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The objective is to study factors that increase the likelihood of acute myocardial infarction (AMI) in hospitalized adult non-elderly patients with pneumonia compared to other medical inpatients and to understand the utilization rate of percutaneous coronary intervention (PCI) for AMI in inpatients with pneumonia and its related impact on hospitalization stay and cost. A population-based study was conducted using the Nationwide Inpatient Sample (NIS, 2019) with adult non-elderly inpatients (age 18-65 years) with a medical condition as their primary diagnosis and a co-diagnosis of pneumonia during hospitalization stay. This study sample was divided by the primary diagnosis of AMI versus other medical conditions (non-AMI). A logistic regression model was used to evaluate the odds ratio (OR) of predictors associated with AMI in patients with pneumonia. The results showed a direct relationship between increasing age and the likelihood of AMI in pneumonia inpatients with three times higher odds seen in 51-65 years of age (OR 2.95, 95% CI 2.82-3.09). The comorbidities included complicated hypertension (OR 2.84, 95% CI 2.78-2.89), diabetes with complications (OR 1.27, 95% CI 1.24-1.29), and drug abuse (OR 1.27, 95% CI 1.22-1.31) that increased the likelihood of AMI-related hospitalization. The utilization rate of surgical treatment (PCI) was 14.37% for the management of AMI in inpatients with pneumonia. Inpatients co-diagnosed with pneumonia and comorbidities such as hypertension and diabetes were more likely to be hospitalized for AMI. These at-risk patients should be considered for early risk stratification. Utilization of PCI was associated with a lower in-hospital mortality rate.
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Objectives The primary goal of this study is to explore demographic and comorbid factors that increase the hospitalization risk of acute myocardial infarction (AMI) in patients with vasculitis along with the utilization rate of percutaneous coronary intervention (PCI)/angioplasty. Additionally, we aim to study the prevalence of AMI in vasculitis inpatients based on geographical distribution. Methods We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) in 2019 involving 33,210 inpatients hospitalized on emergency-based admissions with a co-diagnosis of vasculitis, subdivided into cohorts without AMI (N = 31,790) and with AMI (N = 1,420) as the primary diagnosis. A binomial logistic regression model was used to evaluate the odds ratio (OR) of predictors associated with AMI in patients with vasculitis compared to the non-AMI cohort. Results The prevalence of AMI in the total inpatient population with vasculitis was 4.28%, with a majority of patients being in the older age group of 51-65 years (63%), males (59.2%), and white (59%). Inpatients with vasculitis having pre-existing co-morbid conditions were at greater risk for AMI, such as obesity (OR 2.84, 95%CI 2.78-2.89), metastatic cancer (OR 1.73, 95%CI 1.26-2.37), complicated hypertension (OR 1.64, 95%CI 1.46-1.85), and arthropathies (OR 1.48, 95%CI 1.30-1.68). The in-hospital mortality rate was significantly higher in the AMI cohort compared to the non-AMI cohort (13% vs 2.9%). The utilization rate of PCI/endovascular angioplasty was 13.02% (185 out of 1,420) and had a lower in-hospital mortality rate compared to those managed by medical treatment (8.1% vs 13.8%). Conclusion AMI is an important differential diagnosis to consider in vasculitis patients admitted into the hospital with chest pain. Due to the low prevalence of vasculitis and diagnostic challenges, these primary conditions can be often missed. There is a greater risk of inpatient mortality among vasculitis patients with AMI. Therefore, a higher index of suspicion should be exercised, especially in elderly males with risk factors. Vasculitis patients with chronic comorbidities such as arthropathies, obesity and hypertension are at a greater risk for suffering from AMI. Careful screening and management of cardiovascular risk factors is mandatory in vasculitis patients.
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Objective To delineate the differences in demographic characteristics and hospitalization outcomes in patients with acute myocardial infarction by comorbid acute kidney injury (AKI) and to explore the risk factors for in-hospital mortality due to AKI in acute myocardial infarction (AMI) inpatients. Methods We conducted a retrospective cross-sectional study using a nationwide inpatient sample and included 77,585 adult inpatients with AMI and further divided by the presence of a co-diagnosis of AKI. A logistic regression model was used to evaluate the odds ratio (OR) of the association between in-hospital mortality and AKI and other comorbidities. Results The prevalence of AKI in AMI inpatients during hospitalization was 11.69%. Among AMI inpatients with AKI, it was prevalent in males (73.9%) and whites (48.8%). Patients with AKI had a higher prevalence of complicated comorbid hypertension (58.7%), diabetes with complications (34.8%), cardiogenic shock (17.4%), and drug abuse (12.3%). Male patients had lower odds of in-hospital mortality (OR 0.69; 95% Cl 0.61-0.79) compared to females. Hispanics had a higher association with mortality (OR 1.45; 95% Cl 1.21-1.74) than whites and other races/ethnicities. Patients who developed cardiogenic shock were at 17 times higher odds of in-hospital mortality (OR 17.25; 95% CI 15.14-19.67), followed by AKI (OR 4.64; 95% CI 4.06-5.31), and alcohol abuse (OR 1.29; 95% CI 1.03-1.64). The in-hospital mortality rate among AMI inpatients with AKI (7.6%) was significantly higher compared to that seen in the non-AKI cohort (0.9%). Conclusion AMI inpatients with AKI during hospitalization was prevalent in males and whites. Among the demographic risk factors, females and Hispanics had a higher likelihood of in-hospital mortality during the inpatient management of AMI. Cardiogenic shock and AKI increased the odds of in-hospital mortality compared to other comorbidities in AMI inpatients.
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Objectives The objective is to study the demographic and geographical factors that increase the risk of colorectal cancer (CRC) in inpatients with ulcerative colitis (UC) and evaluate the mortality risk and hospitalization outcomes in terms of length of stay (LOS) and cost of care in patients with CRC in UC. Methods We conducted a cross-sectional study using the nationwide inpatient sample (NIS, 2019). We included 78,835 inpatients (age 15-65 years) hospitalized on emergency-based admissions with a primary diagnosis of UC. The study sample was divided by the presence of CRC. Categorical and continuous data were analyzed using Pearson's chi-square test and independent-sample t-test respectively. Independent binomial logistic regression models were used to evaluate the odds ratio (OR) of predictors associated with CRC in patients with UC compared to non-CRC. Results The prevalence of CRC in inpatients with UC was 0.2%, and the mean age for admission of patients with UC with CRC was 49.6 years (SD ± 10.29). A directly proportionate relationship exists between increasing age and the risk of CRC in UC inpatients with 10 times higher odds seen in 51-65 years of age (OR 10.0, 95% CI 5.11-19.61). Males (OR 2.15, 95% CI 1.49-3.08) and Hispanics (OR 1.69, 95% CI 1.04-2.74) are at higher odds for CRC compared to their counterparts. Acquired immunodeficiency syndrome (AIDS) was associated with increased odds (OR 6.23, 95% CI 2.48-15.68) for CRC in UC inpatients. There existed an increased association for CRC in UC inpatients with complicated hypertension, and alcohol and drug abuse but was statistically non-significant. As per the adjusted regression model, CRC in UC inpatients increased the risk of in-hospital mortality (OR 41.09, 95% CI 19.49-86.58). Conclusions CRC was more prevalent in middle-aged Caucasian males with UC and those with chronic comorbidities including complicated diabetes and hypertension, alcohol abuse, and AIDS. Patients with UC and AIDS were found to have greater odds of developing CRC. A high index of clinical suspicion is needed in the management of these patient groups as the inpatient mortality risk was higher in UC inpatients with CRC.
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This study aims to assess the role of vitamin D on systemic lupus erythematosus (SLE) patients and its effects on systemic lupus erythematosus disease activity index (SLEDAI), anti-double-stranded DNA (anti-dsDNA), C3, C4, and fatigue in patients with SLE. A systemic search was conducted using three electronic databases, i.e., PubMed/Medline, Cochrane Library, and Google Scholar. Review Manager 5.4.1 (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) was employed for statistical analysis. All studies meeting the inclusion criteria were selected. A random-effect model was used to pool the studies, and the result was reported in the standard mean difference (SMD) with its corresponding 95% confidence interval. Six randomized controlled trials were selected. Five outcomes were assessed (SLEDAI, anti-dsDNA, C3, C4, and fatigue) to evaluate the role of vitamin D in SLE patients. A significant decrease in SLEDAI (SMD = -0.85 (-1.12, -0.58); p < 0.00001; I2 = 42%) and a non-significant decrease in anti-dsDNA (SMD = -0.09 (-0.03, 0.12); p = 0.42; I2 = 0%) was noted. A significant increase in levels of C3 (SMD = 0.30 (0.09, 0.51); p = 0.006; I2 = 0%) and fatigue (SMD = -1.27 (-2.38, -0.16); p = 0.02; I2 = 56%) was noted when vitamin D was used. Insignificant difference was observed in C4 (SMD = 0.20 (-0.02, 0.41); p = 0.07; I2 = 0%). Vitamin D in SLE patients showed a significant decrease in SLEDAI scores and a significant increase in C3 levels. The effect of vitamin D on fatigue was inconclusive. No significant difference in anti-dsDNA and C4 levels was noted.
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Objective In this study, we aimed to explore the association of demographic characteristics and comorbidities with the risk of venous thromboembolism (VTE) in cancer inpatients, as well as to delineate the mortality risk in cancer inpatients with VTE. Methods We conducted a retrospective cohort analysis based on the National Inpatient Sample (NIS) 2012-2014, involving 339,395 inpatients with a primary diagnosis of cancer subdivided into cohorts without VTE (n=331,695) and with VTE (n=7,700). We used a binomial logistic regression model to evaluate the odds ratio (OR) of demographics, comorbidities, and in-hospital mortality rate with respect to cancer inpatients with VTE. Results A higher proportion of cancer inpatients with VTE were 36-50 years in age (83.1%), male (50%), and of black (19.3%) and Hispanic ethnicity (17.2%) compared to the non-VTE cohort. The prevalence of comorbidities was higher in the VTE cohort, including HIV/AIDS, congestive heart failure (CHF), chronic pulmonary disease, diabetes, hypertension, and obesity. CHF demonstrated the highest risk of association with VTE (OR: 2.68, 95% CI: 2.30-3.12), followed by hypertension (OR: 1.23, 95% CI: 1.16-1.29), diabetes (OR: 1.16, 95% CI: 1.07-1.26), and chronic pulmonary disease (OR: 1.13, 95% CI: 1.05-1.22). Conversely, valvular diseases, obesity, and drug abuse were not significantly associated with VTE in cancer inpatients. The in-hospital mortality rate was higher in cancer inpatients with VTE (12% vs. 2.1%), thereby increasing the in-hospital mortality risk (OR: 3.87, 95% CI: 3.58-4.18). Conclusion VTE risk was significantly higher in cancer patients with comorbid CHF, hypertension, diabetes, and chronic pulmonary disease. The risk of all-cause in-hospital mortality was increased by four times in cancer inpatients with VTE.
