Pasnoor, Diksha Sanjana

Purpose: Obesity is a risk factor for sepsis complications in older adults. We assessed the impact of metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO) on outcomes in septic shock. Methods: We conducted a retrospective analysis using the National Inpatient Sample (2016-2020) to identify a cohort of 1,737,075 patients aged 65 years and older who were hospitalized with septic shock, as defined by ICD-10 diagnosis codes. Obese patients without hypertension, diabetes, or hyperlipidemia were classified as MHO; those with ≥1 risk factor as MUHO. Baseline demographics and hospital characteristics were compared using χ² and Mann–Whitney U tests. Multivariable logistic regression adjusted for age, sex, race, comorbidity index, and hospital factors estimated odds ratios (ORs) for respiratory failure, mechanical ventilation, in-hospital mortality, and cardiac arrest. Secondary endpoints included length of stay (LOS) and hospitalization cost. Results: Among 268 050 obese patients, 23 915 (1.4%) were classified as MHO and 244 135 (14.1%) as MUHO. Both phenotypes were more prevalent in females and least common among Asian patients. MHO prevalence was highest among Native Americans, while MUHO was most common among Hispanics in 2020. From 2016 to 2019, the prevalence of both phenotypes remained stable, with modest increases observed during the 2020 sepsis surge. Respiratory failure occurred most frequently in the MHO group (∼70%), followed by MUHO (∼65%) and non-obese patients (∼60%). After adjusting for confounders, both MHO and MUHO groups had higher odds of respiratory failure and mechanical ventilation compared to non-obese patients. In-hospital mortality increased across all groups in 2020; however, MUHO patients had lower adjusted mortality risk. Cardiac arrest rates remained unchanged, while length of stay and hospitalization costs were highest among MHO patients. Conclusions: MHO and MUHO both confer higher respiratory failure and ventilation risk; lower mortality in MUHO warrants further study. Clinical Implications Phenotypic obesity classification may improve sepsis risk stratification and inform metabolic-specific management.

BACKGROUND: COVID-19 patients are at higher risk of major adverse cardiovascular and cerebrovascular events (MACCE). The underpinning effect of cancer in COVID-19 enhances this risk. Currently, we have limited nationwide data on MACCE events in cancer patients hospitalized with COVID-19. This study aims to identify demographic and clinical predictors of MACCE in this population. METHODS: We identified COVID-19-hospitalized cancer patients using the 2020 National Inpatient Sample. MACCE, inpatient mortality, and baseline demographics and comorbidities were assessed. Predictors of MACCE were calculated using multivariable regression analysis. RESULTS: Of 68,755 cancer patients hospitalized with COVID-19, 24% had MACCE, and 20.4% died in the hospital, with both outcomes being more significant among males, Asian or Pacific Islanders, and those in the fourth income quartile (all p<0.05). Comorbidities exhibited statistically significant associations for MACCE (all p<0.05). Higher adjusted odds of MACCE were found in age groups >65 (OR 4.17; 95% CI 2.94-5.91) and 45-64 (OR 1.77; 95% CI 1.26-2.48) than 18-44 years, self-paying patients (OR 2.15) than Medicare, urban non-teaching (OR 1.25) and urban teaching hospitalizations (OR 1.24) than rural, prior MI (OR 1.36; 95% CI 1.11-1.66), CKD (OR 1.37; 95% CI 1.22-1.54), severe sepsis (OR 2.75; 95% CI 2.42-2.13), respiratory failure (OR 2.67; 95% CI 2.41-2.96), and mechanical ventilation (OR 12.15; 95% CI 10.40-14.21). Compared to the Northeast, hospitals in the Midwest, West, and South had lower odds of MACCE. Obesity, tobacco use, hyperlipidemia, and prior chemotherapy also exhibited lower odds of MACCE (all p<0.05) (Table. 1). CONCLUSION: Our study using contemporary large-scale data found a concerning burden and higher risk of MACCE, particularly in the elderly, patients with CKD, prior MI, severe sepsis, respiratory failure, and mechanical ventilation.

Background: Limited research has focused on the rising incidence of major adverse cardiac and cerebrovascular events (MACCE) among young women (aged 18-44) with at least one traditional cardiovascular disease risk factor (CVD), especially in rural hospital settings. We aimed to address this research gap by providing insights into the burden of CVD in this population. Methods: Using data from the National Inpatient Sample (2019), we identified young women (aged 18-44) with at least one cardiovascular risk factor admitted to rural hospitals. Baseline demographics, comorbidities, and outcomes were assessed, including MACCE and all-cause mortality. Multivariable logistic regression was performed, adjusting for age, race, income, and comorbidities. Results: Among 179,410 young women, MACCE occurred in 2,455 individuals (1.4%), with varying rates among racial groups: whites (1.2%), blacks (2.4%), Hispanics (1.3%), Asian or Pacific Islanders (API) (2%), Native Americans (NA) (1.6%), and others (1%). All-cause mortality was observed in 385 women (0.2%), with rates of 0.2% for whites and 0.4% for blacks. Blacks had twice the event rates of MACCE, and all-cause mortality compared to whites. Comorbidities and substance abuse were associated with MACCE (P<0.001). In higher-income households, multivariable analysis adjusted for confounders revealed significantly higher odds of MACCE in blacks (OR 1.23, 95% CI 0.11-14.08), API (OR 4.48, 95% CI 1.06-18.93), and NA (OR 10.22, 95% CI 1.03-101.50) compared to whites. In contrast, mortality rates were lower for Hispanics than whites (OR 0.24, 95% CI 0.02-3.80) (all p < 0.001) (Table 1). Conclusion: In higher-income households, greater odds of MACCE were noted among blacks, API, and NA compared to whites. Future research should focus on understanding factors contributing to these disparities and developing interventions to prioritize equitable healthcare access for rural women across diverse ethnic and income classes.

INTRODUCTION: The relentless toll of cardiovascular disease in the United States demands a breakthrough in reliable and cost-effective prognostic markers. Amidst the limited knowledge surrounding the role of adiponectin in stable coronary artery disease (CAD), this study aims to unveil its power in predicting all-cause mortality and major adverse cardiovascular events (MACE) among patients with stable coronary artery disease (CAD). METHODS: We systematically screened PubMed, Scopus, and Google Scholar for articles until May 2023 to identify relevant studies. Random-effects model estimated the pooled odds ratio (OR) with 95% confidence intervals (CI), and I2 statistics assessed heterogeneity. The leave-one-out method was used for sensitivity analysis. RESULTS: Following the screening, five prospective studies involving 3225 patients with a median follow-up duration of 3.8 years were included. In the study population, hypertension, diabetes, hyperlipidemia, and smoking were prevalent risk factors, and common medications included angiotensin-converting enzyme inhibitors, beta-blockers, and statins. The pooled adjusted OR for all-cause mortality was 2.51 (95%CI: 1.36-4.62), with moderate heterogeneity (I2=65.51%, p=0.03), and the pooled adjusted OR for MACE was 1.04 (95%CI: 1.02-1.06), with no significant heterogeneity (I2=0%, p=0.68) (Fig. 1) . The leave-one-out sensitivity analysis showed that no single study significantly influenced the meta-analysis results, indicating robustness. CONCLUSION: Higher adiponectin levels were associated with higher odds of long-term mortality and MACE in stable CAD patients, highlighting its potential as a cost-effective marker for risk stratification and guiding management strategies. Further studies exploring the role of adiponectin can significantly impact clinical decision-making and resource allocation in cardiovascular care.