BACKGROUND The variability of metabolic biomarkers has been determined to provide incremental prognosis information,but the implications of electrolyte variability remained unclear.METHODS We investigate the relations...BACKGROUND The variability of metabolic biomarkers has been determined to provide incremental prognosis information,but the implications of electrolyte variability remained unclear.METHODS We investigate the relationships between electrolyte fluctuation and outcomes in survivors of acute myocardial infarction(n=4386).Ion variability was calculated as the coefficient of variation,standard deviation,variability independent of the mean(VIM)and range.Hazard ratios(HR)were estimated using the multivariable-adjusted Cox proportional regression method.RESULTS During a median follow-up of 12 months,161(3.7%)patients died,and heart failure occurred in 550(12.5%)participants after discharge,respectively.Compared with the bottom quartile,the highest quartile potassium VIM was associated with increased risks of all-cause mortality(HR=2.35,95%CI:1.36–4.06)and heart failure(HR=1.32,95%CI:1.01–1.72)independent of cardiac troponin I(c Tn I),N terminal pro B type natriuretic peptide(NT-pro BNP),infarction site,mean potassium and other traditional factors,while those associations across sodium VIM quartiles were insignificant.Similar trend remains across the strata of variability by other three indices.These associations were consistent after excluding patients with any extreme electrolyte value and diuretic use.CONCLUSIONS Higher potassium variability but not sodium variability was associated with adverse outcomes post-infarction.Our findings highlight that potassium variability remains a robust risk factor for mortality regardless of clinical dysnatraemia and dyskalaemia.展开更多
BACKGROUND Epidemiological studies of chronic pancreatitis(CP)and its association with pancreatic ductal adenocarcinoma(PDAC)are limited.Understanding demographic and ethno-racial factors may help identify patients at...BACKGROUND Epidemiological studies of chronic pancreatitis(CP)and its association with pancreatic ductal adenocarcinoma(PDAC)are limited.Understanding demographic and ethno-racial factors may help identify patients at the highest risk for CP and PDAC.AIM To evaluate the ethno-racial risk factors for CP and its association with PDAC.The secondary aim was to evaluate hospitalization outcomes in patients admitted with CP and PDAC.METHODS This retrospective cohort study used the 2016 and 2017 National Inpatient Sample databases.Patients included in the study had ICD-10 codes for CP and PDAC.The ethnic,socioeconomic,and racial backgrounds of patients with CP and PDAC were analyzed.RESULTS Hospital admissions for CP was 29 per 100000,and 2890(0.78%)had PDAC.Blacks[adjusted odds ratio(aOR)1.13],men(aOR 1.35),age 40 to 59(aOR 2.60),and being overweight(aOR 1.34)were significantly associated with CP(all with P<0.01).In patients with CP,Whites(aOR 1.23),higher income,older age(aOR 1.05),and being overweight(aOR 2.40)were all significantly associated with PDAC(all with P<0.01).Men(aOR 1.81)and Asians(aOR 15.19)had significantly increased mortality(P<0.05).Hispanics had significantly increased hospital length of stay(aOR 5.24)(P<0.05).CONCLUSION Based on this large,nationwide analysis,black men between 40-59 years old and overweight are at significantly increased risk for admission with CP.White men older than 40 years old and overweight with higher income were found to have significant associations with CP and PDAC.This discrepancy may reflect underlying differences in healthcare access and utilization among different socioeconomic and ethno-racial groups.展开更多
This study reviewed programs to improve the efficiency of hospital utilization in the metropolitan area of Syracuse, New York between 1998 and 2015. It involved indicators that were largely under the control of hospit...This study reviewed programs to improve the efficiency of hospital utilization in the metropolitan area of Syracuse, New York between 1998 and 2015. It involved indicators that were largely under the control of hospitals and their nursing and administrative staffs, such as inpatient stays and post admission complications, as well as programs where there was less provider control such as inpatient admissions and readmissions. Large reductions in inpatient lengths of stay were generated by the Syracuse hospitals, contributing to a decline in the average daily adult medicine and adult surgery census of 140 patients. Reductions in post admission complications contributed to these developments. The study suggested that efforts to reduce inpatient admissions in the Syracuse hospitals had limited results. The areas hospital admission rate was conservative, but approximately 2000 resident discharges per year above that of a neighboring community. The need for reduction of hospital admissions resulted from the absence of provider or payor efforts to develop alternative resources in the community. If the experience of the Syracuse hospitals is typical, improvement of the efficiency of community health systems will require creativity and resources from providers. Perhaps more importantly, health care payors will need to assume an active role in these efforts.展开更多
Background Prior studies have demonstrated worse results of women in both hospital and short-term outcomes post-percutaneous coronary intervention. However, with advanced devices like drug-eluting stents （DESs） avai...Background Prior studies have demonstrated worse results of women in both hospital and short-term outcomes post-percutaneous coronary intervention. However, with advanced devices like drug-eluting stents （DESs） available,there are no consistent data revealing gender impact in outcome. This study examined whether gender affected hospital outcome and showed one-year single-center patient results of coronary stenting.Methods The study group included 969 consecutive patients （250 women and 719 men） undergoing coronary stenting for stable or unstable angina. Clinical events were assessed for at least 1 year post-procedure.Results Compared to men, women were older, presented more often with diabetes, hypertension, dyslipidemia, and lower creatinine clearance rate （Ccr）; they had less percutaneous transluminal coronary angioplasty （PTCA） history,smaller vessel size, and shorter lesions. The hospital major adverse cardiovascular event （MACE） rate was 2.8% of women and 0.97% of men （P=0.037）. The one-year MACE rate was 10.0% of women and 10.4% of men （P=0.874）. After adjusting other covariates, women still had significantly higher hospital MACE rates （P=0.034） and odds ratios （0.18;95% confidence interval： 0.036-0.874）. In women （n=250）, there was no statistically significant difference in hospital or one-year MACE between bare metal stent （BMS） and DES groups. Meanwhile, in men （n=719）, DES had a significant one-year improvement of MACE compared to BMS （P=0.004）. The female hospital MACE rate was five times greater than male results. However, there were similar one-year outcomes between women and men. DES currently have an advantage in long-term outcome.Conclusions Currently, with the use of BMS and DES, adverse hospital post-procedure cardiovascular event rate has occurred more often in women than in men. However, the MACE rate differences between women and men resolved with one year follow-up.展开更多
基金supported by the National Key R&D Program of China(No.2016YFC1301100)National Natural Science Foundation of China(No.81827806,81870353,31771241)Key Laboratory of Myocardial Ischemia,Ministry of Education(No.KF201903)。
文摘BACKGROUND The variability of metabolic biomarkers has been determined to provide incremental prognosis information,but the implications of electrolyte variability remained unclear.METHODS We investigate the relationships between electrolyte fluctuation and outcomes in survivors of acute myocardial infarction(n=4386).Ion variability was calculated as the coefficient of variation,standard deviation,variability independent of the mean(VIM)and range.Hazard ratios(HR)were estimated using the multivariable-adjusted Cox proportional regression method.RESULTS During a median follow-up of 12 months,161(3.7%)patients died,and heart failure occurred in 550(12.5%)participants after discharge,respectively.Compared with the bottom quartile,the highest quartile potassium VIM was associated with increased risks of all-cause mortality(HR=2.35,95%CI:1.36–4.06)and heart failure(HR=1.32,95%CI:1.01–1.72)independent of cardiac troponin I(c Tn I),N terminal pro B type natriuretic peptide(NT-pro BNP),infarction site,mean potassium and other traditional factors,while those associations across sodium VIM quartiles were insignificant.Similar trend remains across the strata of variability by other three indices.These associations were consistent after excluding patients with any extreme electrolyte value and diuretic use.CONCLUSIONS Higher potassium variability but not sodium variability was associated with adverse outcomes post-infarction.Our findings highlight that potassium variability remains a robust risk factor for mortality regardless of clinical dysnatraemia and dyskalaemia.
文摘BACKGROUND Epidemiological studies of chronic pancreatitis(CP)and its association with pancreatic ductal adenocarcinoma(PDAC)are limited.Understanding demographic and ethno-racial factors may help identify patients at the highest risk for CP and PDAC.AIM To evaluate the ethno-racial risk factors for CP and its association with PDAC.The secondary aim was to evaluate hospitalization outcomes in patients admitted with CP and PDAC.METHODS This retrospective cohort study used the 2016 and 2017 National Inpatient Sample databases.Patients included in the study had ICD-10 codes for CP and PDAC.The ethnic,socioeconomic,and racial backgrounds of patients with CP and PDAC were analyzed.RESULTS Hospital admissions for CP was 29 per 100000,and 2890(0.78%)had PDAC.Blacks[adjusted odds ratio(aOR)1.13],men(aOR 1.35),age 40 to 59(aOR 2.60),and being overweight(aOR 1.34)were significantly associated with CP(all with P<0.01).In patients with CP,Whites(aOR 1.23),higher income,older age(aOR 1.05),and being overweight(aOR 2.40)were all significantly associated with PDAC(all with P<0.01).Men(aOR 1.81)and Asians(aOR 15.19)had significantly increased mortality(P<0.05).Hispanics had significantly increased hospital length of stay(aOR 5.24)(P<0.05).CONCLUSION Based on this large,nationwide analysis,black men between 40-59 years old and overweight are at significantly increased risk for admission with CP.White men older than 40 years old and overweight with higher income were found to have significant associations with CP and PDAC.This discrepancy may reflect underlying differences in healthcare access and utilization among different socioeconomic and ethno-racial groups.
文摘This study reviewed programs to improve the efficiency of hospital utilization in the metropolitan area of Syracuse, New York between 1998 and 2015. It involved indicators that were largely under the control of hospitals and their nursing and administrative staffs, such as inpatient stays and post admission complications, as well as programs where there was less provider control such as inpatient admissions and readmissions. Large reductions in inpatient lengths of stay were generated by the Syracuse hospitals, contributing to a decline in the average daily adult medicine and adult surgery census of 140 patients. Reductions in post admission complications contributed to these developments. The study suggested that efforts to reduce inpatient admissions in the Syracuse hospitals had limited results. The areas hospital admission rate was conservative, but approximately 2000 resident discharges per year above that of a neighboring community. The need for reduction of hospital admissions resulted from the absence of provider or payor efforts to develop alternative resources in the community. If the experience of the Syracuse hospitals is typical, improvement of the efficiency of community health systems will require creativity and resources from providers. Perhaps more importantly, health care payors will need to assume an active role in these efforts.
文摘Background Prior studies have demonstrated worse results of women in both hospital and short-term outcomes post-percutaneous coronary intervention. However, with advanced devices like drug-eluting stents （DESs） available,there are no consistent data revealing gender impact in outcome. This study examined whether gender affected hospital outcome and showed one-year single-center patient results of coronary stenting.Methods The study group included 969 consecutive patients （250 women and 719 men） undergoing coronary stenting for stable or unstable angina. Clinical events were assessed for at least 1 year post-procedure.Results Compared to men, women were older, presented more often with diabetes, hypertension, dyslipidemia, and lower creatinine clearance rate （Ccr）; they had less percutaneous transluminal coronary angioplasty （PTCA） history,smaller vessel size, and shorter lesions. The hospital major adverse cardiovascular event （MACE） rate was 2.8% of women and 0.97% of men （P=0.037）. The one-year MACE rate was 10.0% of women and 10.4% of men （P=0.874）. After adjusting other covariates, women still had significantly higher hospital MACE rates （P=0.034） and odds ratios （0.18;95% confidence interval： 0.036-0.874）. In women （n=250）, there was no statistically significant difference in hospital or one-year MACE between bare metal stent （BMS） and DES groups. Meanwhile, in men （n=719）, DES had a significant one-year improvement of MACE compared to BMS （P=0.004）. The female hospital MACE rate was five times greater than male results. However, there were similar one-year outcomes between women and men. DES currently have an advantage in long-term outcome.Conclusions Currently, with the use of BMS and DES, adverse hospital post-procedure cardiovascular event rate has occurred more often in women than in men. However, the MACE rate differences between women and men resolved with one year follow-up.
