Shaikh, Asim Jamal

Abstract Background Acute respiratory failure is one of the most common causes of hospitalizations in the US. By 2030, the number of Americans with dementia is expected to reach nearly 9 million and 12 million in 2040. Dementia increases the risk of respiratory illnesses, including pneumonia. This study delves into the intricate interplay between dementia and acute respiratory failure. Methods Our retrospective study analyzed adult patients with acute respiratory failure and secondary diagnosis of dementia using ICD-10 codes in the National Inpatient Sample (NIS) Database from 2017 to 2020. An analysis was conducted on various demographic factors such as age, race, and gender. The study's primary endpoint was mortality, with mechanical ventilation, tracheostomy, and length of stay as secondary endpoints. To account for other variables that could have affected the results, we utilized a multivariate logistic regression with p < 0.05 considered significant. Results The study included 1,795,630 patients admitted with ARF, 112,175 of whom had dementia. The mean age in the dementia group was 80 years, compared to 65 years in the control group. Additionally, 62% of the dementia group were females, while the control group had 55% females. 73% of both groups were Caucasian white. Comorbidities observed in the dementia group include hypertension (81% vs. 72%), diabetes mellitus (36% vs. 35%), supraventricular tachycardia (29% vs. 20%), and sepsis (6% vs. 5%) with p-value less than 0.01. Rates and odds of mortality were higher in the dementia group (15,704 (14%) vs. 151,511 (9%), p-value < 0.01, aOR 1.08, p-value < 0.01). Patients with dementia had lower rates of in-hospital mechanical ventilation, but higher adjusted odds (27% vs. 28%; p < 0.01; aOR + 1.2, p < 0.01). Patients with dementia had lower rates and adjusted odds of undergoing a tracheostomy during their stay (762 (0.7) vs. 16,834 (1), p-value < 0.01, aOR 0.91 p-value 0.33).. Patients with dementia had a longer length of stay (LOS) than those without, with a mean difference of + 0.3 days and p-value < 0.01. Conclusions Clinicians should be aware that dementia was found to be an independent risk factor for mortality in patients admitted with acute respiratory failure.

Background: Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker that is used to predict mortality, readmission, early discharge, and LOS, thus, serves as a useful tool for ED physicians. Our study aims to analyze the efficacy of suPAR in predicting these prognostic markers in ED. Methods: We performed a comprehensive search on 6 databases from the inception to 30th November 2022, to select the following eligibility criteria; a) observation or triage trial studies investigating the role of suPAR levels in predicting: 30 day and 90-day mortality, 30-day readmission, early discharge (within 24hr), and LOS in patients coming to AMU. Results: A total of 13 studies were included, with a population size of 35,178, of which 52.9% were female with a mean age of 62.93 years. Increased risk of 30-day mortality (RR = 10.52; 95% CI = 4.82–22.95; I2 = 38%; P < .00001), and risk of 90-day mortality (RR = 5.76; 95% CI = 3.35–9.91; I2 = 36%; P < .00001) was observed in high suPAR patients. However, a slightly increased risk was observed for 30-day readmission (RR = 1.50; 95% CI = 1.16–1.94; I2 = 54%; P = .002). More people were discharged within 24hr in the low suPAR level group compared to high suPAR group (RR = 0.46; 95% CI = 0.40–0.53; I2 = 41%; P < .00001). LOS was thrice as long in high suPAR level patients than in patients with low suPAR (WMD = 3.20; 95% CI = 1.84–4.56; I2 = 99%; P < .00001). Conclusion: suPAR is proven to be a significant marker in predicting 30-day and 90-day mortality in ED patients.