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Introduction This study described patients hospitalized for acute heart failure (AHF) in Japan who received intravenous (IV) diuretics and/or vasodilators as the initial therapy. Methods The Japan Medical Data Vision database was used to identify adult patients hospitalized for AHF during 2013–2017, who were hemodynamically stable at presentation and treated with IV diuretics and/or IV vasodilators as initial therapy. Treatment patterns and use of cardiac rehabilitation, as well as outcomes (e.g., length of stay [LOS], in-hospital mortality, HF-readmission) were reported overall and by year of AHF hospitalization. Results Of 30,360 patients (mean age = 80.0 years; 52.2% male), 87.0% were treated during the hospitalization with IV diuretics, 63.9% with IV vasodilators, and 13.8% with intensified therapies. On average, the duration of IV therapy was 10.6 days. In-hospital cardiac rehabilitation was utilized by 51.7% of the patients for 11.7 days on average. Mean LOS was 23.3 days, while in-hospital mortality and 30-day HF readmission post-discharge were 13.2 and 9.5%, respectively. Hospitalization outcomes remained stable between 2013 and 2017 despite important changes in AHF management such as a decrease in carperitide use (55.9–40.0% in 2017), and increases in use of tolvaptan (from 14.2% in 2013 to 31.3% in 2017) and of cardiac rehabilitation (from 43.2% in 2013 to 56.1% in 2017). Patients with intensified therapies had the longest IV therapy duration (mean 23.8 days vs. 5.5–9.9 days), the highest cardiac rehabilitation services use (60.2 vs. 38.3–57.0%), the longest LOS (mean 36.7 vs. 16.3–22.2 days), and the highest in-hospital mortality (37.4 vs. 3.1–12.4%) compared to the other treatment groups. Conclusions Contemporary treatment for AHF hospitalization in Japan comprises a long duration of IV therapy followed by extended use of oral medications and in-hospital cardiac rehabilitation prior to discharge. Patients requiring intensified therapies had much longer LOS and higher in-hospital mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s40119-021-00212-y.

Objectives The correlates of manic episodes in dementia have not been systematically studied. The primary goal of our study is to compare the sociodemographic characteristics and psychiatric comorbidities in Alzheimer’s dementia (AD) inpatients with manic episodes versus without manic episodes, and to evaluate the demographic predictors and risk factors for manic episodes in AD inpatients. Methods We conducted a case-control study using the Nationwide Inpatient Sample of 34,285 AD patients (age ≥60 years). Subsequently, the cases i.e., AD inpatients with a manic episode (N = 1,035) and the controls (without a manic episode, N = 1,035), were extracted using propensity-score matching based on age. The cases did not have a past psychiatric history of bipolar disorders. We used the logistic regression model to evaluate the odds ratio (OR) of association between pre-existing psychiatric comorbidities and manic episodes and evaluate the demographic predictors of manic episodes in AD inpatients. Results A higher proportion of AD inpatients with manic episodes were females (63.8%), whites (85.2%), and from low-income families below the 50th percentile (63%). Females were more likely to be hospitalized for manic episodes (OR 1.33; 95% CI 1.09-1.64) than males. AD inpatients with manic episodes had a higher risk of presenting with suicidal behaviors (OR 1.88; 95% CI 1.23-2.86). A significantly higher proportion of AD inpatients with manic episodes had comorbid tobacco use (5.3% vs. 3.4%) and cannabis use (1.4% vs. 0%) compared to those without manic episodes. Conclusion Females with AD had a greater risk of being hospitalized for manic episodes. These patients have an 88% higher risk of suicidal behaviors during the manic presentation and have comorbid tobacco and cannabis use. Early diagnosis and management of manic episodes in at-risk AD patients are important to improve the quality of life (QoL) and outcomes.

Objectives To understand the demographic pattern of substance use disorders (SUD) in Parkinson’s disease (PD) inpatients and to evaluate the impact of SUD on hospitalization outcomes including the severity of illness, length of stay (LOS), total charges, and disposition to nursing facilities. Methods We used the nationwide inpatient sample and identified adult patients (age, ≥40 years) with PD as a primary diagnosis and comorbid SUD (N = 959) and grouped by co-diagnosis of alcohol (N = 789), cannabis (N = 46), opioid (N = 30), stimulants (N = 54) and barbiturate (N = 40) use disorders. We used a binomial logistic regression model to evaluate the odds ratio (OR) for major loss of functioning and disposition to nursing facilities in PD inpatients. All regression models were adjusted for demographics, including age, sex, race, and median household income. Results Alcohol, opioid, and stimulant use disorders were prevalent in old-age adults (60-79 years), males, and whites, but cannabis use was prevalent in middle-aged adults (40-59 years), and barbiturate use among older-age (>80 years). The severity of illness is statistically higher in PD inpatients with comorbid opioid and barbiturate use disorders with major loss of body functioning, closely seconded by alcohol and stimulant use disorder cohorts (27.6% and 25.9%, respectively). Disease severity and loss of body functioning increase with advancing age (>80 years adults, OR 5.8, 95%CI 5.32-6.37), and in blacks (OR 1.7, 95%CI 1.56-1.81), and those with opioid use disorder (OR 3.8, 95%CI 1.96-7.35). PD inpatients with barbiturate use disorder had a higher LOS and charges by 17.4 days and $68,922, and six-fold increased likelihood (95%CI 2.33-15.67) for disposition to nursing facilities. Conclusions SUD is prevalent among PD patients and is associated with more severe illnesses with body loss functioning and prolonged care. A multidisciplinary care model including collaborative neuropsychiatric and addiction management is required to manage SUD among PD patients to lessen disease severity, slow down the disease progression and potentially save medical costs.

Category: Infection Introduction/Purpose: Although intravenous drug use (IDU) is a known risk factor for septic arthritis of the foot and ankle (F&A), little is known about its influence on hospitalization outcomes. This study evaluated differences in demographic characteristics and hospitalization outcomes of septic arthritis of the F&A according to IDU status. Methods: Using the Nationwide Inpatient Sample for the years 2000 to 2013, we identified all patients aged 15-64 with a principal discharge diagnosis of septic arthritis of the F&A. Applying previously published algorithms, septic arthritis of the F&A was classified as related or unrelated to IDU. We assessed differences in demographic characteristics and in-hospital outcomes including length of hospital stay (LOS), leaving against medical advice (AMA), hospital charges, and presence or absence of surgical intervention. Results: Of the 14,198 hospitalizations, 11% were associated with IDU. Patients with IDU were more likely to be younger, black, and have Medicaid or no insurance coverage. Patients with IDU were more likely to leave AMA (9.7% vs 1.4%, pConclusion: IDU-related septic arthritis of the foot and ankle is associated with suboptimal hospitalization outcomes and greater resource use. Given the disparity in outcomes, there is potential to improve outcomes of septic arthritis of the foot and ankle in patients with IDU via enhanced physician communication skills among disenfranchised patient populations and proactively addressing substance abuse issues early during hospital admission.

Background and objectives: This study aimed to analyze and discern the differences in demographics and inpatient outcomes (length of stay (LOS), total charges, disease severity, and mortality) between depressed versus non-depressed sickle cell disease (SCD) patients. Materials and Methods: A retrospective analysis was conducted using the Nationwide Inpatient Sample (2010&ndash, 2014). We identified 73,225 SCD hospitalizations and comorbid depression (6317, 8.6%) as the primary and the other diagnosis, respectively, using International Classification of Diseases (ICD)-9 codes. We used linear and logistic regression model to evaluate the changes in inpatient outcomes. Results: Comorbid depression was more prevalent among middle-aged adults (11.5%), females (10.63%), and whites (12.43%). We did not find any association between income and comorbid depression among SCD patients. After adjusting for the demographic covariates, comorbid depression remained a significant risk factor for longer LOS (mean difference &minus, 1.16 days, 95% CI &minus, 1.30 to &minus, 1.03) and higher total charges (mean difference &minus, USD5058, 95% CI &minus, 6261 to &minus, 3855) during hospitalization. SCD with comorbid depression was also significantly associated with a higher number of chronic conditions (mean difference &minus, 2.08, 95% CI &minus, 2.13 to &minus, 2.03) and 1.5 times (95% CI 1.39 to 1.63) higher odds of major severity of illness. Conclusion: Comorbid depression was significantly associated with longer LOS, more severity of illness, and higher hospital charges. Healthcare providers caring for adults with SCD should consider screening for and treating comorbid depression to improve the health-related quality of life.

Introduction and aims. Serum electrolyte derangements are common in patients with decompensated cirrhosis hospitalized for hepatic encephalopathy. There are limited data describing the association between electrolyte levels and outcomes in hepatic encephalopathy. We assessed the association between initial serum electrolyte values and outcomes in patients with hepatic encephalopathy. Material and methods. A total of 385 consecutive patients hospitalized with encephalopathy were included in the study. Baseline electrolyte levels (sodium, potassium, chloride, bicarbonate, calcium and phosphorus) were measured at the time of admission and assessed for association with outcomes, which included survival, admission to the intensive care unit, requirement for mechanical ventilation, and length of hospital stay. P-values ≤ 0.0083 were considered significant after adjustment for multiple testing. Results. In unadjusted analysis, significant associations were identified regarding both bicarbonate and phosphorus (admission to intensive care unit), and calcium (mechanical ventilation); however these findings weakened and no longer approached statistical significance when adjusting for confounding variables. No other significant associations between serum electrolyte measurements and outcomes were observed. Conclusions. Our findings suggest that in patients hospitalized with encephalopathy, serum electrolyte measurements are not strong predictors of patient outcome.

Background: Diabetic ketoacidosis (DKA) is one of the commonly encountered diabetes mellitus emergencies. Aim: This study aimed at describing the clinical profiles and hospitalization outcomes of DKA patients at the University Teaching Hospital (UTH) in Lusaka, Zambia and to investigate the role of coma on mortality outcome. Materials and Methods: This was a cross-sectional analytical study of hospitalized DKA patients at UTH. The data collected included clinical presentation, precipitating factors, laboratory profiles, complications, and hospitalization outcomes. Primary outcome measured was all-cause in-hospital mortality. Results: The median age was 40 years. Treatment noncompliance was the single highest identified risk factor for development of DKA, followed by new detection of diabetes, then infections. Comatose patients were significantly younger, had lower baseline blood pressure readings, and higher baseline respiratory rates compared to noncomatose patients. In addition, comatose patients had higher baseline admission random blood glucose readings. Their baseline sodium and chloride levels were also higher. The prevalences of hypokalemia, hypernatremia, and hyperchloremia were also higher among comatose patients compared to noncomatose patients. Development of aspiration during admission with DKA, pneumonia at baseline, development of renal failure, and altered mental status were associated with an increased risk of mortality. Development of renal failure was independently predictive of mortality. Conclusion: The mortality rate from DKA hospitalizations is high at UTH. Treatment noncompliance is the single highest identifiable precipitant of DKA. Aspiration, development of renal failure, altered sensorium, and pneumonia at baseline are associated with an increased risk of mortality. Development of renal failure during admission is predictive of mortality.

Background Several studies have reported that diabetic persons have an increased risk for fractures than non-diabetes patients. The association between proximal humerus fractures and type 2 diabetes (T2DM) is unclear and some studies point to insulin treatment, hypoglycaemic episodes consequently to inadequate control of diabetes or, more recently, to an alteration of trabecular bone. We examined trends in the incidence of proximal humerus fractures, surgical procedures and outcomes among hospitalized patients aged ≥65 years, with and without T2DM in Spain, 2001–2013. Methods This retrospective, observational study was conducted using the Spanish National Hospital Discharge Database to select all hospital admissions with proximal humerus fracture. We calculated incidences overall and stratified by diabetes status, year and sex. We analyzed surgical procedures, comorbidities, length of stay, in-hospital complications and in-hospital mortality. Results We identified 43,872 patients with proximal humerus fracture (18.3% had a T2DM diagnosis). Age-adjusted incidence rates elevated steadily over the study period for men and women with and without T2DM, independently of diabetes status, although we found a stable trend in the later years. Patients with T2DM had lower relative risk of proximal humeral fracture incidence: 0.87 (95%IC 0.82–0.93) for men and 0.97 (95%IC 0.95–1.00) for women. In-hospital complications were 4.0% of diabetic men vs. 2.6% in non-diabetic (p

OBJECTIVE: To assess the prevalence of malnutrition according to the new ESPEN definition in a population of geriatric hospital patients and to determine how malnutrition affects the length of hospital stay (LOS) and hospital mortality. DESIGN: A retrospective analysis of data gathered during nutritional screening surveys carried out three consecutive years, from 2012 to 2014, in an Italian geriatric research hospital (INRCA, Ancona) was performed. On the day of the study, demographic data, data on clinical conditions and the nutritional status of newly admitted patients were collected. Patients were screened for malnutrition risk using the Malnutrition Universal Screening Tool (MUST). Subsequently, malnutrition was diagnosed, for subjects at high risk, following the criteria suggested by the European Association for Clinical Nutrition and Metabolism [body mass index (BMI) < 18.5 kg/m2 or different combinations of unintentional weight loss over time and BMI values]. Sensitivity, specificity, positive and negative predictive value of MUST compared to ESPEN criteria were assessed. The characteristics of patients with a diagnosis of malnutrition were compared to those of non-malnourished patients. The impact of malnutrition on LOS and hospital mortality was investigated through logistic and linear regression models. SETTING: The study was performed in an Italian geriatric research hospital (INRCA, Ancona). SUBJECTS: Two hundred eighty-four newly hospitalized geriatric patients from acute care wards (mean age 82.8 ± 8.7 years), who gave their written consent to participate in the study, were enrolled. RESULTS: According to the MUST, high risk of malnutrition at hospitalization was found in 28.2% of patients. Malnutrition was diagnosed in 24.6% of subjects. The malnutrition was an independent predictor of both the LOS and hospital mortality. The multivariate analyses—linear and logistic regression—were performed considering different potential confounders contemporarily. The results showed that the malnutrition is an independent predictor of LOS and hospital mortality. Malnourished subjects were hospitalized almost 3 days longer compared to non-malnourished patients (p = 0.047; CI 0.04–5.80). The risk of death during hospitalization was 55% higher for malnourished patients (p = 0.037; CI 0.21–0.95). CONCLUSION: A new ESPEN consensus of malnutrition was easily applicable in a population of geriatric hospital patients. Given that the nutritional status of geriatric patients was strongly correlated with the LOS and hospital mortality, the use of this simple and non-time consuming tool is highly recommended in clinical practice.