity, and inclusion within samples and the generalizability of results.
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Affiliation(s)
- Michelle LA Nelson
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jason Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Shannon MacDonald
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Hennick Bridgepoint Hospital, Sinai Health, Toronto, ON, Canada
| | - Mark Bayley
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | - Ross Upshur
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
- Institute of Clinical Evaluative Science, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
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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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BALDEMİR R, ERASLAN DOĞANAY G, CIRIK MÖ, ÜLGER G, YURTSEVEN G, ZENGİN M. The relationship between acute physiology and chronic health evaluation-II, sequential organ failure assessment, Charlson comorbidity index and nutritional scores and length of intensive care unit stay of patients hospitalized in the intensive care unit due to chronic obstructive pulmonary disease. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1147178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: It is known that disease severity and nutritional status are determinants of prognosis in patients hospitalized in the intensive care unit (ICU). Different scoring systems are used to evaluate the nutritional status and disease severity of intensive care patients. It will be very useful in clinical practice to determine the intensive care scores that are in harmony with the nutritional parameters and affect the length of stay in the ICU in patients hospitalized with the diagnosis of chronic obstructive pulmonary disease (COPD). It was aimed to determine the relationship between acute physiology and chronic health evaluation-II (Apache-II), sequential organ failure assessment (SOFA), and Charlson comorbidity index (CCI) with nutritional scores in intensive care patients with a diagnosis of COPD. Also, it was aimed to determine the scoring systems that affect the length of stay in the ICU.
Material and Method: Nutritional risk score-2002 (NRS-2002), prognostic nutritional index (PNI), modified nutritional risk in critically ill (mNutric) score, albumin, Apache-II, SOFA and CCI values and intensive care unit length of stay of the patients hospitalized in the intensive care unit due to COPD were recorded. The scoring systems that affect the length of stay in the ICU and the relationship between nutritional scores and Apache-II, SOFA and CCI was analyzed using statistical methods.
Results: A significant correlation was found between only CCI and all nutritional scores. Only the CCI value was found to be significantly higher in those found to be at high risk compared to all nutritional scoring systems. CCI cut-off value determined according to nutritional scoring was determined as 4.5 according to PNI and albumin, and 5.5 according to mNutric score and NRS-2002. It was determined that CCI affects the length of stay in the intensive care unit.
Conclusion: CCI is a scoring system that is compatible with nutritional parameters and affects the length of stay in the intensive care unit. Therefore, we think that CCI can be used to predict prognosis and nutritional risk in patients with COPD in the intensive care unit and to predict the length of stay in the intensive care unit. In terms of malnutrition risk, a cut-off value of ≥6 can be used for CCI.
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Affiliation(s)
| | | | | | - Gülay ÜLGER
- Ankara Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi
| | | | - Musa ZENGİN
- Ankara Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi
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Liu H, Song B, Jin J, Liu Y, Wen X, Cheng S, Nicholas S, Maitland E, Wu X, Zhu D. Length of Stay, Hospital Costs and Mortality Associated With Comorbidity According to the Charlson Comorbidity Index in Immobile Patients After Ischemic Stroke in China: A National Study. Int J Health Policy Manag 2022; 11:1780-1787. [PMID: 34380205 PMCID: PMC9808248 DOI: 10.34172/ijhpm.2021.79] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/03/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In this study, we examined the length of stay (LoS)-predictive comorbidities, hospital costs-predictive comorbidities, and mortality-predictive comorbidities in immobile ischemic stroke (IS) patients; second, we used the Charlson Comorbidity Index (CCI) to assess the association between comorbidity and the LoS and hospitalization costs of stroke; third, we assessed the magnitude of excess IS mortality related to comorbidities. METHODS Between November 2015 and July 2017, 5114 patients hospitalized for IS in 25 general hospitals from six provinces in eastern, western, and central China were evaluated. LoS was the period from the date of admission to the date of discharge or date of death. Costs were collected from the hospital information system (HIS) after the enrolled patients were discharged or died in hospital. The HIS belongs to the hospital's financial system, which records all the expenses of the patient during the hospital stay. Cause of death was recorded in the HIS for 90 days after admission regardless of whether death occurred before or after discharge. Using the CCI, a comorbidity index was categorized as zero, one, two, and three or more CCI diseases. A generalized linear model with a gamma distribution and a log link was used to assess the association of LoS and hospital costs with the comorbidity index. Kaplan-Meier survival curves was used to examine overall survival rates. RESULTS We found that 55.2% of IS patients had a comorbidity. Prevalence of peripheral vascular disease (21.7%) and diabetes without end-organ damage (18.8%) were the major comorbidities. A high CCI=3+ score was an effective predictor of a high risk of longer LoS and death compared with a low CCI score; and CCI=2 score and CCI=3+ score were efficient predictors of a high risk of elevated hospital costs. Specifically, the most notable LoS-specific comorbidities, and cost-specific comorbidities was dementia, while the most notable mortality-specific comorbidities was moderate or severe renal disease. CONCLUSION CCI has significant predictive value for clinical outcomes in IS. Due to population aging, the CCI should be used to identify, monitor and manage chronic comorbidities among immobile IS populations.
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Affiliation(s)
- Hongpeng Liu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Wuhan, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia
- School of Economics and School of Management, Tianjin Normal University, Tianjin, China
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China
- Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
| | | | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
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Li C, Wang J, Wang Q, Liu B, Dang H, Li J, Hou D. Predictive Value of a Quick Pitt Bacteremia Score for Prognosis of Patients with Bloodstream Infection Secondary to Urinary Tract Infection: A Retrospective Cohort Study. Infect Drug Resist 2022; 15:4381-4391. [PMID: 35974895 PMCID: PMC9375986 DOI: 10.2147/idr.s373998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the effect of a quick Pitt bacteremia score (qpitt) on the prognosis of patients with bloodstream infection (BSI) secondary to urinary tract infection (UTI) and to further explore its use in aiding appropriate selection of initial antibiotic treatment. Methods Medical records of patients with BSIs secondary to UTIs who were admitted to our hospital from January 2018 to December 2020 were retrospectively collected. To screen for independent risk factors, logistic analysis was conducted on statistically significant variables. The receiver operating characteristic (ROC) curve was drawn with prognosis and death as the state variables to evaluate the predictive value. Patients were grouped by qpitt 2-point cutoff, to explore the impact of initial antimicrobial treatment regimens on poor prognosis and death in different subgroups. Poor prognosis was defined as a hospital length of stay (HLOS) ≥14 days or death within 28 days from BSI onset (ie, 28-day death). Results A total of 266 patients were included in this study. In BSIs secondary to UTIs, we observed a pathogenic composition of 77.44% Gram-negative bacteria, 19.55% Gram-positive bacteria, and 3.01% fungi. The qpitt had poor predictive value for poor prognosis [area under ROC (AUROC) = 0.653, p < 0.001], while it had a high predictive value for death (AUROC = 0.890, p < 0.001). For patients with a qpitt ≥2, the poor prognosis and death rates of patients who were initially treated with carbapenem antibiotics were lower (p < 0.01). In comparison, initial treatment with carbapenem antibiotics had no significant effect on prognosis and death rates in patients with qpitt <2 (p > 0.1). Conclusion The qpitt is highly predictive for death in patients with BSIs secondary to UTIs and can be used to inform first-line antibiotic treatment strategy.
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Affiliation(s)
- Changxiu Li
- Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical University, Taian, People's Republic of China
| | - Jing Wang
- Department of Respiratory and Critical Care, The Second Affiliated Hospital of Shandong First Medical University, Taian, People's Republic of China
| | - Qiushi Wang
- Simulation Teaching Center, Capital Medical University, Beijng, People's Republic of China.,Department of Intensive Care Unit, The Second Affiliated Hospital of Shandong First Medical University, Taian, People's Republic of China
| | - Beibei Liu
- Department of Intensive Care Unit, The Second Affiliated Hospital of Shandong First Medical University, Taian, People's Republic of China
| | - Heqin Dang
- Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical University, Taian, People's Republic of China
| | - Jin Li
- Department of Laboratory, The Second Affiliated Hospital of Shandong First Medical University, Taian, People's Republic of China
| | - Dapeng Hou
- Department of Intensive Care Unit, The Second Affiliated Hospital of Shandong First Medical University, Taian, People's Republic of China
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Safety and feasibility of same day discharge after per oral endoscopic pyloromyotomy in refractory gastroparesis: a pilot study. Chin Med J (Engl) 2022; 135:1432-1437. [PMID: 35866346 PMCID: PMC9481444 DOI: 10.1097/cm9.0000000000002068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Gastroparesis is a debilitating medical condition with limited treatment options. Gastric per-oral pyloromyotomy (G-POEM) has emerged as a promising treatment option with remarkable short-term clinical success shown in multiple studies. While the post-procedure protocol is not standardized across many centers, the majority of the centers observes these patients in the hospital after the procedure for monitoring. In this single-center prospective study, we evaluated the safety and feasibility of same day discharge after the G-POEM procedure. Methods: All the patients with refractory gastroparesis undergoing G-POEM from October 2019 to March 2020 were enrolled. A total of 25 patients were enrolled in the procedure. Based on the pre-defined criteria, patients were either discharged on the same day after the procedure or admitted to the hospital for further observation. The patient and procedure-related data were extracted from the chart review. Univariate analysis was performed (chi-squared test) on categorical variables after organizing categorical variables as numeric counts or percentages. The student t test was performed on continuous variables after reporting as mean and standard deviation. For analysis with a smaller sample size, Fisher exact and Mann–Whitney tests were used. Results: A total of 25 patients were enrolled. The technical success of G-POEM was 100% and clinical success was 80% (20/25) at 1-month follow-up. Of the 25 patients, 9 patients (36%) were discharged on the same day according to the procedure from the recovery unit. Of the remaining 16 patients who were admitted to the hospital post-procedure, 10 (40%) were admitted due to procedure-related causes while other admissions were either pre-planned or due to social reasons. The average Charlson comorbidity index was lower in the same day discharge group (P < 0.05). The number of patients requiring double myotomy was higher in the same day discharge group (P < 0.05). The overall complication rate of G-POEM in the study cohort was 12% (3/25) with all complications being mild without any severe adverse events. Conclusion: G-POEM is a safe and effective method of treatment for refractory GP with higher clinical success in short-term follow-up. The same day discharge after G-POEM is safe and feasible in >50% of patients with close periprocedural monitoring.
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Canaslan K, Ates Bulut E, Kocyigit SE, Aydin AE, Isik AT. Predictivity of the comorbidity indices for geriatric syndromes. BMC Geriatr 2022; 22:440. [PMID: 35590276 PMCID: PMC9118684 DOI: 10.1186/s12877-022-03066-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aging population and increasing chronic diseases make a tremendous burden on the health care system. The study evaluated the relationship between comorbidity indices and common geriatric syndromes. Methods A total of 366 patients who were hospitalized in a university geriatric inpatient service were included in the study. Sociodemographic characteristics, laboratory findings, and comprehensive geriatric assessment(CGA) parameters were recorded. Malnutrition, urinary incontinence, frailty, polypharmacy, falls, orthostatic hypotension, depression, and cognitive performance were evaluated. Comorbidities were ranked using the Charlson Comorbidity Index(CCI), Elixhauser Comorbidity Index(ECM), Geriatric Index of Comorbidity(GIC), and Medicine Comorbidity Index(MCI). Because, the CCI is a valid and reliable tool used in different clinical settings and diseases, patients with CCI score higher than four was accepted as multimorbid. Additionally, the relationship between geriatric syndromes and comorbidity indices was assessed with regression analysis. Results Patients’ mean age was 76.2 ± 7.25 years(67.8% female). The age and sex of multimorbid patients according to the CCI were not different compared to others. The multimorbid group had a higher rate of dementia and polypharmacy among geriatric syndromes. All four indices were associated with frailty and polypharmacy(p < 0.05). CCI and ECM scores were related to dementia, polypharmacy, and frailty. Moreover, CCI was also associated with separately slow walking speed and low muscle strength. On the other hand, unlike CCI, ECM was associated with malnutrition. Conclusions In the study comparing the four comorbidity indices, it is revealed that none of the indices is sufficient to use alone in geriatric practice. New indices should be developed considering the complexity of the geriatric cases and the limitations of the existing indices.
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Affiliation(s)
- Kubra Canaslan
- Department of Internal Medicine, Sinop Turkeli State Hospital, Sinop, Turkey
| | - Esra Ates Bulut
- Department of Geriatric Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Suleyman Emre Kocyigit
- Department of Geriatric Medicine, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ali Ekrem Aydin
- Department of Geriatric Medicine, Sivas Numune Hospital, Sivas, Turkey
| | - Ahmet Turan Isik
- Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey. .,Yaşlanan Beyin Ve Demans Unitesi, Geriatri Bilim Dalı Dokuz Eylul Universitesi Tıp Fakultesi, Balcova, 35340, Izmir, Turkey.
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22
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Toniazzo MP, Amorim PS, Rost JF, Feldman JV, Beretta MV, Rodrigues TC, Weidlich P. Oral condition as a predictor of risk for malnutrition during hospitalization: A cross-sectional study. Nutr Clin Pract 2022; 37:1438-1447. [PMID: 35271739 DOI: 10.1002/ncp.10851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 01/31/2022] [Accepted: 02/05/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Malnutrition and poor oral health are common conditions in patients in the hospital. Both conditions are associated with poor systemic health. The present study aimed to assess the relationship between the oral condition and the nutrition status of individuals admitted to a large tertiary hospital. METHODS This cross-sectional study evaluated 364 patients who received a comprehensive dental examination at their hospital bed. An examiner recorded visible plaque index, gingival bleeding index, plaque retentive factors, probing depth, clinical attachment loss, bleeding on probing, number of existing teeth, and prosthesis use. Medical status was assessed by the Charlson Comorbidity Index. The nutrition status was evaluated by the Subjective Global Assessment. Crude and adjusted prevalence ratios were estimated by Poisson regression analysis with robust variance. RESULTS Patients with moderate to severe malnutrition presented worse oral hygiene (55.83 ± 25.16 vs 64.90 ± 24.28; P < 0.001), more gingival inflammation (24.31 ± 24.13 vs 33.43 ± 27.36; P < 0.001), higher levels of attachment loss (4.22 ± 1.81 vs 4.80 ± 1.83; P < 0.001), and a lower mean number of teeth (14.58 ± 7.45 vs 10.94 ± 6.85; P < 0.001) than patients without malnutrition. In the multivariable analysis, the number of teeth and higher comorbidity index were associated with malnutrition. CONCLUSIONS Poor oral health and medical condition were associated with malnutrition in this single-institution study, and oral condition may be considered an indicator of malnutrition in patients in the hospital. The implications of this study include the need to raise awareness among health professionals of the importance of oral health and nutrition status in adults.
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Affiliation(s)
- Mirian Paola Toniazzo
- Department of Periodontology, Federal University Rio Grande do Sul, Porto Alegre, Brazil
| | - Paula Sant'na Amorim
- Department of Periodontology, Federal University Rio Grande do Sul, Porto Alegre, Brazil
| | - Julia Franciele Rost
- Department of Periodontology, Federal University Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Mileni Vanti Beretta
- Department of Nutrition, Federal University Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Patricia Weidlich
- Department of Periodontology, Federal University Rio Grande do Sul, Porto Alegre, Brazil
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Meng T, Trickey AW, Harris AHS, Matheson L, Rosenthal S, Traboulsi AAR, Saver JL, Wagner T, Govindarajan P. Lessons Learned From the Historical Trends on Thrombolysis Use for Acute Ischemic Stroke Among Medicare Beneficiaries in the United States. Front Neurol 2022; 13:827965. [PMID: 35309566 PMCID: PMC8931506 DOI: 10.3389/fneur.2022.827965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe most recent time trends on intravenous thrombolysis (IVT) utilization for acute ischemic stroke was reported in 2011 using the Get with the Guidelines. Our objectives are to assess and validate the change in IVT utilization through 2014 in a national sample of Medicare beneficiaries and to examine the effect of patient, stroke center designation, and geography on IVT utilization.MethodsWe built a comprehensive national stroke registry by combining patient-level, stroke center status, and geographical characteristics, using multiple data sources. Using multiple national administrative databases from 2007 to 2014, we generated a mixed-effect logistic regression model to characterize the independent associations of patient, hospital, and geographical characteristics with IVT in 2014.ResultsUse of IVT increased consistently from 2.8% in 2007 to 7.7% in 2014, P < 0.001. Between group differences persisted, with lower odds of use in patients who were ≥86 years (aOR 0.74, 95% CI 0.65–0.83), Black (aOR 0.73, 95% CI 0.61–0.87), or treated at a rural hospital (aOR 0.88, 95% CI 0.77–1.00). Higher odds of use were observed in patients who arrived by ambulance (aOR 2.67, 95% CI 2.38–3.00), were treated at a hospital certified as a stroke center (aOR 1.96, 95% CI 1.68–2.29), or were treated at hospitals located in the most socioeconomically advantaged areas (aOR 1.27, 95% CI 1.05–1.54).ConclusionsBetween 2007 and 2014, the frequency of IVT for patients with acute ischemic stroke increased substantially, though differences persisted in the form of less frequent treatment associated with certain characteristics. These findings can inform ongoing efforts to optimize the delivery of IVT to all AIS patients nationwide.
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Affiliation(s)
- Tong Meng
- Department of Emergency Medicine, Stanford University, Stanford, CA, United States
- Stanford–Surgery Policy Improvement Research & Education Center (S-SPIRE), Department of Surgery, Stanford, CA, United States
| | - Amber W. Trickey
- Stanford–Surgery Policy Improvement Research & Education Center (S-SPIRE), Department of Surgery, Stanford, CA, United States
| | - Alex H. S. Harris
- Stanford–Surgery Policy Improvement Research & Education Center (S-SPIRE), Department of Surgery, Stanford, CA, United States
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, United States
| | - Loretta Matheson
- Department of Emergency Medicine, Stanford University, Stanford, CA, United States
| | - Sarah Rosenthal
- Department of Emergency Medicine, Stanford University, Stanford, CA, United States
| | | | - Jeffrey L. Saver
- Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Todd Wagner
- Stanford–Surgery Policy Improvement Research & Education Center (S-SPIRE), Department of Surgery, Stanford, CA, United States
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, United States
| | - Prasanthi Govindarajan
- Department of Emergency Medicine, Stanford University, Stanford, CA, United States
- Stanford–Surgery Policy Improvement Research & Education Center (S-SPIRE), Department of Surgery, Stanford, CA, United States
- *Correspondence: Prasanthi Govindarajan
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Potasso L, Refardt J, De Marchis GM, Wiencierz A, Wright PR, Wagner B, Dittrich T, Polymeris AA, Gensicke H, Bonati LH, Christ-Crain M. Impact of Sodium Levels on Functional Outcomes in Patients With Stroke - A Swiss Stroke Registry Analysis. J Clin Endocrinol Metab 2022; 107:e672-e680. [PMID: 34480576 DOI: 10.1210/clinem/dgab650] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Correction of hyponatremia might represent an additional treatment for improving stroke patients' clinical outcomes. OBJECTIVE Admission hyponatremia is associated with worse clinical outcome in stroke patients, but whether normalization of hyponatremia improves outcome is unknown. We investigated whether normalization of hyponatremia affects patients' disability, mortality, and stroke recurrence within 3 months; length of hospitalization; and discharge destination. DESIGN This was a registry-based analysis of data collected between January 2016 and December 2018. We linked data from Swiss Stroke Registry (SSR) with electronic patients' records for extracting sodium values. SETTING We analyzed data of hospitalized patients treated at University Hospital of Basel. PATIENTS Stroke patients whose data and informed consent were available. MAIN OUTCOME MEASURE Modified Rankin Scale (mRS) score at 3 months. The tested hypothesis was formulated after SSR data collection but before linkage with electronic patients' records. RESULTS Of 1995 patients, 144 (7.2%) had hyponatremia on admission; 102 (70.8%) reached normonatremia, and 42 (29.2%) remained hyponatremic at discharge. An increase of initial sodium was associated with better functional outcome at 3 months (odds ratio [OR] 0.94; 95% CI, 0.90-0.99, for a shift to higher mRS per 1 mmol/L sodium increase). Compared with normonatremic patients, patients who remained hyponatremic at discharge had a worse functional outcome at 3 months (odds ratio 2.46; 95% CI, 1.20-5.03, for a shift to higher mRS). No effect was found on mortality, recurrence, or length of hospitalization. CONCLUSIONS In hospitalized acute stroke patients, persistent hyponatremia is associated with worse functional outcome. Whether active correction of hyponatremia improves outcome remains to be determined in prospective studies.
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Affiliation(s)
- Laura Potasso
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital of Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Julie Refardt
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital of Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital of Basel, 4031 Basel, Switzerland
| | - Andrea Wiencierz
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Patrick R Wright
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Benjamin Wagner
- Department of Neurology and Stroke Center, University Hospital of Basel, 4031 Basel, Switzerland
| | - Tolga Dittrich
- Department of Neurology and Stroke Center, University Hospital of Basel, 4031 Basel, Switzerland
| | - Alexandros A Polymeris
- Department of Neurology and Stroke Center, University Hospital of Basel, 4031 Basel, Switzerland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital of Basel, 4031 Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital of Basel, 4031 Basel, Switzerland
| | - Mirjam Christ-Crain
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital of Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
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Liu W, Lian XJ, Chen YH, Zou YP, Lin JS, Wu YH, Yu F, Hu WX, Hao WK. Hospital-Acquired Acute Kidney Injury in Older Patients: Clinical Characteristics and Drug Analysis. Gerontology 2022; 68:763-770. [PMID: 34537763 DOI: 10.1159/000518938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/08/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Information on older patients with hospital-acquired acute kidney injury (HA-AKI) and use of drugs is limited. AIM This study aimed to assess the clinical characteristics, drug uses, and in-hospital outcomes of hospitalized older patients with HA-AKI. METHODS Patients aged ≥65 years who were hospitalized in medical wards were retrospectively analyzed. The study patients were divided into the HA-AKI and non-AKI groups based on the changes in serum creatinine. Disease incidence, risk factors, drug uses, and in-hospital outcomes were compared between the groups. RESULTS Of 26,710 older patients in medical wards, 4,491 (16.8%) developed HA-AKI. Older patients with HA-AKI had higher rates of multiple comorbidities and Charlson Comorbidity Index score than those without AKI (p < 0.001). In the HA-AKI group, the proportion of patients with prior use of drugs with possible nephrotoxicity was higher than that of patients with prior use of drugs with identified nephrotoxicity (p < 0.05). The proportions of patients with critical illness, use of nephrotoxic drugs, and the requirements of intensive care unit treatment, cardiopulmonary resuscitation, and dialysis as well as in-hospital mortality and hospitalization duration and costs were higher in the HA-AKI than the non-AKI group; these increased with HA-AKI severity (all p for trend <0.001). With the increase in the number of patients with continued use of drugs with possible nephrotoxicity after HA-AKI, the clinical outcomes showed a tendency to worsen (p < 0.001). Moreover, HA-AKI incidence (adjusted odds ratio [OR], 10.26; 95% confidence interval (CI), 8.27-12.74; p < 0.001), and nephrotoxic drugs exposure (adjusted OR, 1.76; 95% CI, 1.63-1.91; p < 0.001) had an association with an increased in-hospital mortality risk. CONCLUSION AKI incidence was high among hospitalized older patients. Older patients with HA-AKI had worse in-hospital outcomes and higher resource utilization. Nephrotoxic drug exposure and HA-AKI incidence were associated with an increased in-hospital mortality risk.
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Affiliation(s)
- Wei Liu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China,
| | - Xing-Ji Lian
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yuan-Han Chen
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Yi-Ping Zou
- Shantou University Medical College, Shantou, China
| | - Jie-Shan Lin
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yan-Hua Wu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Feng Yu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Wen-Xue Hu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Wen-Ke Hao
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
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Shebeshi DS, Dolja-Gore X, Byles J. Charlson Comorbidity Index as a predictor of repeated hospital admission and mortality among older women diagnosed with cardiovascular disease. Aging Clin Exp Res 2021; 33:2873-2878. [PMID: 33591545 DOI: 10.1007/s40520-021-01805-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/23/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Comorbidity can complicate cardiovascular diseases (CVDs), increasing the risk of adverse events including hospitalisation and death. This study aimed to assess the Charlson Comorbidity Index (CCI) as a predictor of repeated hospital admission and mortality in older CVD patients. METHODS This study linked data from the Australian longitudinal study on women's health (ALSWH) with hospital and National Death Index datasets to identify dates for hospital admission, discharge, and death for women born 1921-26. CCI was calculated using the International Statistical Classification of Diseases, Australia Modification (ICD-10-AM) diagnostic codes. RESULTS Women with a higher CCI on index admission had increased risk of repeated hospital admission (AHR = 1.29, 95% CI 1.06, 1.58) and mortality (AHR = 3.05, 95% CI 2.15, 4.31). Older age and hypertension were also significantly associated with a higher risk of repeated hospital admission and mortality. Living in a remote area was associated with a higher risk of mortality. CONCLUSIONS The Charlson Comorbidity Index predicts repeated hospital admission and mortality incidences among older women with CVD. Improving management of comorbidities for older CVD patients should be considered as part of a strategy to mitigate subsequent repeated hospitalisation and delay mortality.
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Affiliation(s)
- Dinberu S Shebeshi
- Research Centre for Generational Health and Ageing (RCGHA), Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia.
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, 2308, Australia.
- Research Assets Division, SAX Institute, Level 3, 30C Wentworth Street, Glebe, NSW, 2037, Australia.
| | - Xenia Dolja-Gore
- Research Centre for Generational Health and Ageing (RCGHA), Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, 2308, Australia
- Research Assets Division, SAX Institute, Level 3, 30C Wentworth Street, Glebe, NSW, 2037, Australia
| | - Julie Byles
- Research Centre for Generational Health and Ageing (RCGHA), Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
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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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The Charlson Comorbidity Index is associated with risk of 30-day mortality in patients with myocardial injury after non-cardiac surgery. Sci Rep 2021; 11:18933. [PMID: 34556689 PMCID: PMC8460655 DOI: 10.1038/s41598-021-98026-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022] Open
Abstract
Myocardial injury after non-cardiac surgery (MINS) is a well-known and relevant indicator of early postoperative mortality, but factors related to increased mortality in MINS patients are as yet unknown. The Charlson Comorbidity Index (CCI) is widely used to classify various comorbid conditions and underlying diseases. Our study aimed to determine the prognostic value of CCI with regard to mortality of patients with MINS. This study comprises 5633 patients who had MINS as diagnosed by a rise of postoperative cardiac troponin I above the normal range (≥ 0.04 ng/mL) from January 2010 to June 2019. Patients were divided into two groups according to median weighted CCI score: low CCI (≤ 2) and high CCI (> 2) groups. The primary outcome was 30-day mortality after surgery, and secondary outcomes were 1-year and overall mortalities. Of the 5633 patients, 3428 (60.9%) were in the low CCI group (1.21 ± 0.84) and 2205 (39.1%) were in the high CCI group (4.17 ± 1.82). After propensity score matching, mortality during the first 30 days after surgery was significantly greater in the high CCI group than the low CCI group (9.4% vs. 6.0%, respectively; hazard ratio 1.56, 95% confidence interval 1.23–1.98, p < 0.001). A high CCI score was associated with increased 30-day mortality in patients with MINS, suggesting that the CCI may need to be considered when predicting outcomes of MINS patients.
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Zimmermann L, Wendt S, Lübbert C, Karlas T. Epidemiology of pyogenic liver abscesses in Germany: Analysis of incidence, risk factors and mortality rate based on routine data from statutory health insurance. United European Gastroenterol J 2021; 9:1039-1047. [PMID: 34329537 PMCID: PMC8598960 DOI: 10.1002/ueg2.12132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/27/2021] [Indexed: 11/09/2022] Open
Abstract
Background Pyogenic liver abscesses (PLAs) represent potentially life‐threatening abdominal conditions that require immediate diagnosis and therapy. European and American incidence figures vary between one and 15 per 100,000 per year. Structured epidemiological data for European countries are not available. Objective To systematically characterize the epidemiology and clinical outcome of PLA in Germany. Methods In representative statutory health insurance data from four million people in 2013–2019, the prevalence and incidence with clinical coding of International Statistical Classification of Diseases and Related Health Problems (ICD)‐10 code K75.0 were selected (n = 1118). Furthermore, demographics, relevant comorbidities, hospitalizations, mortality and complications were determined within one year. Results The incidence of PLA was approximately seven per 100,000. The average age at diagnosis was 66 years; 65% were male. Of these, biliary disease was documented in over 60% and infectious intestinal diseases were found in 21% within the same or previous calendar year. PLA patients had high comorbidity indices. Liver transplant status, malignancies of the liver and biliary system, liver cirrhosis and pancreatitis were strongly associated. Intensive care was documented in 27% of PLA cases. Nine percent died within 12 months, most with an underlying malignant disease. Conclusion Pyogenic liver abscess is a rare disease with high morbidity. Predisposing and risk factors include intestinal and biliary diseases as well as hepatic malignancies. Further research should focus on PLA therapy within prospective surveys and controlled clinical trials.
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Affiliation(s)
- Lisa Zimmermann
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Sebastian Wendt
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany.,Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Medical Center, Leipzig, Germany
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany.,Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Medical Center, Leipzig, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
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Thomas EH, Lloyd AR, Leopold N. Frailty, multimorbidity and in-hospital cardiopulmonary resuscitation: predictable markers of outcome? Clin Med (Lond) 2021; 21:e357-e362. [DOI: 10.7861/clinmed.2020-1002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Kim JI, Kim S. The determinants of caregiver use and its costs for elderly inpatients in Korea: a study applying Andersen's behavioral model of health care utilization and replacement cost method. BMC Health Serv Res 2021; 21:631. [PMID: 34210296 PMCID: PMC8252285 DOI: 10.1186/s12913-021-06677-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/23/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives The average annual healthcare expenditure among elderly patients in Korea is increasing rapidly in indirect healthcare sectors, requiring an understanding of factors related to the use of both formal and informal caregivers. This study analyzed the characteristics of caregiver use and caregiving costs among elderly patients hospitalized due to acute illness or exacerbation of chronic diseases. Methods A total of 819 study participants were selected from the 2017 Korea Health Panel Study Data. Replacement costing methods were applied to estimate the hours of informal caregiver assistance received by elderly inpatients. Elderly inpatients’ predisposing, enabling, and need factors were studied to identify the relationship between caregiver uses, based on Andersen’s behavior model. A two-part model was applied to analyze the factors related to care receipt and to estimate the incremental costs of care. Results Elderly inpatients who used tertiary hospitals (OR: 2.77, p-value < 0.00) and received financial support (OR: 2.68, p-value < 0.00) were more likely to receive support from a caregiver. However, elderly inpatients living alone were lesser to do so (OR: 0.49, p-value < 0.00). Elderly inpatients with Medicaid insurance (β:0.54, p-value = 0.02) or financial aid (β: 0.64, p-value < 0.00) had a statistically positive association with spending more on caregiving costs. Additionally, financial support receivers had incremental costs of $627 in caregiving costs than nonreceivers. Conclusions This study presented significant socioenvironmental characteristics of formal and informal caregiver use and the related expenditures. Healthcare management plans that encompass multiple social levels should be implemented to ease the caregiver burden. Trial registration Retrospectively registered.
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Affiliation(s)
- Jennifer Ivy Kim
- Department of Public Health, Graduate School, The Catholic University of Korea, 222- Banpo-daero, Seocho-gu, 06591, Seoul, Korea
| | - Sukil Kim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222-Banpo-daero, Seocho-gu, 06591, Seoul, Korea.
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Physical Activity and Diet Quality Modify the Association between Comorbidity and Disability among Stroke Patients. Nutrients 2021; 13:nu13051641. [PMID: 34068135 PMCID: PMC8152968 DOI: 10.3390/nu13051641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Comorbidity is common and causes poor stroke outcomes. We aimed to examine the modifying impacts of physical activity (PA) and diet quality on the association between comorbidity and disability in stroke patients. Methods: A cross-sectional study was conducted on 951 stable stroke patients in Vietnam from December 2019 to December 2020. The survey questionnaires were administered to assess patients’ characteristics, clinical parameters (e.g., Charlson Comorbidity Index items), health-related behaviors (e.g., PA using the International Physical Activity Questionnaire- short version), health literacy, diet quality (using the Dietary Approaches to Stop Hypertension Quality (DASH-Q) questionnaire), and disability (using the World Health Organization Disability Assessment Schedule II (WHODAS II)). Linear regression models were used to analyze the associations and interactions. Results: The proportion of comorbidity was 49.9% (475/951). The scores of DASH-Q and WHODAS II were 29.2 ± 11.8, 32.3 ± 13.5, respectively. Patients with comorbidity had a higher score of disability (regression coefficient, B, 8.24; 95% confidence interval, 95%CI, 6.66, 9.83; p < 0.001) as compared with those without comorbidity. Patients with comorbidity and higher tertiles of PA (B, −4.65 to −5.48; p < 0.05), and a higher DASH-Q score (B, −0.32; p < 0.001) had a lower disability score, as compared with those without comorbidity and the lowest tertile of PA, and the lowest score of DASH-Q, respectively. Conclusions: Physical activity and diet quality significantly modified the negative impact of comorbidity on disability in stroke patients. Strategic approaches are required to promote physical activity and healthy diet which further improve stroke rehabilitation outcomes.
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Kim DH, Park HC, Cho A, Kim J, Yun KS, Kim J, Lee YK. Age-adjusted Charlson comorbidity index score is the best predictor for severe clinical outcome in the hospitalized patients with COVID-19 infection. Medicine (Baltimore) 2021; 100:e25900. [PMID: 33951004 PMCID: PMC8104192 DOI: 10.1097/md.0000000000025900] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/23/2021] [Indexed: 01/08/2023] Open
Abstract
Aged population with comorbidities demonstrated high mortality rate and severe clinical outcome in the patients with coronavirus disease 2019 (COVID-19). However, whether age-adjusted Charlson comorbidity index score (CCIS) predict fatal outcomes remains uncertain.This retrospective, nationwide cohort study was performed to evaluate patient mortality and clinical outcome according to CCIS among the hospitalized patients with COVID-19 infection. We included 5621 patients who had been discharged from isolation or had died from COVID-19 by April 30, 2020. The primary outcome was composites of death, admission to intensive care unit, use of mechanical ventilator or extracorporeal membrane oxygenation. The secondary outcome was mortality. Multivariate Cox proportional hazard model was used to evaluate CCIS as the independent risk factor for death.Among 5621 patients, the high CCIS (≥ 3) group showed higher proportion of elderly population and lower plasma hemoglobin and lower lymphocyte and platelet counts. The high CCIS group was an independent risk factor for composite outcome (HR 3.63, 95% CI 2.45-5.37, P < .001) and patient mortality (HR 22.96, 95% CI 7.20-73.24, P < .001). The nomogram showed that CCIS was the most important factor contributing to the prognosis followed by the presence of dyspnea (hazard ratio [HR] 2.88, 95% confidence interval [CI] 2.16-3.83), low body mass index < 18.5 kg/m2 (HR 2.36, CI 1.49-3.75), lymphopenia (<0.8 x109/L) (HR 2.15, CI 1.59-2.91), thrombocytopenia (<150.0 x109/L) (HR 1.29, CI 0.94-1.78), anemia (<12.0 g/dL) (HR 1.80, CI 1.33-2.43), and male sex (HR 1.76, CI 1.32-2.34). The nomogram demonstrated that the CCIS was the most potent predictive factor for patient mortality.The predictive nomogram using CCIS for the hospitalized patients with COVID-19 may help clinicians to triage the high-risk population and to concentrate limited resources to manage them.
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Affiliation(s)
- Do Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
- Hallym University Kidney Research Institute, Seoul
| | - Hayne Cho Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
- Hallym University Kidney Research Institute, Seoul
| | - Ajin Cho
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
- Hallym University Kidney Research Institute, Seoul
| | - Juhee Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
| | - Kyu-sang Yun
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
| | - Jinseog Kim
- Department of Bigdata and Applied Statistics, Dongguk University, Gyeongju, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
- Hallym University Kidney Research Institute, Seoul
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Bajic B, Galic I, Mihailovic N, Ristic S, Radevic S, Cupic VI, Kocic S, Arnaut A. Performance of Charlson and Elixhauser Comorbidity Index to Predict in-Hospital Mortality in Patients with Stroke in Sumadija and Western Serbia. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:970-977. [PMID: 34183955 PMCID: PMC8223561 DOI: 10.18502/ijph.v50i5.6114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/15/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND Comorbidities are major predictors of in-hospital mortality in stroke patients. The Charlson comorbidity index (CCI) and the Elikhauser comorbidity index (ECI) are scoring systems for classifying comorbidities. We aimed to compare the performance of the CCI and ECI to predict in-hospital mortality in stroke patients. METHODS We included patients hospitalized for stroke in the Clinical Center of Kragujevac, Serbia for the last 7 years. Hospitalizations caused by stroke, were identified by the International Classification of Diseases-10 (ICD-10) codes I60.0 - I69.9. All patients were divided into two cohorts: Alive cohort (n=3297) and Mortality cohort (n=978). RESULTS There were significant associations between higher CCIS and increased risk of in-hospital mortality (HR = 1.07, 95% CI = 1.01-1.12) and between higher ECIS and increased risk of in-hospital mortality (HR = 1.04, 95% CI = 0.99-1.09). Almost 2/3 patients (66.9%) had comorbidities included in the CCI score and 1/3 patients (30.2%) had comorbidities included in the ECI score. The statistically significant higher CCI score (t = -3.88, df = 1017.96, P <0.01) and ECI score (t = -6.7, df = 1447.32, P <0.01) was in the mortality cohort.Area Under the Curve for ECI score was 0.606 and for CCI score was 0.549. CONCLUSION Both, the CCI and the ECI can be used as scoring systems for classifying comorbidities in the administrative databases, but the model's ECI Score had a better discriminative performance of in-hospital mortality in the stroke patients than the CCI Score model.
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Affiliation(s)
- Biljana Bajic
- Health Promotion Center, Institute of Public Health Montenegro, Podgorica, Montenegro
| | - Igor Galic
- Center for Control and Prevention of Noncommunicable Diseases, Institute for Public Health Montenegro, Podgorica, Montenegro
| | - Natasa Mihailovic
- Department of Biostatistics and Informatics, Institute of Public Health Kragujevac, Kragujevac, Serbia
| | - Svetlana Ristic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Svetlana Radevic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Violeta Iric Cupic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Sanja Kocic
- Department of Biostatistics and Informatics, Institute of Public Health Kragujevac, Kragujevac, Serbia
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandra Arnaut
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Derraz I, Ahmed R, Benali A, Corti L, Cagnazzo F, Dargazanli C, Gascou G, Riquelme C, Lefevre PH, Bonafe A, Arquizan C, Costalat V. FLAIR vascular hyperintensities and functional outcome in nonagenarians with anterior circulation large-vessel ischemic stroke treated with endovascular thrombectomy. Eur Radiol 2021; 31:7406-7416. [PMID: 33851277 DOI: 10.1007/s00330-021-07866-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To establish whether imaging assessments of irreversibly injured ischemic core and potentially salvageable penumbral volumes and collateral circulation were associated with functional outcome in nonagenarians (90 years or older) undergoing endovascular thrombectomy (EVT). METHODS Data from a prospectively maintained institutional registry of consecutive stroke patients treated with EVT from January 2012 to December 2018 were retrospectively analyzed. Functional outcome was evaluated with the modified Rankin scale (mRS) at 3 months. mRS score of 0-3 was defined as a good clinical outcome. Ischemic core and penumbral volumes were calculated using the RAPID software. Quantification of collateral circulation was performed using a fluid-attenuated inversion recovery vascular hyperintensity (FVH)-Alberta Stroke Program Early CT Score (ASPECTS) rating system. RESULTS Among 85 patients (age, 92.4 ± 2.6 years; men, 30.6%) treated with EVT, good outcome (mRS 0-3) was achieved in 29 (34.1%) patients and 31 (36.5%) patients died at 90 days. The median estimated ischemic core volume was 15 mL (IQR, 7-27 mL). The median mismatch volume was 83 mL (IQR, 43-120 mL). The median FVH score was 4 (IQR, 3-4). FVH score was independently associated with good functional outcome (adjusted OR = 1.96 [95% CI, 1.16-3.32]; p = 0.01 per 1-point increase) and mortality (adjusted OR = 0.54 [95% CI, 0.34-0.85]; p = 0.007 per 1-point increase). Ischemic core and mismatch volumes were associated with neither good outcome nor mortality. CONCLUSIONS In nonagenarians with anterior circulation large-vessel ischemic stroke, good collaterals as measured by the FVH-ASPECTS rating system are independently associated with improved outcomes and may help select patients for reperfusion therapy in this frail population. KEY POINTS • Endovascular thrombectomy can allow at least 1 in 3 patients older than 90 years of age to achieve good functional outcome (modified Rankin scale of 0-3) at 3 months. • Functional outcome at 3 months is associated with pre-stroke status (number and severity of patients' comorbidities). • A higher FVH score (as reflected by higher FLAIR vascular hyperintensity [FVH]-Alberta Stroke Program Early CT Score [ASPECTS] values) is independently associated with better 3-month functional outcome and mortality in nonagenarians with anterior circulation ischemic stroke.
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Affiliation(s)
- Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France.
| | - Raed Ahmed
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Amel Benali
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Lucas Corti
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Alain Bonafe
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
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Ueshima J, Maeda K, Ishida Y, Shimizu A, Inoue T, Nonogaki T, Matsuyama R, Yamanaka Y, Mori N. SARC-F Predicts Mortality Risk of Older Adults during Hospitalization. J Nutr Health Aging 2021; 25:914-920. [PMID: 34409971 DOI: 10.1007/s12603-021-1647-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the association between SARC-F scores and the in-hospital mortality risk among older patients admitted to acute care hospitals. DESIGN Single-center retrospective study. SETTING A university hospital. PARTICIPANTS All consecutive patients aged older than 65 were admitted and discharged from the study hospital between July 2019 and September 2019. MEASUREMENTS Relevant patient data included age, sex, body mass index, nutritional status, fat-free mass, disease, activities of daily living (ADL), duration of hospital stay, SARC-F, and occurrence of death within 30 days of hospitalization. The diseases that caused hospitalization and comorbidities (Charlson Comorbidity Index; CCI) were obtained from medical records. The Eastern Cooperative Oncology Group-performance status (PS) was used to determine ADL, and the in-hospital mortality rate within 30 days of hospitalization as the outcome. RESULTS We analyzed 2,424 patients. The mean age was 75.9±6.9 and 55.5% were male. Fifty-three in-hospital mortalities occurred among the participants within the first 30 days of hospitalization. Patients who died in-hospital were older, had poorer nutritional status and severer PS scores, and more comorbidities than those who did not. A SARC-F score of ≥4 predicted a higher mortality risk within those 30 days with the following precision: sensitivity 0.792 and specificity 0.805. There were significantly more deaths in Kaplan-Meier curves regarding a score of SARC-F≥4 than a score of SARC-F<4 (p<0.001). Cox proportional hazard analysis was used to identify the clinical indicators most associated with in-hospital mortality. SARC-F≥4 (Hazard Ratio: HR 5.65, p<0.001), CCI scores (HR1.11, p=0.004), and infectious and parasitic diseases (HR3.13, p=0.031) were associated with in-hospital mortality. The SARC-F items with significant in-hospital mortality effects were assistance with walking (HR 2.55, p<0.001) and climbing stairs (HR 2.46, p=0.002). CONCLUSION The SARC-F questionnaire is a useful prognostic indicator for older adults because a SARC-F ≥4 score during admission to an acute care hospital predicts in-hospital mortality within 30 days of hospitalization.
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Affiliation(s)
- J Ueshima
- Keisuke Maeda, M.D., Ph.D. Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan, Phone: +81-562-46-2311; FAX: +81-562-44-8518, E-mail:
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López-Espuela F, Roncero-Martín R, Canal-Macías MDLL, Moran JM, Vera V, Gomez-Luque A, Lendinez-Mesa A, Pedrera-Zamorano JD, Casado-Naranjo I, Lavado-García J. Depressed Mood after Stroke: Predictive Factors at Six Months Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249542. [PMID: 33419273 PMCID: PMC7766010 DOI: 10.3390/ijerph17249542] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
We aimed to know the prevalence of post-stroke depression (PSD) in our context, identify the variables that could predict post-stroke depression, by using the Hamilton Depression Rating Scale, occurring within six months after stroke, and identify patients at high risk for PSD. Methods: descriptive, cross-sectional and observational study. We included 173 patients with stroke (transient ischemic attack (TIA) included) and collected sociodemographic and clinical variables. We used the Hamilton Depression Scale (HDS) for depression assessment and Barthel Index and modified Rankin Scale (mRS) for functional assessment. The neurological severity was evaluated by the National Institutes of Health Stroke Scale (NIHSS). Results: 35.5% were women, aged 71.16 (±12.3). Depression was present in 42.2% patients (n = 73) at six months after stroke. The following variables were significantly associated with PSD: diagnosis of previous depression (p = 0.005), the modified Rankin Scale at discharge (p = 0.032) and length of hospital stay (p = 0.012). Conclusion: PSD is highly prevalent after stroke and is associated with the severity, left location of the stroke, and the degree of disability at discharge. Its impact justifies the evaluation and early treatment that still continues to be a challenge today.
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Affiliation(s)
- Fidel López-Espuela
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Raúl Roncero-Martín
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Maria de la Luz Canal-Macías
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
- Correspondence: ; Tel.: +34-927257450
| | - Jose M. Moran
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Vicente Vera
- Department of Stomatology II, School of Dentistry, Complutense University, 28040 Madrid, Spain;
| | - Adela Gomez-Luque
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Alejandro Lendinez-Mesa
- Nursing Department, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain;
| | - Juan Diego Pedrera-Zamorano
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | | | - Jesus Lavado-García
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
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Wei YJ, Hsieh CF, Huang YT, Huang MS, Fang TJ. The influence of integrated geriatric outpatient clinics on the health care utilization of older people. BMC Geriatr 2020; 20:379. [PMID: 33008337 PMCID: PMC7531091 DOI: 10.1186/s12877-020-01782-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background The number of people aged greater than 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by older people. Methods This was a retrospective case-control study. Patients aged greater than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri-OPD) at a single medical centre were age and sex matched. Data on the number of outpatient clinic visits, emergency department visits, hospitalizations and medical expenditures were collected during the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups. Results A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients in the Geri-OPD group and 5432 (80.8%) patients in the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62 ± 10.85) and the number of clinic visits per year (18.18 ± 48.85) (P < 0.01). After a two-year follow-up, the number of clinic visits, emergency department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and an older age (≧80 years) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared with the non-Geri-POD patients. Conclusion The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in older patients with complicated conditions. The effect was even better in the second year.
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Affiliation(s)
- Yu-Ju Wei
- Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Fang Hsieh
- Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ting Huang
- Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Shyan Huang
- E-Da Cancer Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Tzu-Jung Fang
- Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Mekonnen B, Wang G, Rajbhandari-Thapa J, Shi L, Thapa K, Zhang Z, Zhang D. Weekend Effect on in-Hospital Mortality for Ischemic and Hemorrhagic Stroke in US Rural and Urban Hospitals. J Stroke Cerebrovasc Dis 2020; 29:105106. [PMID: 32912515 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105106] [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] [Received: 02/28/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Previous studies have reported a "weekend effect" on stroke mortality, whereby stroke patients admitted during weekends have a higher risk of in-hospital death than those admitted during weekdays. AIMS We aimed to investigate whether patients with different types of stroke admitted during weekends have a higher risk of in-hospital mortality in rural and urban hospitals in the US. METHODS We used data from the 2016 National Inpatient Sample and used logistic regression to assess in-hospital mortality for weekday and weekend admissions among stroke patients aged 18 and older by stroke type (ischemic or hemorrhagic) and rural or urban status. RESULTS Crude stroke mortality was higher in weekend admissions (p <0.001). After adjusting for confounding variables, in-hospital mortality among hemorrhagic stroke patients was significantly greater (22.0%) for weekend admissions compared to weekday admissions (20.2%, p = 0.009). Among rural hospitals, the in-hospital mortality among hemorrhagic stroke patients was also greater among weekend admissions (36.9%) compared to weekday admissions (25.7%, p = 0.040). Among urban hospitals, the mortality of hemorrhagic stroke patients was 21.1% for weekend and 19.6% for weekday admissions (p = 0.026). No weekend effect was found among ischemic stroke patients admitted to rural or urban hospitals. CONCLUSIONS Our results help to understand mortality differences in hemorrhagic stroke for weekend vs. weekday admissions in urban and rural hospitals. Factors such as density of care providers, stroke centers, and patient level risky behaviors associated with the weekend effect on hemorrhagic stroke mortality need further investigation to improve stroke care services and reduce weekend effect on hemorrhagic stroke mortality.
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Affiliation(s)
- Birook Mekonnen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States.
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States.
| | - Janani Rajbhandari-Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, 205D Wright Hall, Athens, GA 30602, United States.
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
| | - Kiran Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, 205D Wright Hall, Athens, GA 30602, United States.
| | - Zheng Zhang
- Department of Neurology, Wenzhou Medical University, Zhejiang, China.
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, 205D Wright Hall, Athens, GA 30602, United States.
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40
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Nevill A, Duncan M, Cheung DSK, Wong ASW, Kwan RYC, Lai CKY. The use of functional performance tests and simple anthropomorphic measures to screen for comorbidity in primary care. Int J Older People Nurs 2020; 15:e12333. [PMID: 32638518 DOI: 10.1111/opn.12333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/18/2020] [Accepted: 06/09/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Many older adults are unaware that they have comorbid diseases. Increased adiposity and reduced muscle mass are identified as key contributors to many chronic diseases in older adults. Understanding the role they play in the development of comorbidities in older populations is of prime importance. OBJECTIVES To identify the optimal body shape associated with three common functional performance tests and to determine which anthropometric and functional performance test best explains comorbidity in a sample of older adults in Hong Kong. METHODS A total of 432 older adults participated in this cross-sectional study. Researchers assessed their body height, body mass index, waist circumference, waist-to-hip ratio, handgrip strength (kg), functional reach (cm) and results in the timed-up-and-go (TUG) test (seconds). The Charlson Comorbidity Index was used to assess comorbidity. RESULTS Allometric modelling indicated that the optimal body shape associated with all functional performance tests would have required the participants to be taller and leaner. The only variable that predicted comorbidity was the TUG test. The inclusion of body size/shape variables did not improve the prediction model. CONCLUSION Performance in the TUG test alone was found to be capable of identifying participants at risk of developing comorbidities. The TUG test has potential as a screening tool for the early detection of chronic diseases in older adults. IMPLICATIONS FOR PRACTICE Many older people are unaware of their own co-existing illnesses when they consult physicians for a medical condition. TUG can be a quick and useful screening measure to alert nurses in primary care to the need to proceed with more detailed assessments. It is an especially useful screening measure in settings with high patient volumes and fiscal constraints. TUG is low cost and easy to learn and is therefore also relevant for nurses and health workers in low-resource, low-income countries.
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Affiliation(s)
- Alan Nevill
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall, UK
| | - Michael Duncan
- Faculty Research Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Daphne S K Cheung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Anthony S W Wong
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Rick Yiu Cho Kwan
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Claudia K Y Lai
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Liu H, Wu X, Cao J, Jiao J, Zhu C, Song B, Jin J, Liu Y, Wen X, Cheng S. Effect of Comorbidity Assessed by the Charlson Comorbidity Index on the Length of Stay and Mortality Among Immobile Hemorrhagic Stroke Patients Younger Than 50 Years. Front Neurol 2020; 11:487. [PMID: 32625159 PMCID: PMC7314940 DOI: 10.3389/fneur.2020.00487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/04/2020] [Indexed: 12/17/2022] Open
Abstract
Objective: The burden of comorbidity among young patients with hemorrhagic stroke is high. This study examines the effect of comorbidity on the length of stay (LoS) and mortality among immobile hemorrhagic stroke patients younger than 50 years. Materials and Methods: A retrospective post-hoc analysis study design was used. A total of 767 younger adults (mean age 41.64 ± 8.16 years) hospitalized for hemorrhagic stroke between November 2015 and July 2017 were evaluated. All-cause mortality was recorded for 90 days after admission regardless of whether death occurred before or after discharge. Comorbidity was assessed using the Charlson Comorbidity Index (CCI), categorized as low (0–1) and high (≥2). A multiple linear regression model was applied to examine the association between CCI and LoS. Survival was evaluated with Kaplan–Meier and Cox regression analyses. Results: The mean CCI of all patients was 1.25 (SD ± 0.79) and median was 1.0 (IQR 1, 1). The average LoS for patients with a low CCI was 17.73 (± 11.59) days compared with 19.49 (± 15.21) days in those with a high CCI (p = 0.142). The mortality rate was 6.0% (12.10% for high CCI vs. 4.82% for low CCI, p = 0.002). After controlling for confounders, high CCI was not associated with longer LoS (regression coefficient 0.825, 95% CI −1.155 to 2.805; p = 0.413), whereas high CCI was associated with greater likelihood of death than a low CCI (hazard ratio 3.417, 95% CI 1.626 to 7.180; p = 0.001). Conclusions: High global comorbidity was associated with increased short-term mortality but not with LoS. Measures to manage comorbidities aimed at reducing negative clinical impacts of stroke among younger adults are warranted.
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Affiliation(s)
- Hongpeng Liu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Cao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Chen Zhu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jingfen Jin
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Wuhan, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Zhang X, Qiu H, Liu S, Li J, Zhou M. Prediction of Prolonged Length of Stay for Stroke Patients on Admission for Inpatient Rehabilitation Based on the International Classification of Functioning, Disability, and Health (ICF) Generic Set: A Study from 50 Centers in China. Med Sci Monit 2020; 26:e918811. [PMID: 31901931 PMCID: PMC6977619 DOI: 10.12659/msm.918811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background This study aimed to develop a risk prediction model for prolonged length of stay (LOS) in stroke patients in 50 inpatient rehabilitation centers in 20 provinces across mainland China based on the International Classification of Functioning, Disability, and Health (ICF) Generic Set case mix on admission. Material/Methods In this cohort study, 383 stroke patients were included from inpatient rehabilitation settings of 50 hospitals across mainland China. Independent predictors of prolonged LOS were identified using multivariate logistic regression analysis. A prediction model was established and then evaluated by receiver operating characteristic (ROC) curve analysis and the Hosmer-Lemeshow test. Results Multivariate logistic regression analysis showed that the type of medical insurance and the performance of daily activities (ICF, d230) were associated with prolonged LOS (P<0.05). Age and mobility level measured by the ICF Generic Set demonstrated no significant predictive value. The prediction model showed acceptable discrimination shown by an area under the curve (AUC) of 0.699 (95% CI, 0.646–0.752) and calibration (χ2=11.66; P=0.308). Conclusions The risk prediction model for prolonged LOS in stroke patients in 50 rehabilitation centers in China, based on the ICF Generic Set, showed that the scores for the type of medical insurance and the performance of daily activities (ICF, d230) on admission were independent predictors of prolonged LOS. This prediction model may allow stakeholders to estimate the risk of prolonged LOS on admission quantitatively, facilitate the financial planning, treatment regimens during hospitalization, referral after discharge, and reimbursement.
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Affiliation(s)
- Xia Zhang
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China (mainland)
| | - Huaide Qiu
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Shouguo Liu
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jianan Li
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Mouwang Zhou
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China (mainland)
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Lee JH, Kim AJ, Kyong TY, Jang JH, Park J, Lee JH, Lee MJ, Kim JS, Suh YJ, Kwon SR, Kim CW. Evaluating the Outcome of Multi-Morbid Patients Cared for by Hospitalists: a Report of Integrated Medical Model in Korea. J Korean Med Sci 2019; 34:e179. [PMID: 31243937 PMCID: PMC6597483 DOI: 10.3346/jkms.2019.34.e179] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/06/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The lack of medical personnel has led to the employment of hospitalists in Korean hospitals to provide high-quality medical care. However, whether hospitalists' care can improve patients' outcomes remains unclear. We aimed to analyze the outcome in patients cared for by hospitalists. METHODS A retrospective review was conducted in 1,015 patients diagnosed with pneumonia or urinary tract infection from March 2017 to July 2018. After excluding 306 patients, 709 in the general ward who were admitted via the emergency department were enrolled, including 169 and 540 who were cared for by hospitalists (HGs) and non-hospitalists (NHGs), respectively. We compared the length of hospital stay (LOS), in-hospital mortality, readmission rate, comorbidity, and disease severity between the two groups. Comorbidities were analyzed using Charlson comorbidity index (CCI). RESULTS HG LOS (median, interquartile range [IQR], 8 [5-12] days) was lower than NHG LOS (median [IQR], 10 [7-15] days), (P < 0.001). Of the 30 (4.2%) patients who died during their hospital stay, a lower percentage of HG patients (2.4%) than that of NHG patients (4.8%) died, but the difference between the two groups was not significant (P = 0.170). In a subgroup analysis, HG LOS was shorter than NHG LOS (median [IQR], 8 [5-12] vs. 10 [7-16] days, respectively, P < 0.001) with CCI of ≥ 5 points. CONCLUSION Hospitalist care can improve the LOS of patients, especially those with multiple comorbidities. Further studies are warranted to evaluate the impact of hospitalist care in Korea.
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Affiliation(s)
- Jung Hwan Lee
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Ah Jin Kim
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
| | - Tae Young Kyong
- Department of Hospital Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hun Jang
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jeongmi Park
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jeong Hoon Lee
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Man Jong Lee
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jung Soo Kim
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Seong Ryul Kwon
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Cheol Woo Kim
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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