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Education, Teaching, and Quality Improvement |

High Burden of Chronic Disease and Hospital Mortality/Readmissions Among Minority Patients in an Inner-City Medical Intensive Care Unit (ICU) FREE TO VIEW

Sevak Keshishyan, MD; Daile Grave de Peralta, MD; Balavenkatesh Kanna, MBBS; Raghu Loganathan, MD
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Internal Medicine, Lincoln Medical and Mental Health Center, Bronx, NY


Chest. 2014;146(4_MeetingAbstracts):513A. doi:10.1378/chest.1983583
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Abstract

SESSION TITLE: Outcomes/Quality Control Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Minority patients admitted to MICU have several co-morbid conditions. However, there is little data on co-morbid conditions, ICU mortality and hospital re-admissions.

METHODS: We studied 1439 consecutive adult patients admitted to a 22-bed closed type teaching hospital ICU between 2009 and 2011. Patients transferred to other hospital from ICU, pregnancy or lacked complete data were excluded. Subjects were divided into 2 groups based on mortality and re-admissions. Demographics, admission APACHE II score, co-morbid conditions, hospital mortality or re-admissions to the hospital after index ICU admission (composite outcome) were compared between the 2 study groups using multi-variate logistic regression. Odd ratio and 95% Confidence intervals are reported. A p value of < 0.05 was considered significant.

RESULTS: Of 1350 patients, mean age was 53.7 years; 49% were women; 54% Latinos and 34% African Americans. Mean BMI (+/- SD) was 29.9 +/- 9.2 kg/m2. The following co-morbid conditions noted: obese 35%, DM 35%, HTN 58.7%, dyslipidemia 20.4%, CAD 14.2%, previous CVA 8.74%, COPD 17.1%, asthma 10.6%, OSA3.9%, chronic kidney disease (CKD) 13.8%, end stage renal disease (ESRD) 6.5%, had cancer 9.1%, HIV or AIDS 10.4%. Ever-smokers were 47%, alcohol users -19.6% and drug users -29.9%. Mean APACHE II were 15.8 +/-8.3. 517 (38.3%) were either readmitted (n=365) to hospital or died (n= 158) during index hospitalization after ICU admission. COPD (OR 1.4, 95% CI 1.05 - 1.98, p= 0.024), CKD (OR 1.67, 95% CI 1.17 - 2.37, p=0.005), ESRD (OR 1.80, 95% CI 1.13 - 2.87, p=0.013), HIV (OR 1.62, 95% CI 1.11 - 2.36, p=0.012) , drug use (OR 1.40, 95%CI 1.07 - 1.82, p= 0.013) and malignancy (OR1.81, 95% CI 1.22 - 2.69, p=0.003) were associated with adverse outcomes.

CONCLUSIONS: In ICU patients, co-morbidity such as COPD, CKD/ESRD, malignancy, HIV and drug use are associated with mortality and re-admissions.

CLINICAL IMPLICATIONS: Current emphasis on reducing mortality and re-admissions in ICU patients should include a comprehensive approach to care coordination of patients with co-morbid conditions.

DISCLOSURE: The following authors have nothing to disclose: Sevak Keshishyan, Daile Grave de Peralta, Balavenkatesh Kanna, Raghu Loganathan

No Product/Research Disclosure Information


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