Publications by authors named "Neelambuj Regmi"

4 Publications

  • Page 1 of 1

Predictors of Complications Secondary to Infective Endocarditis and Their Associated Outcomes: A Large Cohort Study from the National Emergency Database (2016-2018).

Infect Dis Ther 2021 Nov 24. Epub 2021 Nov 24.

Division of Pulmonary and Critical Medicine, Detroit Medical Center Wayne State University, Detroit, MI, USA.

Introduction: Literature regarding outcomes and predictors of complications secondary to infective endocarditis (IE) is limited. We aimed to study the outcomes and predictors of complications of IE.

Methods: Data from a national emergency department sample, which constitutes 20% sample of hospital-owned emergency departments in the USA, were analyzed for hospital visits for IE. Complications of endocarditis were obtained by using ICD codes. Multivariable generalized linear method was used to evaluate predictors of in-hospital mortality and complications.

Results: Out of 255,838 adult IE patients (mean age 60.3 ± 20.1 years, 48.5% females), 97,803 (38.2%) patients developed one or more major complications. The major complications were cardiovascular system complications [57,900 (22.6%)], neurologic [42,851 (16.7%)] complications, and renal [16,236 (6.4%)] complications. These included cardiogenic shock [3873 (1.5%)], septic shock [25,798 (10.1%)], acute heart failure [35,602 (14%)], systemic thromboembolism (STE) [21,390 (8.36%)], heart block [11,430 (4.47%)], in-hospital dialysis [2880 (1.1%)], and disseminated intravascular coagulation (DIC) [2704 (1.1%)]. Patients with complicated IE had risk of mortality (adjusted RR 1.12, 95% CI 1.11-1.13, p < 0.001). The complications strongly associated with mortality were septic shock (RR 1.29, 95% CI 1.27-1.30, p < 0.001), cardiogenic shock (RR 1.24, 95% CI 1.20-1.29, p < 0.001), DIC (RR 1.4, 95% CI 1.35-1.46, p < 0.001), and STE (RR 1.07, 95% CI 1.05-1.08, p < 0.001). Staphylococci were the predominant causative organisms (30.8%) among the complicated IE subgroups with higher associated mortality (42.8%). The main predictors of complications from IE were congenital heart disease, history of congestive heart failure, high Elixhauser comorbidity profile, staphylococcal infection, and fungal infections. The prevalence of cardiogenic shock increased over the study years from 1.13 to 1.98% (p-trend 0.04).

Conclusion: Complicated IE is not uncommon and is associated with significant mortality. Staphylococcal infections were associated with high mortality rates. There has been an increasing trend of cardiogenic shock among IE patients across the US. Further research is needed to improve the outcomes of complicated endocarditis.
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http://dx.doi.org/10.1007/s40121-021-00563-yDOI Listing
November 2021

Trends in Incidence, and Mortality of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in the United States Emergency Department (2010-2018).

COPD 2021 10 16;18(5):567-575. Epub 2021 Sep 16.

Division of Pulmonary and Critical Care Medicine, Wayne State University, Detroit, MI, USA.

Literature regarding trends of incidence, mortality, and complications of acute exacerbation of chronic obstructive pulmonary disease (COPD) in the emergency departments (ED) is limited. What are trends of COPD exacerbation in ED? Data were obtained from the Nationwide Emergency Department Sample (NEDS) that constitutes a 20% sample of hospital-owned EDs and inpatient sample in the US. All ED encounters were included in the analysis. Complications of AECOPD were obtained by using ICD codes. Out of 1.082 billion ED encounters, 5,295,408 (mean age 63.31 ± 12.63 years, females 55%) presented with COPD exacerbation. Among these patients, 353,563(6.7%) had AECOPD-plus (features of pulmonary embolism, acute heart failure and/or pneumonia) while 4,941,845 (93.3%) had exacerbation without associated features or precipitating factors which we grouped as AECOPD. The AECOPD-plus group was associated with statistically significantly higher proportion of cardiovascular complications including AF (5.6% vs 3.5%;  < 0.001), VT/VF (0.14% vs 0.06%;  < 0.001), STEMI (0.22% vs 0.11%;  < 0.001) and NSTEMI (0.65% vs 0.2%;  < 0.001). The in-hospital mortality rates were greater in the AECOPD-plus population (0.7% vs 0.1%;  < 0.001). The incidence of both AECOPD and AECOPD-plus had worsened (-trend 0.004 and 0.0003) and the trend of mortality had improved (-trend 0.0055 and 0.003, respectively). The prevalence of smoking for among all COPD patients had increased (-value 0.004), however, the prevalence trend of smoking among AECOPD groups was static over the years 2010-2018. There was an increasing trend of COPD exacerbation in conjunction with smoking; however, mortality trends improved significantly. Moreover, the rising burden of AECOPD would suggest improvement in diagnostics and policy making regarding management.
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http://dx.doi.org/10.1080/15412555.2021.1979500DOI Listing
October 2021

Challenges of left atrial appendage closure device and anticoagulation in a patient with immune thrombocytopenia (ITP).

BMJ Case Rep 2021 Mar 25;14(3). Epub 2021 Mar 25.

Department of Cardiology, Wayne State University, Detroit, Michigan, USA.

Among patients with atrial fibrillation (AF) who have high risk of bleeding secondary to haematologic disorders, left atrial appendage (LAA) occlusion therapy has been shown to be an excellent alternative to long-term use of oral anticoagulation for thromboembolic stroke prevention. However, there remains a major concern of device-associated thrombosis post-procedure, that can lead to life-threatening embolic events. To this date, there is no systematic guideline for the selection and management of patients with haematological disorders with LAA occlusion therapy, especially in those with platelet disorders such as immune thrombocytopenia (ITP). Patients with platelet disorders are at a higher risk for bleeding; however, that does not prevent such patients from thromboembolic events secondary to AF. We present a case of ITP with permanent AF, where an LAA device was complicated by thrombus formation due to challenges faced with anticoagulation therapy.
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http://dx.doi.org/10.1136/bcr-2021-241985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006819PMC
March 2021

Does Pulmonary Embolism in Critically Ill COVID-19 Patients Worsen the In-Hospital Mortality: A Meta-Analysis.

Cardiovasc Revasc Med 2021 10 25;31:34-40. Epub 2020 Nov 25.

Detroit Medical Center, Detroit, MI, USA.

Background: Mortality in critically ill COVID (coronavirus disease) patients secondary to pulmonary embolism (PE) has conflicting data. We aim to evaluate the mortality outcomes of critically ill patients with and without PE (WPE).

Methods: Three studies were identified after a digital database search on PE in ICU (intensive care unit) patients until September 2020. The primary outcome was mortality. Outcomes were compared using a random method odds ratio and confidence interval of 95%.

Results: A total of 439 patients were included in the study. Diabetes, hypertension, and renal replacement requirement had no statistically significant association between PE and WPE, p = 0.39, p = 0.23, and p = 0.29 respectively. The study revealed that males have higher odds of PE, OR-1.98, 95%CI-1.01-3.89; p = 0.05. In-hospital mortality results were comparable between PE and WPE after subgroup analysis and correction of heterogeneity, p = 0.25.

Conclusion: PE in critically ill COVID patients had similar in-hospital mortality outcomes as WPE patients. The findings are only hypotheses generated from observational studies and need future randomized, prospective clinical trials for a definitive conclusion.
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http://dx.doi.org/10.1016/j.carrev.2020.11.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7687401PMC
October 2021
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