ABSTRACT
INTRODUCTION: Despite considerable research on the comparison of enteral and parenteral nutrition in patients with acute pancreatitis, there is an ongoing debate about the optimal timing of nutrition initiation, invasiveness of interventions, impact on outcomes, and patient tolerance. Given the gap that still exists in the literature, we investigated the relationship between the mode of nutrition and critical outcomes such as mortality rates, inpatient complications, length of hospitalization, and discharge disposition, using comprehensive national-level data. In addition, we investigated the impact of early enteral nutrition on outcomes in acute pancreatitis. METHODS: All adult discharges for acute pancreatitis between 2016 and 2018 were analyzed from the National (Nationwide) Inpatient Sample (NIS). Discharges of minors and those involving mixed nutrition were excluded from the analysis. Enteral nutrition and parenteral nutrition subgroups were identified using the International Classification of Diseases, 10th revision (ICD-10) codes. Disease severity was defined using the 2013 revised Atlanta Classification of Acute Pancreatitis, along with the All Patient Refined Diagnosis Related Group (APR-DRG)'s severity of illness and likelihood of mortality variables. Complications were identified using ICD-10 codes from the secondary diagnoses variables within the NIS dataset. Multivariable logistic regression analyses were employed to assess associations between the mode of nutrition and the outcomes of interest. RESULTS: A total of 379,410 hospitalizations were studied. About 2,011 (0.53%) received enteral nutrition, while 4,174 (1.1%) received parenteral nutrition. The mean age of the study was 51.7 years (SD 0.1). About 2,280 mortalities were recorded in the study. After adjustments, enteral nutrition was associated with significantly lower odds of mortality (adjusted OR (aOR): 0.833; 95%CI: 0.497-0.933; P<0.001). Parenteral nutrition was linked with significantly greater odds of mortality (aOR: 6.957; 95%CI: 4.730-10.233; P<0.001). Both enteral nutrition and parenteral nutrition were associated with augmented odds of complications and prolonged hospitalization (P<0.001) compared to normal oral feeding. Initiation of enteral nutrition within 24 hours of admission did not improve the odds of mortality in this study (aOR: 5.619; 95%CI: 1.900-16.615; P=0.002). CONCLUSION: Enteral nutrition demonstrates better outcomes in mortality rates and systemic complications compared to parenteral nutrition in patients unable to maintain normal oral feeding.
ABSTRACT
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.
ABSTRACT
Vancomycin, a glycopeptide antibiotic, is widely used for Gram-positive cocci or bacilli bacteria-induced serious infections. Although considered safe and effective, it still causes adverse events. Vancomycin-induced immune thrombocytopenia is a rarely reported adverse event, manifesting from asymptomatic thrombocytopenia to life-threatening bleeding. We underline a case of a 56-year-old male with a diabetic foot with an infected exudating purulent ulcer. He experienced a significant drop in platelet count after commencing vancomycin, and discontinuing vancomycin resulted in improved platelet count with positive vancomycin-induced anti-platelet antibodies. After ruling out other possible causes of thrombocytopenia, a presumptive diagnosis of vancomycin-induced thrombocytopenia was made.
ABSTRACT
Thrombotic thrombocytopenic purpura (TTP) is a rare and potentially devastating blood disorder depicted by thrombocytopenia, fever, widespread small vessel hemolytic anemia, and neurological symptoms. The involvement of the renal and neurological systems is frequently reported in TTP; however, TTP-induced acute coronary syndrome is not widely reported. We describe a case of myocardial infarction induced by TTP in a patient who presented with the typical manifestation of acute coronary syndrome. Echocardiogram revealed a myocardial injury, and detailed investigations revealed increased levels of troponin I, lactate dehydrogenase, diminished levels of haptoglobin and von Willebrand factor-cleaving protease, and schistocytes on peripheral smear, suggestive of TTP-induced myocardial infarction. His condition was stabilized after commencing plasmapheresis, steroids, and rituximab. The initial steps in the management of this patient involve the prompt administration of steroids and the urgent start of plasmapheresis to increase platelet count.
