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Soares Ferreira Junior A, Pinheiro Maux Lessa M, Boyle SH, Sanborn K, Kuchibhatla M, Onwuemene OA. In patients with suspected immune TTP, admission source impacts hospital length of stay and time to therapeutic plasma exchange impacts clinical outcomes. Thromb Res 2023; 227:34-39. [PMID: 37210956 DOI: 10.1016/j.thromres.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/24/2023] [Accepted: 05/01/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION When immune thrombotic thrombocytopenic purpura (TTP) is suspected, outcomes are impacted by time to therapeutic plasma exchange (TPE). We evaluated the impact of time to TPE on outcomes in suspected TTP cases admitted through the Emergency Department (ED) vs. transferred from another facility (Transfer). MATERIALS AND METHODS In a retrospective analysis of the National Inpatient Sample, we examined the association between TTP outcomes and admission source (ED vs. Transfer) for the primary outcome of time to TPE. A second stratified analyses within each analytic group examined the association of time to TPE (<1 day, 1 day, 2 days, and >2 days) and outcomes for the composite outcome of mortality, major bleeding and thrombosis. RESULTS Of 1195 cases, 793 (66 %) were admitted through the ED and 402 (34 %) were transferred. Compared to ED cases, Transfers had a longer hospital length of stay (14.69 vs. 16.65 days, p = 0.0060). For ED cases, TPE after >2 days was associated with higher odds of the composite outcome (OR = 1.68 95 % CI: 1.11-2.54; p = 0.0150) and mortality (OR = 3.01 95 % CI: 1.38-6.57; p = 0.0056). For Transfers, TPE on day 2 was associated with higher odds of the composite outcome (OR = 3.00 95 % CI: 1.31-6.89; p = 0.0096) and mortality (OR = 4.95 95 % CI: 1.12-21.88; p = 0.0350). CONCLUSIONS In suspected TTP admitted through the ED or transferred, there was no significant difference in time to TPE. A longer time to TPE was associated with worse outcomes. Future studies should evaluate strategies to decrease initial time to TPE.
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Affiliation(s)
| | - Morgana Pinheiro Maux Lessa
- Department of Medicine, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | | | - Kate Sanborn
- Duke Biostatistics, Epidemiology and Research Design Core, Duke University School of Medicine, Durham, NC, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Oluwatoyosi A Onwuemene
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
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Carey MR, Ladanyi A, Mehlman Y, Molinsky RL, Eisenberger A, Clerkin KJ, Aaron JG, Takeda K, Sayer GT, Uriel N, Demmer RT, Colombo PC, Yuzefpolskaya M. The impact of pre-existing hematologic disorders on morbidity and mortality following heart transplantation: Focus on early graft dysfunction. Clin Transplant 2023; 37:e14974. [PMID: 36938656 DOI: 10.1111/ctr.14974] [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: 12/06/2022] [Revised: 02/14/2023] [Accepted: 03/08/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Heart transplantation (HT) is the gold standard therapy for advanced heart failure, providing excellent long-term outcomes. However, postoperative outcomes are limited by bleeding, infections, and primary graft dysfunction (PGD) that contribute to early mortality after HT. HT candidates with pre-existing hematologic disorders, bleeding, and clotting, may represent a higher risk population. We assessed the short- and long-term outcomes of patients with pre-existing hematologic disorders undergoing HT. METHODS AND RESULTS Medical records of all adult patients who received HT from January 2010 to December 2019 at our institution were retrospectively reviewed. Hematologic disorders were identified via chart review and adjudicated by a board-certified hematologist. Inverse probability weighting and multivariable models were used to adjust for potential pretransplant confounders. Four hundred and ninety HT recipients were included, of whom 29 (5.9%) had a hematologic disorder. Hematologic disorders were associated with severe PGD requiring mechanical circulatory support (aOR 3.15 [1.01-9.86]; p = .049), postoperative infections (aOR 2.93 [1.38-6.23]; p = .01), and 3-year acute cellular rejection (ACR) (≥1R/1B) (aSHR 2.06 [1.09-3.87]; p = .03). There was no difference in in-hospital mortality (aOR 1.23 [.20-7.58], p = .82) or 3-year mortality (aHR 1.58 [.49-5.12], p = .44). CONCLUSIONS Patients with hematologic disorders undergoing HT are at increased risk of severe PGD, postoperative infections, and ACR, while in-hospital and 3-year mortality remain unaffected.
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Affiliation(s)
- Matthew R Carey
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - Annamaria Ladanyi
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - Yonatan Mehlman
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca L Molinsky
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew Eisenberger
- Division of Hematology/Oncology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Kevin J Clerkin
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - Justin G Aaron
- Division of Infectious Diseases, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, NewYork-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
| | - Gabriel T Sayer
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
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Lanigan M, Siers D, Wilkey A, Barakat A, Shaffer A, John R, Knoper R, Huddleston S, Kaizer A, Perry TE. The use of a viscoelastic based transfusion algorithm significantly reduces non-red blood cell transfusion in patients undergoing left ventricular assist device placement or heart transplantation: A single-center observational study. J Cardiothorac Vasc Anesth 2022; 36:3038-3046. [DOI: 10.1053/j.jvca.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/10/2022] [Accepted: 03/17/2022] [Indexed: 11/11/2022]
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Hernandez GA, Lemor A, Clark D, Blumer V, Burstein D, Byrne R, Fowler R, Frischhertz B, Sandhaus E, Schlendorf K, Zalawadiya S, Lindenfeld J, Menachem JN. Heart transplantation and in‐hospital outcomes in adult congenital heart disease patients with Fontan: A decade nationwide analysis from 2004 to 2014. J Card Surg 2020; 35:603-608. [DOI: 10.1111/jocs.14430] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Gabriel A. Hernandez
- Cardiovascular Division, Department of MedicineUniversity of Mississippi Medical Center Jackson Mississippi
| | - Alejandro Lemor
- Cardiovascular Division, Department of MedicineHenry Ford Hospital Detroit Michigan
| | - Daniel Clark
- Cardiovascular Division, Department of MedicineVanderbilt University Medical Center Nashville Tennessee
| | - Vanessa Blumer
- Cardiovascular Division, Department of MedicineDuke University Durham North Carolina
| | - Danielle Burstein
- Cardiology DivisionChildren's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Ryan Byrne
- Department of MedicineVanderbilt University Medical Cente Nashville Tennessee
| | - Rachel Fowler
- Cardiovascular Division, Department of MedicineVanderbilt University Medical Center Nashville Tennessee
| | - Benjamin Frischhertz
- Cardiovascular Division, Department of MedicineVanderbilt University Medical Center Nashville Tennessee
| | - Emily Sandhaus
- Cardiovascular Division, Department of MedicineVanderbilt University Medical Center Nashville Tennessee
| | - Kelly Schlendorf
- Cardiovascular Division, Department of MedicineVanderbilt University Medical Center Nashville Tennessee
| | - Sandip Zalawadiya
- Cardiovascular Division, Department of MedicineVanderbilt University Medical Center Nashville Tennessee
| | - JoAnn Lindenfeld
- Cardiovascular Division, Department of MedicineVanderbilt University Medical Center Nashville Tennessee
| | - Jonathan N. Menachem
- Cardiovascular Division, Department of MedicineVanderbilt University Medical Center Nashville Tennessee
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Association of Cardiac Rehabilitation With Decreased Hospitalizations and Mortality After Ventricular Assist Device Implantation. JACC-HEART FAILURE 2019; 6:130-139. [PMID: 29413368 DOI: 10.1016/j.jchf.2017.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/10/2017] [Accepted: 11/03/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study characterized cardiac rehabilitation (CR) use in ventricular assist device (VAD) recipients in the United States and the association of CR with 1-year hospitalization and mortality by using the 2013 to 2015 Medicare files. BACKGROUND Exercise-based CR is indicated in patients with heart failure with reduced ejection fraction, but no data exist regarding CR participation after VAD implantation. METHODS The study included Medicare beneficiaries enrolled for disability or age >65 years. The investigators identified VAD recipients by diagnosis codes and cumulated CR sessions occurring within 1 year after VAD implantation. Multivariable-adjusted Andersen-Gill models were used to evaluate the association of CR with 1-year hospitalization risk, and Cox regression was used to evaluate the association of CR with 1-year mortality. RESULTS There were 1,164 VADs implanted in Medicare beneficiaries in the United States in 2014. CR use was low, with 348 patients (30%) participating in CR programs. The Midwest had the highest proportion of VAD recipients who began CR (38%), whereas the Northeast had the lowest proportion of CR participants (25%). Each 5-year increase in age was associated with attending an additional 1.6 CR sessions (95% confidence interval [CI]: 0.7 to 2.5; p < 0.001). CR participation was associated with a 23% lower 1-year hospitalization risk (95% CI: 11% to 33%; p < 0.001) and a 47% lower 1-year mortality risk (95% CI: 18% to 66%; p < 0.01) after multivariable adjustment. CONCLUSIONS Approximately one-third of VAD recipients attend CR. Although it is not possible to account fully for unmeasured confounding, VAD recipients who participate in CR appear to have lower risks for hospitalization and mortality.
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Suda KJ, Calip GS, Zhou J, Rowan S, Gross AE, Hershow RC, Perez RI, McGregor JC, Evans CT. Assessment of the Appropriateness of Antibiotic Prescriptions for Infection Prophylaxis Before Dental Procedures, 2011 to 2015. JAMA Netw Open 2019; 2:e193909. [PMID: 31150071 PMCID: PMC6547109 DOI: 10.1001/jamanetworkopen.2019.3909] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/27/2019] [Indexed: 12/12/2022] Open
Abstract
Importance Antibiotics are recommended before certain dental procedures in patients with select comorbidities to prevent serious distant site infections. Objective To assess the appropriateness of antibiotic prophylaxis before dental procedures using Truven, a national integrated health claims database. Design, Setting, and Participants Retrospective cohort study. Dental visits from 2011 to 2015 were linked to medical and prescription claims from 2009 to 2015. The dates of analysis were August 2018 to January 2019. Participants were US patients with commercial dental insurance without a hospitalization or extraoral infection 14 days before antibiotic prophylaxis (defined as a prescription with ≤2 days' supply dispensed within 7 days before a dental visit). Exposures Presence or absence of cardiac diagnoses and dental procedures that manipulated the gingiva or tooth periapex. Main Outcomes and Measures Appropriate antibiotic prophylaxis was defined as a prescription dispensed before a dental visit with a procedure that manipulated the gingiva or tooth periapex in patients with an appropriate cardiac diagnosis. To assess associations between patient or dental visit characteristics and appropriate antibiotic prophylaxis, multivariable logistic regression was used. A priori hypothesis tests were performed with an α level of .05. Results From 2011 to 2015, antibiotic prophylaxis was prescribed for 168 420 dental visits for 91 438 patients (median age, 63 years; interquartile range, 55-72 years; 57.2% female). Overall, these 168 420 dental visits were associated with 287 029 dental procedure codes (range, 1-14 per visit). Most dental visits were classified as diagnostic (70.2%) and/or preventive (58.8%). In 90.7% of dental visits, a procedure was performed that would necessitate antibiotic prophylaxis in high-risk cardiac patients. Prevalent comorbidities include prosthetic joint devices (42.5%) and cardiac conditions at the highest risk of adverse outcome from infective endocarditis (20.9%). Per guidelines, 80.9% of antibiotic prophylaxis prescriptions before dental visits were unnecessary. Clindamycin was more likely to be unnecessary relative to amoxicillin (odds ratio [OR], 1.10; 95% CI, 1.05-1.15). Prosthetic joint devices (OR, 2.31; 95% CI, 2.22-2.41), tooth implant procedures (OR, 1.66; 95% CI, 1.45-1.89), female sex (OR, 1.21; 95% CI, 1.17-1.25), and visits occurring in the western United States (OR, 1.15; 95% CI, 1.06-1.25) were associated with unnecessary antibiotic prophylaxis. Conclusion and Relevance More than 80% of antibiotics prescribed for infection prophylaxis before dental visits were unnecessary. Implementation of antimicrobial stewardship in dental practices is an opportunity to improve antibiotic prescribing for infection prophylaxis.
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Affiliation(s)
- Katie J. Suda
- College of Pharmacy, University of Illinois at Chicago
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois
| | | | - Jifang Zhou
- College of Pharmacy, University of Illinois at Chicago
| | - Susan Rowan
- College of Dentistry, University of Illinois at Chicago
| | - Alan E. Gross
- College of Pharmacy, University of Illinois at Chicago
| | - Ronald C. Hershow
- School of Public Health, University of Illinois at Chicago
- College of Medicine, University of Illinois at Chicago
| | - Rose I. Perez
- College of Medicine, University of Illinois at Chicago
| | - Jessina C. McGregor
- Oregon State University, Corvallis
- College of Pharmacy, Oregon Health and Science University, Portland
| | - Charlesnika T. Evans
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Bachmann JM, Shah AS, Duncan MS, Greevy RA, Graves AJ, Ni S, Ooi HH, Wang TJ, Thomas RJ, Whooley MA, Freiberg MS. Cardiac rehabilitation and readmissions after heart transplantation. J Heart Lung Transplant 2018; 37:467-476. [PMID: 28619383 PMCID: PMC5947994 DOI: 10.1016/j.healun.2017.05.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/27/2017] [Accepted: 05/17/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Exercise-based cardiac rehabilitation (CR) is under-utilized. CR is indicated after heart transplantation, but there are no data regarding CR participation in transplant recipients. We characterized current CR utilization among heart transplant recipients in the United States and the association of CR with 1-year readmissions using the 2013-2014 Medicare files. METHODS The study population included Medicare beneficiaries enrolled due to disability (patients on the transplant list are eligible for disability benefits under Medicare regulations) or age ≥65 years. We identified heart transplant patients by diagnosis codes and cumulative CR sessions occurring within 1 year after the transplant hospitalization. RESULTS There were 2,531 heart transplant patients in the USA in 2013, of whom 595 (24%) received Medicare coverage and were included in the study. CR utilization was low, with 326 patients (55%) participating in CR programs. The Midwest had the highest proportion of transplant recipients initiating CR (68%, p = 0.001). Patients initiating CR attended a mean of 26.7 (standard deviation 13.3) sessions, less than the generally prescribed program of 36 sessions. Transplant recipients age 35 to 49 years were less likely to initiate CR (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.23 to 0.66, p < 0.001) and attended 8.2 fewer sessions (95% CI 3.5 to 12.9, p < 0.001) than patients age ≥65 years. CR participation was associated with a 29% lower 1-year readmission risk (95% CI 13% to 42%, p = 0.001). CONCLUSIONS Only half of cardiac transplant recipients participate in CR, and those who do have a lower 1-year readmission risk. These data invite further study on barriers to CR in this population.
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Affiliation(s)
- Justin M Bachmann
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Ashish S Shah
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Meredith S Duncan
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy J Graves
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shenghua Ni
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Henry H Ooi
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas J Wang
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Randal J Thomas
- Department of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota, USA
| | - Mary A Whooley
- Measurement Science Quality Enhancement Research Initiative, Department of Veterans Affairs, San Francisco, California, USA
| | - Matthew S Freiberg
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Mumtaz K, Patel N, Modi RM, Patel V, Hinton A, Hanje J, Black SM, Krishna S. Trends and outcomes of transarterial chemoembolization in hepatocellular carcinoma: a national survey. Hepatobiliary Pancreat Dis Int 2017; 16:624-630. [PMID: 29291782 DOI: 10.1016/s1499-3872(17)60077-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/25/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is a palliative procedure frequently used in patients with advanced hepatocellular carcinoma (HCC). We examined the national inpatient trends of TACE and related outcomes in the United States over the last decade. METHODS We utilized the National Inpatient Sample (2002 to 2012) and performed trend analyses of TACE for HCC in all adult patients (age >18 years). Multivariate analyses for the outcomes of in-hospital "procedure-related complications" (PRCs) and "post-procedure complications" (PPCs) were performed. We also compared early (2002 to 2006) and late (2007 to 2012) eras by multivariate analyses to identify predictors of complications, healthcare resource utilization and mortality. RESULTS Overall, 19058 patients underwent TACE for HCC where PRCs and PPCs were seen in 24.2% and 17.6% of patients, respectively. The overall trends in the use of TACE (P<0.001) and associated PRCs (P=0.006) were observed to be increasing. There was less mortality [adjusted Odds ratio (aOR): 0.58; 95% CI: 0.41, 0.82], reduced length of hospital stay (-1.87 days; 95% CI: -2.77, -0.97) and increased hospital charges ($19232; 95% CI: 11013, 27451) in the late era. Additionally, there was increased mortality (aOR: 4.07; 95% CI: 2.96, 5.59), PRCs (aOR: 3.21; 95% CI: 2.56, 4.02), and PPCs (aOR: 2.70; 95% CI: 2.11, 3.46) among patients with coagulopathy. CONCLUSIONS There is an increasing trend of TACE utilization in HCC. However, the outcomes are worse in patients with coagulopathy. Although PRCs have increased, mortality has decreased in recent years. These findings should be considered during TACE evaluation in patients with HCC.
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Affiliation(s)
- Khalid Mumtaz
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Nishi Patel
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rohan M Modi
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vihang Patel
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - James Hanje
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sylvester M Black
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Somashaker Krishna
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Murthy SB, Shastri A, Merkler AE, Hanley DF, Ziai WC, Fink ME, Iadecola C, Kamel H, Navi BB. Intracerebral Hemorrhage Outcomes in Patients with Systemic Cancer. J Stroke Cerebrovasc Dis 2016; 25:2918-2924. [PMID: 27569708 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/05/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Single-center studies suggest that patients with cancer have similar outcomes after intracerebral hemorrhage (ICH) compared to patients without cancer. However, these studies were limited by small sample sizes and high rates of intratumoral hemorrhage. Our hypothesis was that systemic cancer patients without brain involvement fare worse after ICH than patients without cancer. METHODS We identified all patients diagnosed with spontaneous ICH from 2002 to 2011 in the Nationwide Inpatient Sample. Our predictor variable was systemic cancer. Our primary outcome was discharge disposition, dichotomized into favorable discharge (home/self-care or rehabilitation) or unfavorable discharge (nursing facility, hospice, or death). We used logistic regression to compare outcomes and performed secondary analyses by cancer subtype (i.e., nonmetastatic solid tumors, nonmetastatic hematologic tumors, and metastatic solid or hematologic tumors). RESULTS Among 597,046 identified ICH patients, 22,394 (3.8%) had systemic cancer. Stroke risk factors such as hypertension and diabetes were more common in patients without cancer, whereas anticoagulant use and higher Charlson comorbidity scores were more common among cancer patients. In multivariate logistic regression analysis adjusted for demographics, comorbidities, and hospital-level characteristics, patients with cancer had higher odds of death (OR 1.62, 95% CI 1.56-1.69) and lower odds of favorable discharge (OR .59, 95% CI .56-.63) than patients without cancer. Among cancer groups, patients with nonmetastatic hematologic tumors and those with metastatic disease fared the worst. CONCLUSIONS Patients with systemic cancer have higher mortality and less favorable discharge outcomes after ICH than patients without cancer. Cancer subtype may influence outcomes after ICH.
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Affiliation(s)
- Santosh B Murthy
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.
| | - Aditi Shastri
- Department of Hematology and Medical Oncology, Albert Einstein College of Medicine, Bronx, New York
| | | | - Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wendy C Ziai
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E Fink
- Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Costantino Iadecola
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
| | - Babak B Navi
- Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
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