Key Clinical MessageAlthough cryoglobulinemia is a well‐appreciated complication of hepatitis C (HC), myopericarditis with resulting pericardial effusion is extremely rare, especially in the absence of a liver transplant. In patients with HC, pericardial effusion with impending tamponade can be a florid and potentially life‐threatening manifestation of multiorgan cryoglobulinemic disease.
Introduction Type 2 myocardial infarction (T2MI) is an ischemic myocardial injury in the context of oxygen supply/demand mismatch in the absence of a primary coronary event. T2MI is often diagnosed in patients with a higher risk of morbidity and mortality. T2MI in young adults is poorly understood due to limited available data. Methods The Nationwide Readmission Database 2017-2018 was queried for admission with T2MI diagnosis in young adults (age ≤ 45 years). Index admissions with T2MI were identified. Other types of myocardial infarction and observations with missing data were excluded. December admissions were excluded to allow the 30-day follow-up. Cox proportional hazard multivariate regression model was used to determine predictors of readmissions. All P-values were two-sided, with 0.05 as the threshold for statistical significance. Results A total of 11,750 patients with a secondary diagnosis of T2MI were admitted between October 2017 and November 2018. The main primary etiologies of index admission were sepsis (14%) followed by hypertensive heart disease with heart failure (11%) and hypertensive emergency (7%), while main etiologies of readmission were hypertensive heart disease with heart failure (12%) followed by sepsis (9%) and acute kidney injury (3%). Valvular heart disease, chronic pulmonary disease, drug abuse, and depression were amongst the predictors of all-cause readmission. Conclusion We identified primary etiologies of admission and readmission, and predictors of readmissions in young adults presenting with T2MI. Further studies are needed to guide the management of T2MI in this age group.
Background: Short term outcomes of patients hospitalized with hypertension urgency defined as sudden elevation of Blood pressure above 180 systolic or 110 diastolic is poorly studied in literature. Uncontrolled Hypertension is a major risk factor of stroke. Sex differences exist in stroke presentation and risk factors. Objective: To evaluate the sex specific predictors of short term (90-day) readmission with stroke in patients hospitalized with hypertension urgency. Methods: The study is a retrospective analysis of National Readmission Database (NRD) of years 2016-2018. Adult patients admitted with a primary diagnosis of hypertension urgency were included. Patients were excluded if they had stroke or transient ischemic attack (TIA) in index admission. October to December admissions were excluded to allow for 90 day follow up. Univariate logistic regression was performed on each variable. Variables with a p value >0.2 were included in multivariate logistic regression model (figure1). Results: A total of 104813 patients (58% female) included in our cohort of whom 1057 (1%) were readmitted with ischemic stroke or TIA within 90 days. Mean age of stroke readmissions was higher in female (68±16 vs 61±14 years, p<0.001). Diabetes Mellitus was an independent predictor of stroke readmission in both sexes. Independent predictors specific to females were peripheral vascular disorders (aOR:1.60 95% CI[1.13-2.28], P=0.008) and Hypothyroidism (aOR: 1.38, 95% CI[1.02-1.85], P=0.035). Independent predictor specific to males was age (aOR: 1.016, 95% CI [1.005-1.027], P=0.005). Paradoxically, prior CABG was associated with decreased risk of stroke readmission in females (aOR: 0.39. 95% CI[0.20-078], P=0.007) but not in males (P=0.229). Conclusion: We identified several sex specific predictors of 90-day readmission with stroke in patients admitted with hypertensive crisis. Knowledge of these predictors would help identify patients at risk and improve quality of care.
Background: Type 2 myocardial infarction (T2MI) is an ischemic myocardial injury in the context of oxygen supply/demand mismatch in the absence of a primary coronary event. Chronic myocardial injury was linked to increased risk of stroke in the long term follow up. However, association between T2MI and stroke in short term follow up is unclear due to limited available data. Objective: To study the impact T2MI on 90-day readmission with ischemic stroke or transient ischemic attack (TIA) in elderly hospitalized patients. Methods: The study is a retrospective analysis of national readmission database (NRD) of year 2018 for patients ≥ 65 years. Patients were excluded if they had stroke, myocardial infarction other than T2MI or prior stroke in index admission. Patients admitted between October and December to allow 90 days follow up. International classification of disease, tenth edition (ICD 10-CM) was used to identify diagnoses. Multivariate logistic regression model was used to calculate adjusted odds ratio (aOR) and adjust for potential confounders (figure 1). Results: A total of 6,643,620 patients were admitted in 2018 that met our criteria. T2MI was present in 88,282 (1.3%) index admissions. A total of 1,549,951 patients were readmitted to the hospital within 90 days of whom 36,981 (2%) patients were diagnosed with stroke or TIA. Patients readmitted with stroke were more likely to be female (56% vs 55%, P=0.005), had complicated hypertension (46% vs 35%, P<0.001), complicated diabetes mellitus (28% vs. 20%, P<0.001), and congestive heart failure (35% vs 26%, P<0.001). T2MI was associated with increased risk of 90-day stroke readmission (aOR: 1.21, 95%CI [1.09-1.35], P<0.001). Conclusion: In our large retrospective study, T2MI was found to be an independent predictor of 90-day readmission with stroke or TIA in hospitalized elderly patients. Further studies are warranted to identify optimum strategy of risk stratification and management of such patient.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.