Background and Objectives: With the growing recreational cannabis use and recent reports linking it to hypertension, we sought to determine the risk of hypertensive crisis (HC) hospitalizations and major adverse cardiac and cerebrovascular events (MACCE) in young adults with cannabis use disorder (CUD+). Material and Methods: Young adult hospitalizations (18–44 years) with HC and CUD+ were identified from National Inpatient Sample (October 2015–December 2017). Primary outcomes included prevalence and odds of HC with CUD. Co-primary (in-hospital MACCE) and secondary outcomes (resource utilization) were compared between propensity-matched CUD+ and CUD- cohorts in HC admissions. Results: Young CUD+ had higher prevalence of HC (0.7%, n = 4675) than CUD- (0.5%, n = 92,755), with higher odds when adjusted for patient/hospital-characteristics, comorbidities, alcohol and tobacco use disorder, cocaine and stimulant use (aOR 1.15, 95%CI:1.06–1.24, p = 0.001). CUD+ had significantly increased adjusted odds of HC (for sociodemographic, hospital-level characteristics, comorbidities, tobacco use disorder, and alcohol abuse) (aOR 1.17, 95%CI:1.01–1.36, p = 0.034) among young with benign hypertension, but failed to reach significance when additionally adjusted for cocaine/stimulant use (aOR 1.12, p = 0.154). Propensity-matched CUD+ cohort (n = 4440, median age 36 years, 64.2% male, 64.4% blacks) showed higher rates of substance abuse, depression, psychosis, previous myocardial infarction, valvular heart disease, chronic pulmonary disease, pulmonary circulation disease, and liver disease. CUD+ had higher odds of all-cause mortality (aOR 5.74, 95%CI:2.55–12.91, p < 0.001), arrhythmia (aOR 1.73, 95%CI:1.38–2.17, p < 0.001) and stroke (aOR 1.46, 95%CI:1.02–2.10, p = 0.040). CUD+ cohort had fewer routine discharges with comparable in-hospital stay and cost. Conclusions: Young CUD+ cohort had higher rate and odds of HC admissions than CUD-, with prevalent disparities and higher subsequent risk of all-cause mortality, arrhythmia and stroke.
Introduction: Data on the burden of congestive heart failure (CHF) in aspiration pneumonia (AP) patients is sparse. Our aim is to study the burden, morbidity and outcomes of CHF on AP patients. Methods: We queried the National Inpatient Sample (2015 October-2017) to identify admissions for AP in patients with CHF vs without CHF using relevant ICD-codes. Primary outcomes reported were all-cause mortality and pulmonary morbidity. Secondary outcomes included patient disposition, LOS and utilization of hospital resources. Results: We included 14,38,034 aspiration pneumonia (AP) hospitalizations amongst which 3,33,975 had associated CHF (23.2%). AP-CHF cohort often included older (79 [68-87]), white (74.8% vs 72.6%), male (54.7% vs 45.3%) patients admitted non-electively with Medicare insurance at Urban teaching facilities compared to AP only cohort (p<0.001) (Table 1) . AP-CHF cohort was more often associated with valvular disease, pulmonary circulation disease, peripheral vascular disease, chronic pulmonary disease, hypertension (secondary/complicated), diabetes mellitus, hyperlipidemia and obesity compared to AP-only cohort. AP-CHF cohort had lower rates of alcohol abuse, drug abuse and smoking. AP- CHF cohort had higher adjusted odds of all-cause mortality (aOR 1.14 95% CI 1.13-1.15, p<0.001), ARDS (aOR 2.27), respiratory failure (aOR 1.77), severe sepsis with septic shock (aOR 1.34) and requirement of respiratory support (aOR 1.40) compared to AP only cohort. AP-CHF cohort was more often discharged to short-term or intermediate facility and had longer stay with higher hospital charges compared to AP only cohort. Conclusion: Based on our analysis it can be concluded that nearly one-fourth of AP hospitalizations have concomitant CHF and that is associated with higher morbidity, mortality and complications ultimately leading to higher hospital resource utilization.
Aim of the study: Biliary complications are the leading causes of morbidity and mortality after liver transplant (LT). However, national data on endoscopic retrograde cholangiopancreatography (ERCP) usage and outcomes in LT patients are lacking. Our study aims to identify the trends, outcomes, and predictors of ERCP and related complications in this patient subgroup. Material and methods: We derived our study cohort from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) between 2007 and 2017. LT patients were identified using ICD-9/10-CM diagnosis codes and patients who underwent ERCP were identified by ICD-9/10-CM procedure codes. We utilized the Cochrane-Armitage trend test and multivariate logistic regression to analyze temporal trends, outcomes, and predictors. Results: A total of 372,814 hospitalizations occurred in LT patients between 2007 and 2017. ERCP was performed in 2.05% (n = 7632) of all hospitalizations. There was a rise in ERCP procedures from 1.96% (n = 477) in 2007 to 2.05% (n = 845) in 2017. Among LT patients who underwent ERCP, the in-hospital mortality rate was 1% (n = 73) and 8% (n = 607) were discharged to facilities. Mean length of hospital stay was 7 ±0.3 days. Septicemia was the most common periprocedural complication (18.3%, n = 1399) followed by post-ERCP pancreatitis (8.8%, n = 674). Conclusions: There has been an increase in ERCP procedures over the past decade among LT patients. Our study highlights the periprocedural complications and outcomes of ERCP in LT patients from a nationally representative dataset.
Sepsis-induced cardiomyopathy has been increasingly recognized; however, the prevalence and impact of sepsis in peripartum cardiomyopathy (PPCM) patients need further exploration. We aimed to assess the burden and outcomes of PPCMrelated hospitalization with vs. without sepsis in this population-based study in the United States. METHODS:We queried the National Inpatient Sample (2015October-2017) to access PPCM with vs. without sepsis using relevant ICD-10 codes. We compared baseline demographics and comorbidities between the groups (sepsisþ vs. sepsis-). The primary outcomes included all-cause mortality, cardiac arrest including ventricular tachyarrhythmias, cardiogenic shock, respiratory failure, mechanical ventilation/respiratory intubation, and secondary outcomes included patient disposition, length of stay, and hospital charges. A two-tailed p-value<0.05 was considered for statistical significance.RESULTS: Of the 10,275 PPCM admissions, 460 were related to sepsis (0.04%). The PPCM-sepsisþ cohort often consisted of younger (30 [24-36]), white (47.1% vs 39%, p<0.001) patients admitted non-electively (90.2% vs 87.7%, p¼0.109) compared to the PPCM-sepsis-cohort. The PPCM-sepsisþ cohort more frequently comprised of Medicaid enrollees (52.2% vs 51.9%, p<0.001), patients in middle income quartile (27.2% vs 26.0%, p¼0.007), admissions to large bedsized hospitals (64.1% vs 62%, p¼0.588) compared to PPCM-sepsis -cohort. The PPCM-sepsisþ cohort was often associated with congestive heart failure (55.4% vs 48.2%, p¼0.003), coagulopathy (10.9% vs 6.4%, p<0.001), chronic kidney disease (15.2% vs 5.9%, p<0.001), anemias (27.2% vs 20.8%, p<0.001), pulmonary circulation disorder (3.3% vs 1.7%, p¼0.012), and psychoses (4.3% vs 1.9%, p<0.001) compared to PPCM-sepsis-cohort. PPCM-sepsisþ cohort showed lower frequency of hypertension (40.2% vs 59.9%, p<0.001), obesity (16.3% vs 26.3%, p<0.001), chronic pulmonary disease (8.7% vs 14.9%, p<0.001) and valvular heart disease (7.6% vs 13.0%, p<0.001) compared to sepsis-cohort. The PPCM-sepsisþ cohort had significantly higher frequency and odds of all-cause mortality (7.6% vs 1.2%, aOR 7.59, 95% CI 4.35-13.23; p<0.001) along with higher rates of cardiac arrest (5.4% vs 3.0%, p0.003), cardiogenic shock (8.7% vs 5.2%, p<0.001), respiratory failure (56.5% vs 19.8%, p<0.001), mechanical ventilation/respiratory intubation (28.3% vs 10.9%, p<0.001) compared to the PPCM-sepsis-cohort. The PPCM-sepsisþ cohort were less often discharged routinely (63.0% vs. 81.5%, p<0.001), experienced prolonged hospital stay (5 vs 3 days) and higher hospital charges (60,752$ vs 30,554$) as compared to PPCM-sepsis-cohort (p<0.001). CONCLUSIONS:The frequency of sepsis in PPCM-related admissions remains low. However, concomitant sepsis predicted nearly seven times higher all-cause mortality and alarmingly higher rates of cardiopulmonary complications in PPCM. Preventive screening measures and timely management of sepsis in PPCM could prevent worse outcomes.CLINICAL IMPLICATIONS: Sepsis in PPCM patients leads to si...
Background: Cannabis use disorder (CUD) is more prevalent in the young population and cannabis use has been linked to an increased risk of first-time stroke or transient ischemic attack (TIA). Prevalence and risk of recurrent stroke in patients with prior stroke/TIA in cannabis users are not clearly established. Methods: Using weighted data from the National Inpatient Sample (2015 October-2017 December) and pertinent ICD-10 codes, we identified hospitalizations among young (18-44 years) patients with prior history of stroke/TIA grouped into those with CUD+ and those without (CUD-). We compared the frequency (with disparities based on gender, race, hospital region and median household income) and odds of subsequent/recurrent stroke in young adults (18-44 years) with vs without cannabis use (CUD+ vs. CUD-) and prior history of stroke/TIA. Results: Young adult hospitalizations with prior stroke/TIA were 4690 in the CUD+ arm, and 156700 in CUD- arm (median age 37 years in both cohorts). The CUD+ cohort often consisted of males (55.2% vs. 40.2%), African Americans (44.6% vs. 37.2%), and patients with higher rates of concomitant substance abuse, COPD, depression and psychoses, and a lower rate of cardiovascular comorbidities compared to the CUD- cohort (p<0.001) [Table 1a]. The CUD+ arm had considerably higher rate (6.9 vs 5.4%) [Table 1b] and adjusted odds (aOR 1.48, 95 CI 1.28-1.71, p<0.001) of recurrent stroke than CUD- arm [Table 1c] . On subgroup comparison, admission among male (7.7% vs. 5.9%), white (6.6% vs. 5.1%), African American (8.0% vs. 5.2%), and admissions in low household income quartile (7.7% vs. 5.5%) patients, Northeast (6.1% vs. 4.4%) and Southern (7.6% vs. 5.7%) region hospitals showed higher rates of recurrent stroke with CUD+ vs. CUD- (p<0.05). Conclusion: The frequency and risk (~50% higher) of recurrent stroke were found to be significantly increased with disparities in subgroups among young adults with prior history of stroke/TIA and concomitant CUD.
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