Aseptic Liver Abscess in a Patient With Diversion Colitis.

Aseptic abscess syndrome is a rare clinical entity mainly associated with systemic inflammatory conditions, particularly inflammatory bowel disease. The syndrome is characterized by an inflammatory infiltrate predominantly consisting of neutrophils, most commonly in the liver and spleen. We present a case of a patient with symptomatic diversion colitis diagnosed with a clinical and histological presentation consistent with aseptic abscess syndrome of the liver. Treatment and resolution of the inflamed colon was associated with complete disappearance of the liver lesions and normalization of liver enzymes. To the best of our knowledge, this is the first report suggesting the unique link between diversion colitis and aseptic liver abscess.

Hyponatremia is associated with poor prognosis among patients with chest pain discharged from internal medicine wards following acute coronary syndrome-rule-out.

BACKGROUND: Hyponatremia is the most common electrolyte abnormality observed in clinical practice. Among patients with acute coronary syndrome (ACS), serum sodium levels are inversely associated with mortality risk. We assessed associations of serum sodium level with ACS and mortality in patients with chest pain. METHODS: This retrospective cohort study used clinical data from a large, academic hospital. All adults admitted with chest pain and without hypernatremia and discharged after ACS rule-out from January 2010 through June 2016 were included. The primary endpoint was the composite of 30-day ACS and mortality. Secondary endpoints were a hospital admission due to ACS and mortality in the first year following discharge. RESULTS: Included were 12 315 patients (mean age 58.2 ± 13 years, 60% male). Patients were classified according to the serum sodium (Na) level: hyponatremia, defined as less than 135 mEq/L (n = 289, 2.3%); 140 > Na ≥ 135 mEq/L (n = 8066, 65.5%), and 145 > Na ≥ 140 mEq/L (n = 3960, 32.2%). Patients with serum sodium more than 145 mEq/L were excluded. Among patients with hyponatremia, low-normal, and high-normal levels, rates of the composite outcome of unadjusted 30-day all-cause mortality and ACS admission were 4.5, 1.0, and 0.7%, respectively (P < 0.001). Unadjusted one-year ACS rates were 3.8, 1.5, and 1.4%, respectively (P < 0.01). CONCLUSION: Hyponatremia is associated with higher mortality and ACS risk among patients with chest pain who were discharged from internal medicine wards following ACS-rule-out. Sodium level may be included in the risk stratification of patients with chest pain.

The association between red cell distribution width and clinical outcomes in patients hospitalised due to chest pain.

Background: Red blood cell distribution width (RDW) is a measure of the degree of heterogeneity of erythrocyte volume. Higher RDW levels are associated with increased mortality among patients with acute coronary syndrome (ACS), heart failure and other cardiovascular diseases. The association between RDW levels and clinical outcomes in patients admitted for further evaluation of chest pain is not known. Methods: A retrospective analysis of patients hospitalised with chest pain 2010-2016 was conducted. Patients diagnosed with ACS in the emergency department (ED) were excluded. Patients were divided into tertiles according to baseline ED RDW levels (≤13.1%, 13.1%13.9%). Study endpoints were diagnosis of ACS during the index hospitalisation and ACS and all-cause mortality during a median follow-up of 3.3 ± 1.9 years. Results: Included were 13,018 patients (mean age 58 ± 13 years, 61% male). Increased RDW levels were associated with higher rates of ACS in the index hospitalisation (6.1%, 6.6% and 8.1% for 1st, 2nd and 3rd tertiles, respectively, p < .01), ACS during follow-up (8.6%, 10.1% and 13.4%, respectively, p < .01), and with all-cause mortality during follow-up (2.5%, 4.6% and 15.4%, respectively, p < .01). In multivariate analysis, RDW levels >13.9% (vs. ≤13.1%) were associated with ACS in the index hospitalisation (adjusted OR 1.25, 95% CI 1.04-1.51, p = .02), ACS during follow-up (adjusted OR 1.35, 95% CI 1.05-1.73, p = .02) and with all-cause mortality (adjusted HR 2.41, 95% CI 1.94-2.99, p < .01). Conclusion: In this retrospective study of patients hospitalised with chest pain, higher RDW levels were associated with future ACS and long-term mortality.

The association between red cell distribution width and poor outcomes in hospitalized patients with influenza.

PURPOSE: To examine an association between red blood cell distribution width (RDW) and the prognosis of influenza patients. METHODS: We conducted a retrospective analysis of patients hospitalized with influenza during 2012-2015 in the internal medicine wards of one medical center. RDW measurements during hospitalization were analyzed. Primary outcome was complicated hospitalization (defined as at least one of: length of stay ≥7days, need for mechanical ventilation, septic shock, transfer to intensive-care, or 30-day mortality). Secondary outcome was 30-day mortality. RESULTS: 153 patients were included, mean age: 62.5±1, 82 (54%) male; 84 (55%) had a high RDW value (>14.5%) during hospitalization. Patients with high and low RDW (≤14.5%) had similar age and comorbidity profiles, but those with high RDW had lower hemoglobin and higher creatinine levels. Patients with high RDW had a higher rate of complicated hospitalization (32.5% vs. 10.3%, p<0.01) and a trend for increased 30-day mortality. In a multivariate regression model, high RDW was a predictor of complicated hospitalization (OR 5.03, 95% CI 1.81-13.93, p<0.01). Each 1-point increase in RDW was associated with a 29% increase in the risk for the primary outcome. CONCLUSION: RDW>14.5% was a predictor of severe hospital complications in patients with influenza.

Amniotic fluid discordance in monochorionic diamniotic twin pregnancies is associated with increased risk for twin anemia-polycythemia sequence.

OBJECTIVE: To estimate the risk for twin anemia-polycythemia sequence (TAPS) and adverse perinatal outcome in monochorionic diamniotic (MCDA) twin pregnancies with amniotic fluid discordance (AFD). METHODS: Retrospective cohort study of 34 MCDA pregnancies with AFD (intertwin difference of ≥3 cm in maximal vertical pocket measurement) without meeting the criteria for twin to twin transfusion syndrome or selective intrauterine growth restriction. Perinatal outcome measures and the risk for TAPS were compared with a control group consisted of 101 MCDA twin pregnancies without AFD, twin to twin transfusion syndrome, or selective intrauterine growth restriction. Composite neonatal morbidity was defined as the presence of respiratory distress syndrome, intraventricular hemorrhage grades 3 and 4, necrotizing enterocolitis or sepsis. RESULTS: Overall, in the AFD group, seven twin pairs (20.6%) were complicated by TAPS compared with none in the controls (p < 0.001). In the AFD group, women who developed TAPS had significantly higher AFD compared with women who did not develop TAPS (7.3 cm vs 4.2 cm, p < 0.01). Patients in the AFD group delivered earlier (34.6 vs 35.8 weeks, p < 0.001) and had significantly higher rate of composite neonatal morbidity compared with the control group (13.2 vs 2.5%, p = 0.002). CONCLUSIONS: Despite the overall favorable outcome, MCDA twins with AFD are at increased risk for developing TAPS. © 2016 John Wiley & Sons, Ltd.