Regional trends in In-hospital Cardiac Arrest following sepsis-related admissions and subsequent mortality.

BACKGROUND: Previous studies have reported regional variation in either the incidence or outcomes of sepsis or In-hospital Cardiac Arrest (IHCA) discretely; however, regional variations in the incidence and outcomes of sepsis-associated IHCA (SA-IHCA) have never been studied. METHODS: From the National Inpatient Sample (NIS), discharges with sepsis and sepsis-associated IHCA were identified in 4 geographic regions (Northeast, Midwest, South, West) from 2007 to 2014 using applicable ICD-9-CM codes. We assessed the regional incidence and trends in SA-IHCA and subsequent inpatient outcomes. RESULTS: Out of 8,058,091 sepsis-related admissions, 187,163 (2.3%) were associated with IHCA with a rising trend in the incidence from 2007- to 2014 (2.0% to 2.6%, ptrend < 0.001). The overall incidence of SA-IHCA was highest in South (2.6%) with the highest mortality in West (74.4%) (p < 0.001). The incidence of SA-IHCA increased in the South (2.4%-3.0%) and Midwest (1.6%-2.4%) from 2007 to 2014. Mortality has not significantly increased or decreased across all regions. Compared with the West, survivors in the Northeast, Midwest, and the South were less likely to be discharged home and were more likely to be transferred to other facilities. In the SA-IHCA cohort, the mean length of stay for SA-IHCA was highest in Northeast (˜10.9 days) and lowest in Midwest (˜8.6 days) (p < 0.001). Hospital charges were highest in the West ($234,278) and lowest in the Midwest ($125,725) (p < 0.001). CONCLUSION: This nationwide analysis demonstrates that the highest incidence of SA-IHCA is in the Southern region of the US whereas the associated in-hospital mortality was highest in the West. The incidence of SA-IHCA is rising in the Midwest and South from 2007 to 2014. Despite significant advances in the treatment of sepsis and IHCA, there has been no significant improvement in the incidence of SA-IHCA and subsequent survival in any US geographic region from 2007 to 2014.

Epidemiology of acute coronary syndrome co-existent with allergic/hypersensitivity/anaphylactic reactions (Kounis syndrome) in the United States: A nationwide inpatient analysis.

BACKGROUND: The nationwide epidemiological data on Kounis Syndrome (KS), still remains indistinct in the United States (US) after it was first reported in 1991. METHODS: We assessed the prevalence of KS among patients primarily hospitalized for allergic/hypersensitivity/anaphylactic reactions. We then compared baseline demographics, comorbidities, and outcomes of KS with patients with only allergic/hypersensitivity/anaphylactic reactions using the National Inpatient Sample, 2007-2014. RESULTS: The cohort comprised of 235,420 patients primarily hospitalized with allergy/hypersensitivity/anaphylactic reactions. Of these, 2616 [1.1%; 0.2% unstable angina, 0.2% ST-elevation myocardial infarction & 0.7% non-ST-elevation myocardial infarction] patients experienced ACS and were identified as having KS. Patients with KS were older (mean 65.9 ±â€¯14.1 vs. 57.2 ±â€¯17.8 yrs), more often White (71.1% vs. 58.6%), male (46.4% vs. 39.9%) and Medicare enrollees (58.9% vs. 41.5%) admitted non-electively (96.8% vs. 95.3%) as compared to non-KS group (p < 0.001). The hospitalizations with KS demonstrated higher all-cause in-hospital mortality (7.0% vs. 0.4%, p < 0.001), prolonged hospitalization stay (mean 5.8 ±â€¯6.0 vs. 3.0 ±â€¯3.9 days, p < 0.001), higher hospitalization charges ($52,656 vs. $20,487, p < 0.001) and more frequent transfers to other facilities. The rates of stroke (1.0% vs. 0.2%), arrhythmias (30.4% vs. 12.4%), venous thromboembolism (1.6% vs. 1.0%), and diagnostic and therapeutic coronary interventions were also found to be significantly higher in patients with KS (p < 0.05). Patients with KS had increased odds of in-hospital mortality [unadjusted OR: 18.52; 95% CI: 15.74-21.80, p < 0.001 & adjusted OR: 9.74, 95% CI: 8.08-11.76, p < 0.001] compared to non-KS group. CONCLUSIONS: Overall US prevalence of KS among patients hospitalized for allergic/hypersensitivity/anaphylactic reactions is 1.1% with a subsequent all-cause inpatient mortality rate of 7.0%.