ALBERT

Beschreibung: Background: Portal vein thrombosis (PVT) is a common complication of liver cirrhosis but can also be seen in non-cirrhotic patients. In this context, we present a single institution experience of PVT in our patient population contrasting the difference of presentation between both groups of PVT. Methods: We retrospectively analyzed electronic medical records of patients with PVT (confirmed with radiographic criteria) from 2009 to 2018. We collected data regarding the demographics, characteristics of PVT, liver cirrhosis, presence of malignancy, treatment and laboratory investigations done at the time of diagnosis. Clinical endpoints of 90-death mortality, admission to intensive care unit and length of stay were also collected. Results: a total of 162 patients fulfilled inclusion criteria. 104 (64.2%) male patients, mean age of 56.4, predominantly African American patients 75 (46.3%). 81 (50.0%) patients had cirrhotic PVT and 85 (52.5%) had malignant PVT. Most patients presented with abdominal pain 102 (63%), with an acute onset 51 (31.5%). 111 (68.5%) patients were not treated with anticoagulation. 28 (17.3%) patients died within 90 days of diagnosis and 22 (13.6%) patients were admitted to intensive care unit during same admission. When comparing Malignant with non-malignant PVT, patients with malignancy had a higher death rate 22 (30.1%) vs 6 (8.8%), p value

Beschreibung: Introduction US Food and Drug Administration has recently approved the use of rivaroxaban 2.5mg BID in patients with coronary heart disease based on Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial. However, it's unclear whether there is net clinical benefit with use of rivaroxaban in such patients. Therefore, we did a systematic review and meta-analysis to evaluate the effects of rivaroxaban on clinical outcomes in coronary heart disease patients. Methods: Embase, Ovid, Pubmed and Scopus were extensively searched from inception of these databases to April 2019 by two independent reviewers. Only randomized controlled trials of low dose rivaroxaban (2.5 mg BID) reporting mortality and cardiovascular outcomes of interest in baseline coronary heart disease patients (≥ 18 years) with at least 1000 patients and follow-up of ≥ 1 year were included. The co-primary outcomes were cardiovascular mortality and all-cause mortality. The secondary endpoints were myocardial infarction (MI), stroke, major adverse cardiovascular events, major bleeding and cerebral nervous system (CNS) bleeding. Cochrane Collaboration's tool was used for risk of bias assessment. Statistical heterogeneity was quantified using I2 statistics whereas publication bias was assessed with Eggers regression test. We combined estimates using DerSimonian and Laird random effects models. Outcomes were reported as hazard ratios (HR) with 95% confidence intervals (CI). Results: Five randomized control trials including 39,979 patients were included in our meta-analysis. Trials ATLAS and Commander HF used placebo as their control while COMPASS and GEMINI ACS-1 used aspirin as control. Pioneer AF-PCI used vitamin K antagonist as the control. Mean age (SD) of the patients was 65.6 ± 3.7 years with 74.3% females. Mean follow up in years was 1.6 ±0.5. Majority of the patients in each trial had hypertension. Our pooled analysis showed reduction in all-cause mortality (HR, 0.85, 95% CI, 0.72-1.00, P=0.05), cardiovascular mortality (HR, 0.83, 95% CI, 0.70-1.00, P=0.05), MI (HR, 0.88, 95% CI, 0.78-1.00, P=0.05) and stroke (HR, 0.70, 95% CI, 0.53-0.94, P=0.02) with low dose rivaroxaban. No significant difference in risk of bleeding was observed (HR, 1.45, 95% CI, 0.83-2.51, P=0.19). Our pooled analysis also showed reduction in major cardiovascular events (HR, 0.91, 95% CI, 0.85-0.98, P=0.01). CNS bleeding was only reported by ATLAS and COMPASS trials and net effect showed no statistically significant bleeding risk (HR, 1.63, 95% CI, 0.70-3.79, P=0.26). Conclusion: Our data suggest that the use of rivaroxaban is associated with reduction in all-cause and cardiovascular mortality in coronary heart disease patients without significantly increasing the risk of bleeding. To further decrease the residual risk of cardiovascular events in coronary heart disease patients, low dose rivaroxaban can be considered by clinicians. Disclosures No relevant conflicts of interest to declare.

Beschreibung: Background: The median age of diagnosis in acute myeloid leukemia (AML) is 67 years and it is the second most common subtype of leukemia in the elderly, after CLL. Management of elderly leukemics has unique challenges related to disease characteristics and health status of host, leading to a disproportionate representation of this population in AML related deaths (〉75% of all AML related deaths on population analysis). A SEER analysis demonstrated that close to half of elderly patients diagnosed with AML do not receive any treatment, seemingly with a greater focus on palliative care. We aim to study in-hospital outcomes in elderly patients with AML when they receive aggressive inpatient medical care. Methods: This is a retrospective cohort analysis of NIS database (years 2005 to 2014) of patients with the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) diagnosis code for AML not in remission and aged ≥ 65 years. Aggressive inpatient care was defined as use of mechanical ventilation, vasopressors, hemodialysis (end stage renal disease excluded) or cardiopulmonary resuscitation. Inpatient encounter with Palliative service was identified using ICD-9-CM diagnosis codes. Our cohort of interest was elderly AML patients receiving aggressive inpatient care. Primary outcome was inpatient mortality within this cohort and factors associated with it were analyzed using multivariate logistic regression. Secondary outcome was proportion of admissions which had an inpatient encounter with palliative care within this cohort. Longitudinal analysis was conducted to determine trends in inpatient mortality and rates of encounter with palliative care over the study years. We used a linear (continuous outcome)/ logistic (binary) regression model with year as the independent variable for trend analysis. We also estimated the mean total charge of hospitalization on a yearly basis after adjusting for inflation. Statistical analysis was done using STATA. Results: A total of 230,074 elderly AML admissions were identified between the years 2005 and 2014. Aggressive inpatient care as defined above was utilized in 6.3% (n=14,606) of total admission. Mean age for those receiving aggressive inpatient care was 73.3 years, 61.5% were males and 76.2% Caucasian. The utilization of aggressive inpatient care in these patients remained stable over the years on longitudinal trend analysis after adjusting for patient and hospital factors. Amongst elderly AML patients receiving intensive care, 71.6% (n=10,461) died in the same admission. Also, inpatient mortality had no association with age, gender, race, Charlson Co-morbidity Index, mean income quartile for patient's zip-code, insurance type and hospital characteristics (teaching status, urban or rural location and hospital bed size). Proportion of elderly AML patients experiencing inpatient mortality over the years after adjusting for age, race, gender, mean income quartile for zip-code, Charlson comorbidity index and hospital characteristics are shown in the attached graph. Amongst elderly AML patients receiving aggressive inpatient care, the adjusted inpatient mortality improved from 77.27% in 2005 to 67.40% in 2014 (p for trend

Beschreibung: Background: Risk factors for Clostridium difficile infection (CDI) include antibiotic use, prolonged hospitalization, cancer chemotherapy, hematopoietic stem cell transplantation (HSCT) and gastric acid suppression, all of which, are encountered in acute leukemia patients. We sought to examine the impact of CDI on inpatient outcomes and resource utilization, as well as, to evaluate the trends of CDI in acute leukemia patients. Methods: The Nationwide Inpatient Sample (NIS) database was queried to include all adults with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), who were admitted between 2012 and 2017 for inpatient chemotherapy and/or hematopoietic stem cell transplant (HSCT). Those with and without CDI were compared. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Multivariable logistic regression was used to evaluate risk factors for CDI, as well as, inpatient mortality. Statistical tests for trends of resource utilization across six years were performed. Results: A total of 187,105 admissions met the inclusion criteria, of which, 5.3% had CDI. Mean age (51.3 years) and gender (male 56.4%) did not significantly differ between those with and without CDI. AML accounted for a larger proportion of the CDI group (72.4% vs 64.6%, p

Beschreibung: Background: Myelodysplastic syndromes (MDS) are a group of clonal stem cell-derived disorders characterized by cytopenias, ineffective hemopoiesis, and a considerable risk of progression to acute myeloid leukemia (AML). Patients with MDS have higher rates of cardiovascular mortality, when compared to age-matched population. This has been attributed to the effects of chronic anemia, iron overload and systemic inflammatory state. Erythropoiesis-stimulating agents (ESA) have also been implicated. The aim of this study is to compare inpatient outcomes and readmissions in MDS patients admitted with congestive heart failure (CHF), to those without MDS. Methods: Patients older than 65 years of age, with and without MDS, were queried for admissions of CHF between the years 2012 and 2017, from the Nationwide Inpatient Sample (NIS) database. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Statistical tests for trends of resource utilization across six years were performed. Multivariable logistic regression was used evaluate risk factors for inpatient mortality. Then, we utilized the Nationwide Readmissions Database (NRD) to evaluate the readmission rates, as well as, the causes of readmissions among patients, with and without MDS, admitted with CHF during index admission, from 2016 to 2017. Results: A total of around 4.3 million admissions met the inclusion criteria, of which, 0.75% had MDS, accounting for 32,305 admissions. Mean age was higher in those with MDS (82.3 v 79.8 years, p