Depression Impairs Level of Functioning in Chronic Kidney Disease Inpatients: A Case-Control Study.

Objectives To evaluate the difference in demographics and clinical correlates during hospitalization for chronic kidney disease (CKD) between patients with depression and those without depression, and its impact on the severity of illness and in-hospital mortality. Methods We conducted a case-control study and included 2,296 adult inpatients (age ≥18 years) with a primary discharge diagnosis of CKD using the nationwide inpatient sample (NIS). We used propensity score matching to extract the cases i.e., CKD inpatients with depression (N = 1,264) and the controls i.e. CKD inpatients without depression (N = 1,032). The matching was done based on demographic characteristics of age at admission, sex, race, and median household income. Our outcomes of interest are the severity of illness and all-cause in-hospital mortality. All patient refined drg (APR-DRG) are allocated using health information systems software by the NIS and the severity of illness within each base APR-DRG was classified into minor, moderate, or major loss of body functions. Binomial logistic regression analysis was conducted to find the odds ratio (OR) of association for major loss of function in CKD inpatients with depression, and this model was adjusted for potential confounders of congestive heart failure (CHF), coronary artery disease (CAD), diabetes, hypertension, obesity, and tobacco abuse, and utilization of hemodialysis. Results A higher proportion of CKD inpatients with depression had a statistically significant higher prevalence of major loss of function (49.8% vs. 40.3% in non-depressed). There was a statistically significant difference with higher utilization of hemodialysis in CKD inpatients with depression (76.2% vs. 70.7% in non-depressed). The all-cause in-hospital mortality rate was lower in CKD inpatients with depression (2.1% vs. 3.5% in non-depressed). After controlling the logistic regression model for potential comorbidities and utilization of hemodialysis, depression was associated with increased odds (OR 1.46; 95% CI 1.227 - 1.734) for major loss of function versus in non-depressed CKD inpatients Conclusion Comorbid depression increases the likelihood of major loss of functioning in CKD inpatients by 46%. Treating depression can allow patients to better cope emotionally and physically with CKD and other comorbidities and significantly improve the patient's quality of life (QoL) and health outcome.

Incidence and Predictors of In-Hospital Mortality Among Diabetics Undergoing Transcatheter Aortic Valve Replacement.

Objectives The main goals of this study are to delineate the differences in demographics, comorbidities and hospital outcomes between diabetic and non-diabetic aortic stenosis (AS) patients, and next is to evaluate the predictors of in-hospital mortality in AS patients undergoing transcatheter aortic valve replacement (TAVR). Methods We conducted an observational cross-sectional study using the nationwide inpatient sample (NIS) and included 33,325 adult patients with a primary discharge diagnosis of AS who underwent TAVR during the hospitalization. This sample was further grouped by comorbid diabetic which include non-diabetics (N = 23,585) versus diabetic patients (N = 9,740). Among the hospital outcomes we included the length of stay (LOS) and total cost during hospitalization, and the all-cause in-hospital mortality. We used an independent logistic regression model adjusted for demographic confounders to measure the adjusted odds ratio (aOR) of association of comorbid medical conditions and in-hospital mortality risk in non-diabetic and diabetic groups. Results The most prevalent medical comorbidities among inpatients with diabetes were hypertension (85.1%), followed by renal failure (38.0%), chronic lung disease (37.1%), obesity (21.3%), and these values were significantly higher compared with the non-diabetic group. The in-hospitality mortality was higher among the non-diabetic group (4.7%) compared to the diabetic group (2.8%). There was no significant difference in mean length of stay and mean total cost between the diabetic and non-diabetic groups. In diabetic AS inpatients, stroke (aOR: 4.58, 95%CI: 2.23-9.42) and fluid/electrolyte disorders (aOR: 4.25, 95%CI: 3.29-5.48) had a statistically significant association with mortality risk when compared to the non-diabetic group. Among the non-diabetic AS inpatients, fluid/electrolyte disorders had the highest mortality risk (aOR: 2.48, 95% CI 2.17-2.83) followed by coagulopathy (aOR: 2.03; CI: 1.77-2.32), congestive heart failure (aOR: 1.67; CI: 1.40-1.98), and renal failure (aOR: 1.62; CI: 1.41-1.86). Meanwhile, hypertension and obesity had a statistically non-significant and negative association with in-hospital mortality in diabetic and non-diabetic groups. Conclusions Diabetic AS inpatients following TAVR had a higher mortality risk with comorbid fluid/electrolyte disorders and stroke. In-hospital mortality following TAVR was lower among the diabetics compared to non-diabetics, and it underscores diabetes as a surgical risk factor in patients with AS. So, TAVR may be the preferred approach for diabetic patients with AS along with cardiovascular risk factor modification, strict glycemic control and timely renal function follow-up.

Utilization of Left Ventricular Assist Device for Congestive Heart Failure: Inputs on Demographic and Hospital Characterization From Nationwide Inpatient Sample.

Objectives The first goal of the study is to provide a descriptive overview of the utilization of left ventricular assist device (LVAD) for the treatment of congestive heart failure (CHF) and determine the rates of LVAD use stratified by patients' demographic and hospitals' characteristics in the United States. Next, is to measure the hospitalization outcomes of length of stay (LOS) and cost in inpatients managed with LVAD. Methods We conducted a cross-sectional study using the nationwide inpatient sample and included 184,115 patients (age ≥65 years) with a primary discharge diagnosis of hypertensive and non-hypertensive CHF and was further classified by inpatients who were managed with LVAD. We compared the distributions of demographic and hospital characteristics in CHF inpatients with versus without LVAD by performing Pearson's chi-square test for categorical variables, and independent sample t-test for continuous variables. Results The inpatient utilization of LVAD was 0.93% (1690 out of 184,115) in CHF patients. The LVAD cohort were younger compared to non-LVAD group (mean age, 69.9 years vs. 79.4 years). The utilization rate of LVAD was also almost four times higher in males (1.50%) compared to females (0.36%). Although whites (78.5%) accounted for majority of LVAD recipients, the rate of LVAD utilization was highest in blacks (1.04%) and lowest in Hispanics (0.58%) with whites having utilization rate of 0.89%. Medicare was the dominant primary payer to cover the LVAD inpatients (91.1%), though the rate of LVAD utilization is highest in private (2.22%) and lowest in those covered by public insurance (medicaid/medicare). CHF patients in public hospitals (1.79%) were more than twice more likely to receive LVAD than in private hospitals (0.83%) due to higher utilization rate. LVAD utilization rate was approximately 55 times higher in teaching hospitals (1.67%) compared to non-teaching hospitals (0.03%), and 20 times higher in large bed hospitals (1.41%) compared to small bed-size hospitals (0.07%). CHF patients that received LVAD had a significantly longer LOS (34.6 days vs 9.8 days) and higher inpatient treatment costs ($802,118 vs. $86,302) compared to non-LVAD group. Conclusion The inpatient utilization of LVAD was in CHF patients is higher in males, blacks and private health insurance beneficiaries. In terms of hospital characteristics, the utilization of LVAD for CHF management was higher in large bed sized, and public type and teaching hospitals compared to their counterparts. This data will allow us to devise strategies to improve LVAD utilization and increase its outreach for heart failure patients, especially those on the transplant waiting list. Despite its effectiveness, aggressive usage of LVAD is restricted due to cost-effectiveness and lack of technical confidence among medical professional due to complications.

Cannabis Use Disorders Lead to Hospitalizations for Peptic Ulcer Disease: Insights From a Nationwide Inpatient Sample Analysis.

Objectives In this study, we aimed to explore the independent association between cannabis use disorders (CUD) and peptic ulcer disease (PUD)-related hospitalization, and then to delineate the demographic differences among PUD inpatients with versus without CUD. Methodology We conducted a cross-sectional study using the Nationwide Inpatient Sample of 50,444,133 patients. We then subgrouped them into PUD and non-PUD cohorts. We compared non-PUD and PUD cohorts using bivariate analysis to delineate the differences in demographics and comorbid risk factors (chronic lung disease, chronic kidney disease, liver disease, diabetes, chronic nonsteroidal anti-inflammatory drug use, tobacco abuse, and alcohol abuse). We used logistic regression analysis to measure the odds ratio (OR) of the association between CUD and PUD-related hospitalization. Results The prevalence of PUD was 0.14% (N = 70,898) among the total inpatient population. It was more prevalent in whites (65%) and males were at higher odds (OR: 1.11; P < 0.001) of being hospitalized for PUD. After controlling for potential comorbid risk factors and demographic confounders, the odds of association between CUD and PUD-related hospitalization were statistically significant (OR: 1.18; P < 0.001). Conclusions CUD was associated with a modest but significant increase of 18% in the likelihood of hospitalization for PUD. With the legalization of cannabis use and its increasing and problematic consumption, it is imperative to understand the impact of cannabis use on the physical health of patients and the related gastrointestinal problems.

Demographic Pattern and Mortality Risk Factors for Prescription Opioid Overdose Hospitalizations: Results From Nationwide Inpatient Sample Analysis.

Objectives To explore the demographic patterns of hospitalizations related to prescription opioid overdose (POD) and evaluate the mortality risk of association in POD inpatients. Methodology We conducted a cross-sectional study using the Nationwide Inpatient Sample of 184,711 POD inpatients. A binomial logistic regression model was used to evaluate the odds ratio (OR) of association for mortality risk due to comorbidities (substance use disorders (SUD) and medical complications) in POD inpatients. Results POD inpatients were majorly females (54.1%), older adults aged 51-75 years (48.5%), whites (81.5%), and from lower household income quartet (32.8%). The most prevalent comorbid SUD among POD inpatients was alcohol (15.7%), followed by cannabis (5.7%), cocaine (4.2%), and amphetamine (1.8%). Comorbid alcohol use disorders had a minimally increased association with mortality but were not statistically significant (OR = 1.036; P = 0.438). POD in patients with cardiac arrest had the highest risk of mortality (OR = 103.423; P < 0.001), followed by shock (OR = 15.367; P < 0.001), coma (OR = 13.427; P < 0.001), and respiratory failure (OR = 12.051; P < 0.001). Conclusions Our study indicates that the hospitalizations related to POD were more prevalent among females, elders between 51 and 75 years of age, whites, and those in the lower household income quartet. The prevalence of prescription opioid use and the hospitalization related to POD remains a significant public health issue. POD inpatients with medical complications were at a higher risk of mortality than with comorbid SUD.

National Trends of Arrhythmia Hospitalizations and Comorbid Alcohol Use Disorders in the United States.

Objective To study the trends of arrhythmia hospitalizations with comorbid alcohol use disorders (AUDs) in terms of demographic characteristics and inpatient outcomes. Methods We used the Nationwide Inpatient Sample (NIS) data from 2010 to 2014 and included 570,556 arrhythmia inpatients (age, 15-54 years), and 55,730 inpatients had comorbid AUD. We used the linear-by-linear association test for measuring the differences in demographics, comorbidities, and hospital outcomes over the study period of 2010 to 2014, and the analysis of variance (ANOVA) for measuring the changes seen in the length of stay (LOS) and total charges. Results Arrhythmia inpatients with AUD were majorly males (85.9%), and older-age adults (45 to 54 years, 68%). Hypertension (52.2%), tobacco abuse (42.3%), and elevated cholesterol and lipids (22.6%) were the most prevalent comorbidities in the study population. There was a statistically significant increasing trend in arrhythmia inpatients with AUD with comorbid diabetes, hypertension, and obesity over the five-year period. In-hospital mortality had a variable trend from 1.1% in 2010 to 1.3% in 2014, but there was a statistically non-significant difference in the trend (P = 0.418). Mean LOS was three days with statistically no significant change during the study period (P = 0.080), whereas total charges have been increasing significantly (P <0.001), averaging $37,473 per hospitalization. Conclusion The prevalence trend of arrhythmia hospitalizations with comorbid AUD is increasing in the United States population, and is majorly seen in older-age men. Overall, in-hospital mortality in arrhythmia inpatients with comorbid AUD was 1.4%. So, this necessitates the development of an integrated clinical care model for early diagnosis and management of alcohol abuse and dependence in order to improve the arrhythmia patient outcomes and quality of life.