INTRODUCTION: This study seeks to confirm the risk factors linked to cardiovascular (CV) events in chronic kidney disease (CKD), which have been identified as CKD-related. We aim to achieve this using a larger, more diverse, and nationally representative dataset, contrasting with previous research conducted on smaller patient cohorts. METHODS: The study utilized the nationwide inpatient sample database to identify adult hospitalizations for CKD from 2016 to 2020, employing validated ICD-10-CM/PCS codes. A comprehensive literature review was conducted to identify both traditional and CKD-specific risk factors associated with CV events. Risk factors and CV events were defined using a combination of ICD-10-CM/PCS codes and statistical commands. Only risk factors with specific ICD-10 codes and hospitalizations with complete data were included in the study. CV events of interest included cardiac arrhythmias, sudden cardiac death, acute heart failure, and acute coronary syndromes. Univariate and multivariate regression models were employed to evaluate the association between CKD-specific risk factors and CV events while adjusting for the impact of traditional CV risk factors such as old age, hypertension, diabetes, hypercholesterolemia, inactivity, and smoking. RESULTS: A total of 690,375 hospitalizations for CKD were included in the analysis. The study population was predominantly male (375,564, 54.4%) and mostly hospitalized at urban teaching hospitals (512,258, 74.2%). The mean age of the study population was 61 years (SD 0.1), and 86.7% (598,555) had a Charlson comorbidity index (CCI) of 3 or more. At least one traditional risk factor for CV events was present in 84.1% of all CKD hospitalizations (580,605), while 65.4% (451,505) included at least one CKD-specific risk factor for CV events. The incidence of CV events in the study was as follows: acute coronary syndromes (41,422; 6%), sudden cardiac death (13,807; 2%), heart failure (404,560; 58.6%), and cardiac arrhythmias (124,267; 18%). A total of 91.7% (113,912) of all cardiac arrhythmias were atrial fibrillations. Significant odds of CV events on multivariate analyses included: malnutrition (aOR: 1.09; 95% CI: 1.06-1.13; p<0.001), post-dialytic hypotension (aOR: 1.34; 95% CI: 1.26-1.42; p<0.001), thrombophilia (aOR: 1.46; 95% CI: 1.29-1.65; p<0.001), sleep disorder (aOR: 1.17; 95% CI: 1.09-1.25; p<0.001), and post-renal transplant immunosuppressive therapy (aOR: 1.39; 95% CI: 1.26-1.53; p<0.001). CONCLUSION: The study confirmed the predictive reliability of malnutrition, post-dialytic hypotension, thrombophilia, sleep disorders, and post-renal transplant immunosuppressive therapy, highlighting their association with increased risk for CV events in CKD patients. No significant association was observed between uremic syndrome, hyperhomocysteinemia, hyperuricemia, hypertriglyceridemia, leptin levels, carnitine deficiency, anemia, and the odds of experiencing CV events.
Background Obesity, a widespread national epidemic that impacts one in three U.S. adults, is closely linked with the development and exacerbation of cardiovascular disease. The objective of this study was to assess and contrast the outcomes of adults, both obese and non-obese, who present with cardiac chest pain in the emergency department (ED). Methodology A retrospective analysis of the 2020 Nationwide Emergency Department Sample database was conducted. Multivariate regression models were utilized to examine the association between obesity and mortality, discharge disposition, number of procedures, complications, and hospital costs. Results No significant difference in mortality odds was observed between obese and non-obese patients presenting with cardiac chest pain in the ED (adjusted odds ratio (aOR) = 0.92; 95% confidence interval (CI) = 0.59-1.46; p = 0.736). However, obesity was found to be associated with a decreased likelihood of being discharged home from the ED (aOR = 0.57; 95% CI = 0.52-0.63; p < 0.001), as well as an increased likelihood of hospital admission from the ED (aOR = 1.66; 95% CI = 1.53-1.81; p < 0.001). Obesity also correlated with higher odds of non-home discharge (aOR = 1.74; 95% CI = 1.54-1.97; p < 0.001), elevated mean total hospital costs (mean = $13,345 vs. $9,952; mean increase = $3,360; 95% CI = $2,816-$3,904; p < 0.001), and increased risks of cardiac arrests (aOR = 1.52; 95% CI = 1.05-1.88; p < 0.001) and acute respiratory failures (aOR = 1.43; 95% CI = 1.25-1.96; p < 0.001). Obese patients with cardiac pain underwent more procedures on average than non-obese patients (19 vs. 15; aOR = 3.57; 95% CI = 3.04-4.11; p < 0.001). Conclusions Obesity is associated with higher odds of hospital admission from the ED, non-home discharges, higher total hospital costs, and a greater number of procedures.
Background Alcoholic liver disease (ALD) is known to contribute to the onset of insulin resistance (IR), which has been speculated to worsen the outcome of the disease. This study examines the impact of IR on the severity and outcomes of hospitalizations for ALD. Methods A retrospective study was performed using the combined 2016 to 2018 Nationwide Inpatient Sample. All admissions for ALD were included. The association between IR and the clinical and resource utilization of hospitalizations for ALD was analyzed using multivariate regression models to adjust for confounding variables. Results About 294,864 hospitalizations for ALD were analyzed. Of these, 383 cases (0.13%) included a secondary diagnosis of IR, while the remaining 294,481 hospitalizations (99.87%) were considered as controls. The incidence of IR in the study was 1.3 per 1000 admissions for ALD. IR was not associated with any significant difference in the likelihood of mortality (adjusted odds ratio (aOR): 1.10, 95% confidence interval (CI): 0.370-3.251, p=0.867), acute liver failure, or the incidence of complications (aOR: 0.83, 95% CI: 0.535-1.274, p<0.001). However, the study found that ALD hospitalizations with IR had longer hospital stays (7.3 days vs. 6.0 days: IRR, 1.17; 95% CI, 1.09-1.26; p<0.001) and higher mean hospital costs ($91,124 vs. $65,290: IRR, 1.32; 95% CI, 1.20-1.46; p<0.001) compared to patients without IR. Conclusion IR alone does not worsen the outcomes of patients with ALD, and its association with longer hospital stays and higher mean hospital costs could be due to other confounding factors.
INTRODUCTION: Focused antenatal care (FANC) is a newer and better approach to antenatal care for pregnant women than the traditional model. FANC emphasizes individual assessment and decision-making by both the provider and the pregnant woman, resulting in better health outcomes for both mother and baby. Despite the adoption of FANC care in Nigeria, maternal mortality indices have not significantly decreased. This study aimed to assess the level of awareness and utilization of FANC among pregnant women in Nigeria, as well as the factors that influence its utilization. METHODS: This study was conducted in Enugu, Nigeria, using the antenatal clinics of three major tertiary hospitals. A cross-sectional design was used, and a sample size of 300 pregnant women was selected using systematic random sampling. Data were collected using a structured, self-administered questionnaire and analyzed using IBM Statistical Package for Social Sciences (SPSS) version 26. The findings were presented using frequencies, tables, charts, and figures, and Fisher's exact test was used to determine the relationship between respondents' knowledge of focused antenatal care and their demographic factors. RESULTS: A study involving 300 pregnant women in Nigeria found that only 15% of them had heard of focused antenatal care (FANC) and just 7.3% had good knowledge of its components, which was attributed to the low level of education among the respondents (X2=16.68, p=0.001). Health talks during antenatal visits were the most common source of information on FANC. The study also revealed that late initiation of antenatal care (n=144, 48%) in current pregnancy and (n=106, 54.6%) among those previously pregnant, as well as insufficient attendance, were identified as risk factors for maternal mortality. Long waiting times (n=196, 65.3%) and overcrowded healthcare facilities (n=110, 36.7%) were the major causes of dissatisfaction with antenatal care services among the respondents. Pregnant women preferred delivering at tertiary hospitals or private hospitals due to the perceived better quality of care and personal preference. These findings could inform targeted interventions to improve knowledge and awareness of FANC among pregnant women, particularly those with lower levels of education. CONCLUSION: This study provides important insights into the low awareness and utilization of FANC among pregnant women in Enugu, Nigeria, highlighting the need for targeted interventions to improve knowledge and awareness of FANC. The study's findings have important implications for the development of maternal and child health policies and interventions aimed at improving the utilization of healthcare services during pregnancy and childbirth in Nigeria. Further research that includes qualitative methods could provide more nuanced information on pregnant women's experiences and perspectives on FANC.
