Publications by authors named "Yusuke Sasabuchi"

70 Publications

Resource-rich Intensive Care Units vs. Standard Intensive Care Units on Patient Mortality: A Nationwide Inpatient Database Study.

JMA J 2021 Oct 27;4(4):397-404. Epub 2021 Sep 27.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

Introduction: In this present study, we aimed to assess whether care in resource-rich intensive care unit (ICU) was associated with lower ICU mortality compared with care in standard ICU.

Methods: This retrospective cohort study used administrative data that are routinely collected in Japan. Using the Japanese Diagnosis Procedure Combination inpatient database, we identified patients aged >15 years who were admitted to the ICU from April 2016 to March 2019. We defined resource-rich ICUs as ICUs with two or more intensivists as full-time employees, ≥20 m per ICU bed, and a medical engineer in the hospital 24 hours per day; other ICUs were categorized as standard ICUs. The primary outcome was ICU mortality. A generalized estimating equation approach with ICUs as the clusters was used to compare ICU mortality between the two groups.

Results: Of the 789,630 eligible patients from 458 ICUs, 237,138 (30%) were treated in the 111 resource-rich ICUs, whereas 552,492 (70%) were treated in the 347 standard ICUs. The crude ICU mortality rate was 3.6% (8443/237,138) among patients admitted to resource-rich ICUs, while it was 4.3% (23,490/552,492) among those admitted to standard ICUs. The results of the generalized estimating equation analysis showed that patients treated in resource-rich ICUs tended to have lower ICU mortality compared to patients treated in standard ICUs (difference, -0.4%; 95% confidence interval, -0.8%-0.0%).

Conclusions: The findings of this nationwide study suggest that, compared with care in standard ICUs, care in resource-rich ICUs is associated with lower ICU mortality. This study showed the overall effect of treatment in hospitals with resource-rich ICUs including intensivist staffing and greater hospital resources. Further studies are required to assess the effects of organizational factors on mortality.
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http://dx.doi.org/10.31662/jmaj.2021-0098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8580699PMC
October 2021

Association between hepatic oxygenation on near-infrared spectroscopy and clinical factors in patients undergoing hemodialysis.

PLoS One 2021 21;16(10):e0259064. Epub 2021 Oct 21.

Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

The hepato-splanchnic circulation directly influences oxygenation of the abdominal organs and plays an important role in compensating for the blood volume reduction that occurs in the central circulation during hemodialysis (HD) with ultrafiltration. However, the hepato-splanchnic circulation and oxygenation cannot be easily evaluated in the clinical setting of HD therapy. We included 185 HD patients and 15 healthy volunteers as the control group in this study. Before HD, hepatic regional oxygen saturation (rSO2), a marker of hepatic oxygenation reflecting the hepato-splanchnic circulation and oxygenation, was monitored using an INVOS 5100c oxygen saturation monitor. Hepatic rSO2 was significantly lower in patients undergoing HD than in healthy controls (56.4 ± 14.9% vs. 76.2 ± 9.6%, p < 0.001). Multivariable regression analysis showed that hepatic rSO2 was independently associated with body mass index (BMI; standardized coefficient: 0.294), hemoglobin (Hb) level (standardized coefficient: 0.294), a history of cardiovascular disease (standardized coefficient: -0.157), mean blood pressure (BP; standardized coefficient: 0.154), and serum albumin concentration (standardized coefficient: 0.150) in Model 1 via a simple linear regression analysis. In Model 2 using the colloid osmotic pressure (COP) in place of serum albumin concentration, the COP (standardized coefficient: 0.134) was also identified as affecting hepatic rSO2. Basal hepatic oxygenation before HD might be affected by BMI, Hb levels, a history of cardiovascular disease, mean BP, serum albumin concentration, and the COP. Further prospective studies are needed to clarify whether changes in these parameters, including during HD, affect the hepato-splanchnic circulation and oxygenation in HD patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0259064PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8530328PMC
November 2021

Association of onset time of new-onset atrial fibrillation with in-hospital mortality among critically ill patients: A secondary analysis of a prospective multicenter observational study.

Int J Cardiol Heart Vasc 2021 Oct 27;36:100880. Epub 2021 Sep 27.

Data Science Center, Jichi Medical University, Japan.

Background: New-onset atrial fibrillation (AF) in critically ill patients is associated with adverse outcomes. In non-critical settings, the circadian variation in paroxysmal AF is of significant interest; however, circadian variation in critically ill patients with new-onset AF has not been thoroughly studied. This study aimed to examine the association between AF onset time and in-hospital mortality.

Methods: This was a secondary analysis of a prospective multicenter observational study enrolling adult critically ill patients. According to AF onset time, patients were divided into nighttime (0:00-7:59), daytime (8:00-15:59), and evening (16:00-23:59). We conducted a multiple logistic regression analysis to assess the potential association between AF onset time and in-hospital mortality. We also assessed the distribution of AF onset, crude in-hospital mortality, and adjusted in-hospital mortality according to bihourly intervals.

Results: Of 423 patients, in-hospital mortality was 26%. During nighttime, 135 patients (32%) developed new-onset AF. AF emerged during daytime for 141 (33%) and during evening for 147 (35%). Daytime AF was significantly associated with an increased risk of in-hospital mortality (adjusted OR: 1.92; 95% CI: 1.07-3.44;  = 0.030). Bihourly interval analysis showed that adjusted in-hospital mortality was unevenly distributed and bimodal with troughs between 6:00 and 7:59 and between 18:00 and 19:59. A similar trend was seen in the distribution of the number of new-onset AF.

Conclusions: We found that the bihourly adjusted in-hospital mortality was distributed in a bimodal fashion. Further research is needed to determine the causes of the diurnal variation and its impact on patient outcomes.
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http://dx.doi.org/10.1016/j.ijcha.2021.100880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8488237PMC
October 2021

Intensive care unit versus high-dependency care unit for mechanically ventilated patients with pneumonia: a nationwide comparative effectiveness study.

Lancet Reg Health West Pac 2021 Aug 5;13:100185. Epub 2021 Jul 5.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.

Background: Many mechanically ventilated patients in Japan are treated in high-dependency care units (HDUs) rather than intensive care units (ICUs). HDUs can provide intermediate-level care with reduced costs; however, there is limited evidence on whether mechanically ventilated patients should be treated in the ICU or HDU.

Methods: This was a comparative effectiveness study using a nationwide administrative database in Japan. We identified mechanically ventilated patients with pneumonia in ICU or HDU on the day of admission in the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2019. The primary outcome was 30-day in-hospital mortality. Propensity score matching analysis was performed to compare this outcome between patients treated in the ICU and HDU. The robustness of the analyses was evaluated with multivariable regression, overlap weighting, and instrumental variable analyses.

Findings: Of 14,859 mechanically ventilated patients with pneumonia, 7,528 (51%) were treated in the ICU and 7,331 (49%) were treated in the HDU. After propensity score matching, patients treated in the ICU had significantly lower 30-day in-hospital mortality than did those treated in the HDU (24.0% vs. 31.2%; difference, -7.2%; 95% confidence interval, -10.0% to -4.4%). The multivariable regression, overlap weighting, and instrumental variable analyses showed a similar direction and magnitude of association.

Interpretation: Critical care for mechanically ventilated patients with pneumonia in the ICU was associated with a 7.2% decrease in 30-day in-hospital mortality vs. care in the HDU. Residual confounding may still play a role in the effect estimates.

Funding: This study received funding from Ministry of Health, Labour and Welfare, Japan, and Ministry of Education, Culture, Sports, Science and Technology, Japan.
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http://dx.doi.org/10.1016/j.lanwpc.2021.100185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350066PMC
August 2021

Clinical prediction scores and early anticoagulation therapy for new-onset atrial fibrillation in critical illness: a post-hoc analysis.

BMC Cardiovasc Disord 2021 09 8;21(1):423. Epub 2021 Sep 8.

Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Centre, Saitama, Japan.

Purpose: This study sought to describe the epidemiology of anticoagulation therapy for critically ill patients with new-onset atrial fibrillation (NOAF) according to CHA2DS2-VASc and HAS-BLED scores and to assess the efficacy of early anticoagulation therapy.

Method: Adult patients who developed NOAF during intensive care unit stay were included. We compared the patients who were treated with and without anticoagulation therapy within 48 h from AF onset. The primary outcome was a composite outcome that included mortality and ischemic stroke during the period until hospital discharge.

Results: In total, 308 patients were included in this analysis. Anticoagulants were administered to 95 and 33 patients within 48 h and after 48 h from NOAF onset, respectively. After grouping the patients into four according to their CHA2DS2-VASc and HAS-BLED bleeding scores, we found that the proportion of anticoagulation therapy administered was similar among all groups. After adjustment using a multivariable Cox regression model, we noted that early anticoagulation therapy did not decrease the composite outcome (adjusted hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.47‒1.23). However, in patients without rhythm control drugs, early anticoagulation was significantly associated with better outcomes (adjusted HR 0.46; 95% CI; 0.22‒0.87, P = 0.041).

Conclusions: We found that clinical prediction scores were supposedly not used in the decision to implement anticoagulation therapy and that early anticoagulation therapy did not improve clinical outcomes in critically ill patients with NOAF. Trial registration UMIN-CTR UMIN000026401. Registered 5 March 2017.
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http://dx.doi.org/10.1186/s12872-021-02235-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424957PMC
September 2021

Intravenous cyclophosphamide in acute exacerbation of rheumatoid arthritis-related interstitial lung disease: A propensity-matched analysis using a nationwide inpatient database.

Semin Arthritis Rheum 2021 10 13;51(5):977-982. Epub 2021 Jul 13.

Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.

Objectives: We aimed to investigate the effect of intravenous cyclophosphamide (CYC) as the initial therapy in patients with acute exacerbation of rheumatoid arthritis-related interstitial lung disease.

Methods: This was a retrospective observational study. Using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018, we identified patients with acute exacerbation of rheumatoid arthritis-related interstitial lung disease (RA-ILD) who received high-dose methylprednisolone within 3 days after admission. RA-ILD was defined as having either the diagnosis of RA-ILD or the diagnoses of both RA and ILD, based on the ICD-10 codes recorded by attending physicians. Patients were divided into two groups: those receiving intravenous CYC within 3 days after admission (CYC group) and those who did not (control group). One-to-four propensity-score matching analyses were performed.

Results: A total of 6130 eligible patients were included. After propensity score matching, 129 patients in the CYC group and 516 patients in the control group were further analyzed. 90-day in-hospital mortality, defined as all-cause mortality during hospitalization within 90 days after admission, was not significantly different between the CYC and control groups (50.4% versus 42.2%, hazard ratio 1.20, 95% confidence interval 0.91-1.58). A larger proportion of patients in the CYC group received platelet transfusion than that in the control group (7.0% versus 2.3%, odds ratio 3.05, 95% confidence interval 1.20-7.73).

Conclusion: In this retrospective database study, the initial therapy with CYC did not show a survival benefit in patients with acute exacerbation of RA-ILD. CYC was associated with a larger proportion of platelet transfusion.
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http://dx.doi.org/10.1016/j.semarthrit.2021.07.008DOI Listing
October 2021

Gap between desired and self-determined roles of general practitioners: a multicentre questionnaire study in Japan.

BMC Fam Pract 2021 07 31;22(1):162. Epub 2021 Jul 31.

Department of Clinical Oncology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan.

Background: Primary care physicians have diverse responsibilities. To collaborate with cancer specialists efficiently, they should prioritise roles desired by other collaborators rather than roles based on their own beliefs. No previous studies have reported the priority of roles such clinic-based general practitioners are expected to fulfil across the cancer care continuum. This study clarified the desired roles of clinic-based general practitioners to maximise person-centred cancer care.

Methods: A web-based multicentre questionnaire in Japan was distributed to physicians in 2019. Physician roles within the cancer care continuum were divided into 12 categories, including prevention, diagnosis, surgery, follow-up with cancer survivors, chemotherapy, and palliative care. Responses were evaluated by the proportion of three high-priority items to determine the expected roles of clinic-based general practitioners according to responding physicians in similarly designated roles.

Results: Seventy-eight departments (25% of those recruited) from 49 institutions returned questionnaires. Results revealed that some physicians had lower expectations for clinic-based general practitioners to diagnose cancer, and instead expected them to provide palliative care. However, some physicians expected clinic-based general practitioners to be involved in some treatment and survivorship care, though the clinic-based general practitioners did not report the same priority.

Conclusion: Clinic-based general practitioners prioritised involvement in prevention, diagnoses, and palliative care across the cancer continuum, although lower expectations were placed on them than they thought. Some additional expectations of their involvement in cancer treatment and survivorship care were unanticipated by them. These gaps represent issues that should be addressed.
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http://dx.doi.org/10.1186/s12875-021-01512-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325324PMC
July 2021

Association Between Third-Generation Fluoroquinolones and Achilles Tendon Rupture: A Self-Controlled Case Series Analysis.

Ann Fam Med 2021 May-Jun;19(3):212-216

Data Science Center, Jichi Medical University, Tochigi, Japan.

Purpose: We investigated whether use of third-generation fluoroquinolones is associated with occurrence of Achilles tendon rupture using a case series analysis in which patients served as their own control.

Methods: We used administrative claims data to identify residents in a single Japanese prefecture who were enrolled in National Health Insurance and Elderly Health Insurance from April 2012 to March 2017 and experienced Achilles tendon rupture after receiving an antibiotic prescription. Antibiotics were categorized into 3 groups: first- and second-generation fluoroquinolones, third-generation fluoroquinolones, and nonfluoroquinolones. We used a conditional Poisson regression model to estimate the incidence rate ratio (IRR) of Achilles tendon rupture during the antibiotic exposure period relative to the nonexposure period for each patient. An exposure period was defined as 30 days from start of the prescription.

Results: Analyses were based on 504 patients with Achilles tendon rupture who had received antibiotic prescriptions. Risk of rupture was not significantly elevated during exposure to third-generation fluoroquinolones (IRR = 1.05; 95% CI, 0.33-3.37) and nonfluoroquinolones (IRR = 1.08; 95% CI, 0.80-1.47). In contrast, risk was significantly elevated during exposure to first- and second-generation fluoroquinolones (IRR = 2.94; 95% CI, 1.90-4.54). Findings were similar across subgroups stratified by sex and by recent corticosteroid use.

Conclusions: Our analysis showed that third-generation fluoroquinolone use was not associated with an increased risk of Achilles tendon rupture. These antibiotics may be a safer option for patients in whom this risk is elevated, such as athletes.
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http://dx.doi.org/10.1370/afm.2673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8118488PMC
October 2021

Intensive care unit occupancy in Japan, 2015-2018: a nationwide inpatient database study.

J Epidemiol 2021 Apr 10. Epub 2021 Apr 10.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo.

Background: Detailed data on intensive care unit (ICU) occupancy in Japan are lacking. Using a nationwide inpatient database in Japan, we aimed to assess ICU bed occupancy to guide critical care utilization planning.

Methods: We identified all ICU patients admitted from January 1, 2015 to December 31, 2018 to ICU-equipped hospitals participating in the Japanese Diagnosis Procedure Combination inpatient database. We assessed the trends in daily occupancy by counting the total number of occupied ICU beds on a given day divided by the total number of licensed ICU beds in the participating hospitals. We also assessed ICU occupancy for patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies.

Results: Over the 4 study years, 1,379,618 ICU patients were admitted to 495 hospitals equipped with 5,341 ICU beds, accounting for 75% of all ICU beds in Japan. Mean ICU occupancy on any given day was 60%, with a range of 45.0% to 72.5%. Mean ICU occupancy did not change over the 4 years. Mean ICU occupancy was about 9% higher on weekdays than on weekends and about 5% higher in the coldest season than in the warmest season. For patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies, mean ICU occupancy was 24%, 0.5%, and 30%, respectively.

Conclusion: Only one-fourth of ICU beds were occupied by mechanically ventilated patients, suggesting that the critical care system in Japan has substantial surge capacity under normal temporal variation to care for critically ill patients.
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http://dx.doi.org/10.2188/jea.JE20210016DOI Listing
April 2021

Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU study.

Int J Cardiol Heart Vasc 2021 Apr 1;33:100742. Epub 2021 Mar 1.

Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

Background: Sustained new-onset atrial fibrillation (AF) in the intensive care unit has been reported to be associated with poor outcomes. However, in critical illness, whether rhythm-control therapy can achieve sinus rhythm (SR) restoration is unknown. This study aimed to assess the impact of rhythm-control therapy on SR restoration for new-onset AF in critically ill patients.

Methods: This post-hoc analysis of a prospective multicenter observational study involving 32 Japan intensive care units compared patients with and without rhythm-control therapy for new-onset atrial fibrillation (AF) and conducted a multivariable analysis using Cox proportional hazards regression analysis including rhythm-control therapy as a time-varying covariate for SR restoration.

Results: Of 423 new-onset AF patients, 178 patients (42%) underwent rhythm-control therapy. Among those patients, 131 (31%) underwent rhythm-control therapy within 6 h after AF onset. Magnesium sulphate was the most frequently used rhythm-control drug. The Cox proportional hazards model for SR restoration showed that rhythm-control therapy had a significant positive association with SR restoration (adjusted hazard ratio: 1.46; 95% confidence interval: 1.16-1.85). However, the rhythm-control group had numerically higher hospital mortality than the non-rhythm-control group (31% vs. 23%, p = 0.09).

Conclusions: Rhythm-control therapy for new-onset AF in critically ill patients was associated with SR restoration. However, patients with rhythm-control therapy had poorer prognosis, possibly due to selection bias. These findings may provide important insight for the design and feasibility of interventional studies assessing rhythm-control therapy in new-onset AF.
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http://dx.doi.org/10.1016/j.ijcha.2021.100742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937754PMC
April 2021

Increased risk of infective endocarditis after traumatic skin wound.

Heart 2021 12 25;107(23):1868-1874. Epub 2021 Feb 25.

Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan.

Objective: Current data suggest that a history of traumatic open skin wounds may be a risk factor for infectious endocarditis, with limited evidence. We tested the hypothesis that traumatic skin wound is a risk factor for infectious endocarditis.

Methods: Using the Japan Medical Data Center (JMDC) database (4 650 927 people aged 20-64 years, 2012-2018) and the Kumamoto database (493 414 people aged ≥65 years, 2012-2017), we conducted nested case-control and self-controlled case series (SCCS) analyses.

Results: In the JMDC database, 544 cases hospitalised for infective endocarditis (IE) were matched with 2091 controls; 2.8% of cases and 0.5% of controls were exposed to traumatic skin wounds in the previous 1-4 weeks, with an adjusted OR of 4.31 (95% CI 1.74 to 10.7). In the Kumamoto database, 4.0% (27/670) of cases and 1.1% (29/2581) of controls were exposed to traumatic skin wounds in the previous 1-4 weeks, with an adjusted OR of 4.15 (95% CI 2.04 to 8.46). In the SCCS, the incidence rate ratios for IE were 2.61 (95% CI 1.67 to 4.09), 1.73 (95% CI 1.01 to 2.94), 1.19 (95% CI 0.63 to 2.27) and 1.52 (95% CI 0.82 to 2.74) for the Kumamoto database and 3.78 (95% CI 2.07 to 6.92), 1.58 (95% CI 0.64 to 3.89), 1.60 (95% CI 0.65 to 3.94) and 1.29 (95% CI 0.47 to 3.53) for the JMDC database at 1-4, 5-8, 9-12 and 13-16 weeks after traumatic skin wound, respectively, compared with the baseline period.

Conclusions: This study suggests that traumatic skin wound is a risk factor for IE 1-4 weeks after the wound.
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http://dx.doi.org/10.1136/heartjnl-2020-318632DOI Listing
December 2021

Association between Cerebral Oxygenation, as Evaluated with Near-Infrared Spectroscopy, and Cognitive Function in Patients Undergoing Hemodialysis.

Nephron 2021 8;145(2):171-178. Epub 2021 Feb 8.

Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Introduction: The prevalence of cognitive impairment in patients undergoing hemodialysis (HD) is higher than that in healthy controls. To date, studies on the association between cognitive function and cerebral oxygenation in these patients are limited. Therefore, in this study, we aimed to cross-sectionally investigate the association between cognitive assessment scores and clinical factors, including cerebral oxygenation, in patients undergoing HD.

Methods: In this observational study, 193 HD patients were included. Cerebral regional oxygen saturation (rSO2) was monitored using an INVOS 5,100c oxygen saturation monitor. Poor cognition was defined as a Mini-Mental State Examination (MMSE) score ≤23. We analyzed the association between MMSE score and clinical factors, including cerebral rSO2.

Results: MMSE score in HD patients included in this study was 26.8 ± 3.3. There were 164 patients (85%) with MMSE score ≥24 and 29 patients (15%) with an MMSE score ≤23. In the patients with MMSE score ≥24, cerebral rSO2 (53.8% ± 8.3%) was significantly higher than that in patients with MMSE score ≤23 (49.5% ± 9.8%; p = 0.013). Multivariable linear regression analysis was performed using the following confounding factors: age, mean blood pressure, cerebral rSO2, HD duration, ultrafiltration rate, hemoglobin, serum Cr, serum calcium, serum phosphate, total cholesterol, high-density lipoprotein cholesterol levels, serum albumin, presence of diabetes mellitus or chronic glomerulonephritis, history of comorbid cardiovascular or cerebrovascular disease, and use of renin-angiotensin-aldosterone system inhibitors or vitamin D analogs. MMSE score was independently and significantly associated with age (standardized coefficient: -0.244) and cerebral rSO2 (standardized coefficient: 0.180).

Conclusions: MMSE score was independently associated with age (negative effect) and cerebral rSO2 (positive effect) in this cross-sectional study. Further prospective studies are needed to clarify whether maintaining cerebral oxygenation prevents the deterioration of cognitive function in patients undergoing HD.
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http://dx.doi.org/10.1159/000513327DOI Listing
November 2021

Intermittent versus continuous neuromuscular blockade during target temperature management after cardiac arrest: A nationwide observational study.

J Crit Care 2021 04 14;62:276-282. Epub 2021 Jan 14.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

Purpose: Whether intermittent or continuous neuromuscular-blocking agents (NMBAs) would be appropriate during target temperature management (TTM) after cardiac arrest remains unclear.

Materials And Methods: In this retrospective cohort study, we utilized the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018 and identified patients who received NMBAs during TTM after cardiac arrest on the day of admission. We compared the in-hospital mortality between the propensity-score-matched intermittent and continuous NMBA groups.

Results: We identified 5584 eligible patients; 1488 received intermittent NMBAs and 4096 received continuous NMBAs. After propensity score matching, there was no significant difference in the in-hospital mortality between the intermittent and continuous NMBA groups (32.9% vs. 33.1%; odds ratio, 0.98; 95% confidence interval, 0.82-1.18). In subgroup analyses, in-hospital mortality of the continuous NMBA group was significantly higher than that of the intermittent NMBA group in patients aged ≥65 years (p for interaction = 0.021).

Conclusions: This large retrospective study did not suggest that intermittent NMBAs may be inferior to continuous NMBAs in terms of mortality reduction in the overall population receiving TTM for cardiac arrest. However, continuous NMBAs may be inferior to intermittent NMBAs for reducing mortality in elderly patients.
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http://dx.doi.org/10.1016/j.jcrc.2021.01.002DOI Listing
April 2021

Safety and effectiveness of intracardiac echocardiography in ventricular tachycardia ablation: a nationwide observational study.

Heart Vessels 2021 Jul 21;36(7):1009-1015. Epub 2021 Jan 21.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

Intracardiac echocardiography (ICE) utilized in conjunction with three-dimensional (3-D) mapping systems could enhance ventricular tachycardia (VT) ablation procedures. ICE has been increasingly used in VT ablation; however, the safety and effectiveness of VT ablation under the combined use of ICE remains unclear. The present study aimed to analyze the safety and short-term effects of VT ablation with or without ICE. We retrospectively enrolled patients who underwent initial VT ablation with a combination of ICE and a 3-D mapping system within 3 days of hospitalization and discharged from April 2011 to March 2017 using a nationwide Japanese inpatient database. Following enrollment, we conducted a propensity score-matching analysis to compare safety (in-hospital complications) and effectiveness (readmission within 30 days after discharge due to cardiovascular disease and readmissions within 30 days for repeat VT ablations) between patients who underwent VT ablation with (ICE group) and without ICE (non-ICE group). 3-D mapping systems were applied to both groups. We identified 5,804 eligible patients (1,272 and 4,532 patients in the ICE and non-ICE groups, respectively). One-to-one propensity score matching created a total of 1,147 pairs between the ICE and non-ICE groups. The ICE group showed a significantly lower prevalence of cardiac tamponade than the non-ICE group. There were no significant differences observed between the two groups regarding other outcomes concerning safety and effectiveness. Ventricular tachycardia ablation with ICE used in combination with a 3-D mapping system may reduce cardiac tamponade; however, no additional clinical advantages were noted in terms of safety and effectiveness.
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http://dx.doi.org/10.1007/s00380-020-01766-yDOI Listing
July 2021

Clinical Impact of Prescribed Doses of Nutrients for Patients Exclusively Receiving Parenteral Nutrition in Japanese Hospitals: A Retrospective Cohort Study.

JPEN J Parenter Enteral Nutr 2021 09 11;45(7):1514-1522. Epub 2020 Nov 11.

Medical Affairs Department, Otsuka Pharmaceutical Factory, Inc, Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, Japan.

Background: In patients receiving parenteral nutrition (PN), the association between nutrition achievement in accordance with nutrition guidelines and outcomes remains unclear. Our purpose was to assess the association between nutrition achievement and clinical outcomes, including in-hospital mortality, activity of daily living (ADL), and readmission.

Methods: In this retrospective cohort study, data were extracted from an inpatient medical-claims database at 380 acute care hospitals. This study included patients who underwent central venous catheter insertion between January 2009 and December 2018. Patients were classified into 3 groups: (1) target-not-achieved; (2) target-partially-achieved; and (3) target-achieved. The target doses of energy, amino acids, and lipid were defined as ≥20 kcal/kg/day, ≥1.0 g/kg/day, and ≥2.5 g/day, respectively. To examine the effect of nutrition achievement on outcomes, a multivariable logistic regression analysis was performed.

Results: A total of 54,687 patients were included; of these, 21,383 patients were in the target-not-achieved group, 29,610 patients were in the target-partially-achieved group, and 3694 patients were in the target-achieved group. The adjusted odds ratio (OR) (95% CI) for in-hospital mortality was 0.69 (0.66-0.72) in the target-partially-achieved group and 0.47 (0.43-0.52) in the target-achieved group with reference to the target-not-achieved group. The adjusted ORs for deteriorated ADL was 0.93 (0.85-1.01) in the target-partially-achieved group and 0.77 (0.65-0.92) in the target-achieved group with reference to the target-not-achieved group. Readmission was not associated with nutrition achievement.

Conclusion: In-hospital mortality was lower and deteriorated ADL was suppressed in patients whose PN management was in accordance with the nutrition guidelines.
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http://dx.doi.org/10.1002/jpen.2033DOI Listing
September 2021

Correction to: Prognostic impact of sustained new-onset atrial fibrillation in critically ill patients.

Intensive Care Med 2021 Mar;47(3):367-368

Department of Biostatistics, The University of Tokyo, Tokyo, Japan.

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http://dx.doi.org/10.1007/s00134-020-06253-6DOI Listing
March 2021

A survey on total parenteral nutrition in 55,000 hospitalized patients: Retrospective cohort study using a medical claims database.

Clin Nutr ESPEN 2020 10 21;39:198-205. Epub 2020 Jul 21.

Medical Affairs Department, Otsuka Pharmaceutical Factory, Inc., 2-9 Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, 101-0048, Japan.

Background & Aims: Identifying the prevalence of underfed patients and risk factors for underfeeding in patients with total parenteral nutrition (TPN) is essential to improve the management of patients receiving TPN. The aim of this study was to examine the prevalence and risk factors for underfeeding using a medical claims database.

Methods: In this retrospective cohort study using a medical claims database, we analyzed patient characteristics, timing and duration of nutrition prescription, daily dose of nutrients, and types of parenteral nutrition products administered after central venous catheter (CVC) insertion in hospitalized Japanese patients between 2009 and 2018. The mean prescriptions of energy <20 kcal/kg/day, amino acids <1.0 g/kg/day, and fat <2.5 g/day received by patients between the 4th and 10th day after CVC insertion were regarded as underfeeding. To study the association between nutritional adequacy and body mass index (BMI) with TPN, the proportions of patients with a prescription of energy ≥20 kcal/kg/day or amino acids ≥1.0 g/kg/day were calculated and categorized according to BMI, and the Cochran-Armitage trend test was performed.

Results: Of 54,687 patients included in the study, 70.3% were aged ≥70 years, and 31.3% had a BMI <18.5. The mean prescription of energy was insufficient in 49.9% of patients, and 82.9% were insufficiently prescribed with amino acids. In addition, 44.4% of the patients were never prescribed a single dose of fat emulsion during their hospital stay. On the 10th day after CVC insertion, the majority of patients used commercial 2-in-1 compounds containing carbohydrates and amino acids. A higher BMI was associated with underfeeding of energy and amino acids (both p < 0.001).

Conclusions: It is important to adjust the nutrition dose according to the patient's body size and weight, and it is necessary to supplement inadequate nutrients by single-nutrition solutions in addition to compounded solutions.
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http://dx.doi.org/10.1016/j.clnesp.2020.06.013DOI Listing
October 2020

Associations of cerebral oxygenation with hemoglobin levels evaluated by near-infrared spectroscopy in hemodialysis patients.

PLoS One 2020 10;15(8):e0236720. Epub 2020 Aug 10.

Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Hemoglobin (Hb) is associated with cerebral oxygenation status owing to its important role of carrying oxygen to systemic tissues. However, data concerning the associations between Hb levels and cerebral regional oxygen saturation (rSO2) of hemodialysis (HD) patients is limited. We aimed to identify these associations to consider a target Hb level for renal anemia management. This study included 375 HD patients. Cerebral rSO2 before HD was monitored using the INVOS 5100c oxygen saturation monitor. Multivariable linear regression analysis showed that cerebral rSO2 was independently associated with natural logarithm (Ln)-HD duration (standardized coefficient: -0.36), mean blood pressure (standardized coefficient: 0.13), pH (standardized coefficient: -0.10), serum albumin (standardized coefficient: 0.14), presence of diabetes mellitus (standardized coefficient: -0.20), and Hb level (standardized coefficient: 0.29). Furthermore, a generalized linear model with restricted cubic spline function was used to investigate the non-linear association between cerebral rSO2 and Hb levels. In the multivariable analysis for the adjustment with Ln-HD duration, mean blood pressure, pH, serum albumin, and presence of diabetes mellitus, a linear relationship was demonstrated between the two variables (p for linearity = 0.79). Hb levels revealed the positive and significant association with cerebral rSO2 in this study. Moreover, the relationship between cerebral rSO2 and Hb level was proven to be linear. Therefore, the target Hb level in renal anemia management would be considered to be the upper limits for the appropriate management of renal anemia by previous guidelines and position statement from the viewpoint of maintaining cerebral oxygenation in HD patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236720PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416957PMC
October 2020

Histamine-2 receptor antagonists versus proton pump inhibitors for septic shock after lower gastrointestinal tract perforation: a retrospective cohort study using a national inpatient database.

J Intensive Care 2020 31;8:56. Epub 2020 Jul 31.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan.

Background: Studies have shown the potential benefit of stress ulcer prophylaxis including histamine-2 receptor antagonists (H2RA) and proton pump inhibitors (PPI) in critically ill patients. However, the adverse effects of stress ulcer prophylaxis such as infection (CDI) and hospital-acquired pneumonia have been reported. Abdominal septic shock is associated with increased risk of bleeding, CDI, and pneumonia; however, which ulcer prophylaxis might be associated with better outcomes in patients with septic shock after lower gastrointestinal tract perforation is unknown.

Methods: In this retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2015, we identified patients aged 18 years or older who received open abdominal surgery for lower gastrointestinal tract perforation and who used vasopressors and antibiotics within 2 days of admission. We performed propensity score matching and inverse probability of treatment weighting (IPTW) to compare the outcomes between patients who received H2RA and those who received PPI within 2 days of admission. The outcomes included gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission, 28-day mortality, CDI, and hospital-acquired pneumonia.

Results: The propensity score matching created 1088 pairs of patients who received H2RA or PPI within 2 days of admission. There were no significant differences between the H2RA and PPI groups regarding gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission (0.74% vs 1.3%, risk ratio 0.57 (0.24-1.4), and = 0.284), 28-day mortality (11.3% vs 12.9%, risk ratio 0.88 (0.68-1.1), and = 0.386), CDI (0.64% vs 0.46%, risk ratio 1.4 (0.45-4.4), and = 0.774), and hospital-acquired pneumonia (3.0% vs 4.3%, risk ratio 0.70 (0.45-1.1), and = 0.138). IPTW analysis showed similar results.

Conclusions: There were no significant differences in gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission, 28-day mortality, CDI, and hospital-acquired pneumonia between H2RA and PPI in patients with septic shock after lower gastrointestinal tract perforation.
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http://dx.doi.org/10.1186/s40560-020-00473-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395359PMC
July 2020

Clinical course after identification of new-onset atrial fibrillation in critically ill patients: The AFTER-ICU study.

J Crit Care 2020 10 5;59:136-142. Epub 2020 Jul 5.

Data Science Center, Jichi Medical University, Tochigi, Japan.

Purpose: Epidemiological information is lacking after identification of new-onset atrial fibrillation (AF) in critically ill patients. This study aimed to describe the clinical course after the identification of new-onset AF.

Materials And Methods: This prospective cohort study enrolled adult patients with new-onset AF in 32 Japanese ICUs during 2017-2018. We collected data on patient comorbidities, physiological information before and at the AF onset, interventions for AF, cardiac rhythm transition, adverse events and in-hospital death and stroke.

Results: We included 423 new-onset AF patients. At the AF onset, mean arterial pressure decreased and the heart rate increased. Eighty-four patients (20%) spontaneously restored sinus rhythm and 328 patients (78%) received various pharmacological interventions (rate-control drugs, 67%; rhythm-control drugs, 34%). Anticoagulants were administered in 173 patients (40%) and 13 patients (3%) experienced bleeding complications. Twenty-four patients (6%) were still in AF at 168 h after the onset (sustained AF 4%; recurrent AF 2%). The overall hospital mortality was 26% and the incidence of in-hospital stroke was 4.5%.

Conclusions: Although the proportion of patients with AF continued to decrease with various treatments, these patients had high risk of death. Further research to assess the management of new-onset AF in critically ill patients is warranted.
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http://dx.doi.org/10.1016/j.jcrc.2020.06.014DOI Listing
October 2020

Angiography versus colonoscopy in patients with severe lower gastrointestinal bleeding: a nation-wide observational study.

Acute Med Surg 2020 Jan-Dec;7(1):e533. Epub 2020 Jun 30.

Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan.

Aim: Clinical guidelines for acute lower gastrointestinal bleeding (LGIB) recommend non-endoscopic treatment when endoscopic treatment is difficult or the patient is hemodynamically unstable. The aim of this study was to investigate whether angiography should be prioritized as initial treatment for severe LGIB patients over colonoscopy.

Methods: We undertook a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We compared adult patients who underwent colonoscopy or angiography within 1 day of admission for severe LGIB from 2010 to 2017. The primary outcome was in-hospital mortality. Secondary outcomes included surgery carried out within 1 day after admission and surgery carried out between 2 and 7 days of admission. Propensity score-matched analyses were undertaken to adjust for confounders.

Results: We identified 6,546 eligible patients. The patients were divided into the colonoscopy group ( = 5,737) and angiography group ( = 809). After one-to-four propensity score matching, we compared 3,220 and 805 patients who underwent colonoscopy and angiography, respectively. The angiography group was not significantly associated with reduced in-hospital mortality compared with the colonoscopy group. In contrast, the number of patients who underwent surgery within 1 day of admission was significantly lower in the angiography group than in the colonoscopy group.

Conclusions: The present study revealed that in-hospital mortality did not significantly differ between colonoscopy and angiography, even in severe LGIB patients. Although this study was unable to identify which subgroups should undergo angiography for primary hemostasis, angiography might be a better option than colonoscopy for initial hemostasis in more severe cases of LGIB.
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http://dx.doi.org/10.1002/ams2.533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326725PMC
June 2020

Patient characteristics, procedure details including catheter devices, and complications of catheter ablation for ventricular tachycardia: a nationwide observational study.

J Arrhythm 2020 Jun 5;36(3):464-470. Epub 2020 May 5.

Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan.

Background: Nationwide data are insufficient with respect to the characteristics of patients undergoing ventricular tachycardia (VT) ablation, complications of VT ablation, and procedure details including catheter devices used during VT ablation. The present study was performed to describe the patient characteristics, procedure details including catheter devices, and in-hospital complications of catheter ablation for VT using a national inpatient database.

Methods: We used the Diagnosis Procedure Combination database, a national Japanese inpatient database, to identify patients who underwent VT ablation from July 2010 to March 2017. We examined patients' age, gender, baseline diseases, comorbid conditions, admission status, catheter devices and drugs used, and in-hospital complications of VT ablation.

Results: We identified 10 641 patients (median age, 61 years) who underwent VT ablation. The most frequently observed background heart disease among patients with structural heart disease was ischemic cardiomyopathy. An irrigated ablation catheter was used in 73% of patients, a force-sensing ablation catheter was used in 22%, and intracardiac echocardiography was used in 25%. The frequency of using these procedures continuously increased over time. Overall, the prevalence of in-hospital complications was 3.5% (cardiac tamponade, 0.8%; stroke, 0.6%; critical bleeding, 1.9%; mechanical circulatory support, 0.9%; and in-hospital death, 0.8%).

Conclusions: The results of this study show the clinical features of VT ablation in a real-world clinical setting. The use of irrigated catheters, force-sensing catheters, and intracardiac echocardiography increased over time. The prevalence of in-hospital complications was 3.5%.
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http://dx.doi.org/10.1002/joa3.12356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279962PMC
June 2020

Acute Kidney Injury Following Elective Open Aortic Repair with Suprarenal Clamping.

Ann Vasc Dis 2020 Mar;13(1):45-51

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan.

: To investigate predictors of acute kidney injury (AKI) following open aortic repair (OAR) requiring suprarenal clamping. : The study included 833 nonhemodialysis patients who had undergone elective OAR (with suprarenal clamping, n=73; with infrarenal clamping, n=760). We evaluated AKI as defined by the criteria of the Kidney Disease Improving Global Outcomes (KDIGO) and compared in-hospital outcomes between the two groups. We also investigated the effects of AKI on outcomes, factors related to post-suprarenal clamping AKI, and efficacy of hypothermic renal perfusion (HRP) in the suprarenal clamping group. : For the suprarenal vs. infrarenal clamping group, in-hospital mortality was 0% (0/73) vs. 0.5% (4/760). The incidence of AKI was greater in the suprarenal clamping group (37% vs. 15%, P<0.001), and the hospital stay for patients with AKI was longer than for those patients without AKI (median, 21 days vs. 16 days; P=0.005). Renal ischemia time and bleeding volume >1,000 mL were associated with post-suprarenal clamping AKI. Renal ischemia time was longer with HRP (n=15) than without HRP (n=58) (median, 51 min vs. 33 min; P=0.011), and HRP did not decrease the incidence of AKI (40% vs. 36%; P=0.78). : Prolonged renal ischemia and substantial intraoperative bleeding are associated with postoperative AKI following suprarenal clamping.
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http://dx.doi.org/10.3400/avd.oa.19-00095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7140154PMC
March 2020

Etiology and impact on outcomes of polycystic kidney disease in abdominal aortic aneurysm.

Surg Today 2020 Oct 6;50(10):1213-1222. Epub 2020 Apr 6.

Department of General Internal Medicine, School of Medicine, The Jikei University, Tokyo, 105-8461, Japan.

Purpose: We investigated the etiology and impact on outcomes of polycystic kidney disease in patients with abdominal aortic aneurysm.

Methods: Eight-hundred patients who underwent open (n = 603) or endovascular aortic repair (n = 197) were divided into three groups: no cyst (n = 204), non-polycystic kidney (n = 503), and polycystic kidney (≥ 5 cysts in the bilateral kidneys, n = 93). The characteristics and outcomes were compared among the groups.

Results: In the polycystic kidney group, the age was increased and the proportions of patients with male sex, hypertension, and estimated glomerular filtration rate < 30 mL/min/1.73 m were greater. The overall hospital mortality rates were similar. The incidence of acute kidney injury after elective open aortic repair was increased in the polycystic kidney group (12%, 17%, and 29%, P = 0.020). In the polycystic kidney group, 80 patients did not have renal enlargement or a family history of renal disease, while 13 (corresponding to 1.6% [13/800] of the overall patients), had renal enlargement, suggesting the possibility of hereditary polycystic kidney disease.

Conclusions: In our cohort, 1.6% of the patients with abdominal aortic aneurysm who underwent surgery were at risk of hereditary polycystic kidney disease. Polycystic kidney disease was associated with acute kidney injury after open aortic repair.
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http://dx.doi.org/10.1007/s00595-020-01997-6DOI Listing
October 2020

Vasodilator Therapy and Mortality in Nonocclusive Mesenteric Ischemia: A Nationwide Observational Study.

Crit Care Med 2020 05;48(5):e356-e361

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

Objectives: Previous studies have suggested that vasodilator therapy may be beneficial for patients with nonocclusive mesenteric ischemia. However, robust evidence supporting this contention is lacking. We examined the hypothesis that vasodilator therapy may be effective in patients diagnosed with nonocclusive mesenteric ischemia.

Design: Retrospective cohort study.

Setting: The Japanese Diagnosis Procedure Combination inpatient database.

Patients: A total of 1,837 patients with nonocclusive mesenteric ischemia from July 2010 to March 2018.

Interventions: None.

Measurements And Main Results: We compared patients who received vasodilator therapy (vasodilator group; n = 161) and those who did not (control group; n = 1,676) using one-to-four propensity score matching. Vasodilator therapy was defined as papaverine and/or prostaglandin E1 administered via venous and/or arterial routes within 2 days of admission. Only patients who did not receive abdominal surgery within 2 days of admission were analyzed. The main outcomes were in-hospital mortality and abdominal surgery performed greater than or equal to 3 days after admission. After propensity score matching, in-hospital mortality was significantly lower in the vasodilator group (risk difference, -11.6%; p = 0.005). The proportion of patients who received abdominal surgery at greater than or equal to 3 days after admission was also significantly lower in the vasodilator group (risk difference, -10.2%; p = 0.002).

Conclusions: Vasodilator therapy with papaverine and/or prostaglandin E1 is associated with lower in-hospital mortality and prevalence of abdominal surgery in patients with nonocclusive mesenteric ischemia.
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http://dx.doi.org/10.1097/CCM.0000000000004255DOI Listing
May 2020

The effect of antithrombin added to recombinant human-soluble thrombomodulin for severe community-acquired pneumonia-associated disseminated intravascular coagulation: a retrospective cohort study using a nationwide inpatient database.

J Intensive Care 2020 13;8. Epub 2020 Jan 13.

4Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033 Japan.

Background: Studies showed potential benefits of recombinant human-soluble thrombomodulin (rhTM) and antithrombin for treating sepsis associated disseminated intravascular coagulation. However, benefits of their combination have been inconclusive.

Methods: Using a nationwide inpatient database in Japan, we performed propensity-score matched analyses to compare outcomes between rhTM combined with antithrombin and rhTM alone for severe community-acquired pneumonia associated disseminated intravascular coagulation from July 2010 to March 2015. The outcomes included in-hospital mortality and requirement of red cell transfusion.

Results: Propensity score matching created 189 pairs of patients who received rhTM combined with antithrombin or rhTM alone within 2 days of admission. There was no significant difference between the two groups for in-hospital mortality (40.2% vs. 45.5%). Patients treated with rhTM and antithrombin were more likely to require red cell transfusion than those treated with rhTM alone (37.0% vs. 25.9%).

Conclusions: Compared with rhTM alone, combination of rhTM with antithrombin for severe community-acquired pneumonia-associated disseminated intravascular coagulation may be ineffective for reducing mortality and may increase bleeding.
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http://dx.doi.org/10.1186/s40560-019-0419-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6958595PMC
January 2020

Clinical Effect of the Acrylonitrile-Co-Methallyl Sulfonate Surface-Treated Membrane as a Cytokine Adsorption Therapy for Sepsis due to Acute Panperitonitis: A Retrospective Cohort Study.

Blood Purif 2020 15;49(3):364-371. Epub 2020 Jan 15.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

Introduction: Sepsis is a systemic inflammatory response syndrome caused by infectious diseases, with cytokines possibly having an important role in the disease mechanism. Acrylonitrile-co-methallyl sulfonate surface-treated (AN69ST) membrane is expected to improve the outcomes of patients with sepsis through cytokine adsorption.

Objective: This study aimed to investigate the clinical effect of the AN69ST membrane in comparison to standard continuous renal replacement therapy (CRRT) membranes for panperitonitis due to lower gastrointestinal perforation.

Methods: Using the Diagnosis Procedure Combination database, we identified adult patients with sepsis due to panperitonitis receiving any CRRT. Propensity score matching was used to compare patients who received CRRT with the AN69ST membrane (AN69ST group) and those who received CRRT with other membranes (non-AN69ST group). The primary outcome measure was in-hospital mortality.

Results: A total of 528 and 1,445 patients were included in the AN69ST group and in the non-AN69ST group, respectively. Propensity score matching resulted in 521 pairs. There was no significant difference in in-hospital mortality (32.1 vs. 35.5%; p = 0.265) and 30-day mortality (41.3 vs. 42.8%, p = 0.074) between the AN69ST group and the non-AN69ST group.

Conclusion: There is no significant difference in-hospital mortality between CRRT with the AN69ST membrane and CRRT with standard CRRT membranes for panperitonitis due to lower gastrointestinal perforation. These results indicate that the AN69ST membrane is not superior to the standard CRRT membrane.
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http://dx.doi.org/10.1159/000504560DOI Listing
April 2021

Patient characteristics and in-hospital complications of subcutaneous implantable cardioverter-defibrillator for Brugada syndrome in Japan.

J Arrhythm 2019 Dec 16;35(6):842-847. Epub 2019 Sep 16.

Department of Clinical Epidemiology and Health Economics School of Public Health The University of Tokyo Tokyo Japan.

Background: Clinical features and complications of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation for Brugada syndrome have not been well studied.

Methods: We used the Japanese Diagnosis Procedure Combination database to retrospectively investigate patients who had undergone ICD implantation between April 2016 and March 2017. We compared the characteristics and in-hospital complications of patients with Brugada syndrome implanted with S-ICD or transvenous (TV)-ICD.

Results: We extracted 3090 patients who received ICD implantation. Among them, we identified 278 Brugada patients. The mean age was 43 ± 14.4 years and 262 (94%) were male. Of these 278 patients, 136 (49%) received S-ICD and 142 (51%) received TV-ICD. TV-ICD recipients had a history of atrial fibrillation more frequently compared with S-ICD recipients. The median (interquartile range) of length of hospital stay was not significantly different between patients with S-ICD and TV-ICD (13 days [10-20.5] vs 12 days [10-18], respectively). The prevalence of in-hospital complications after ICD implantation was similar between the two groups. There were no patients with cardiac tamponade, hemothorax, pneumothorax, cardiovascular event, stroke, and death following the procedure during hospitalization in either group.

Conclusions: Short-term safety of S-ICD implantation may be identical to that of TV-ICD. Large prospective studies are warranted to compare the effects and long-term safety of S-ICD compared with TV-ICD.
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http://dx.doi.org/10.1002/joa3.12234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898525PMC
December 2019

Large volume infusions of hydroxyethyl starch during cardiothoracic surgery may be associated with postoperative kidney injury: propensity-matched analysis.

Perioper Med (Lond) 2019 31;8:13. Epub 2019 Oct 31.

3Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi 329-0498 Japan.

Background: The safety of intraoperative administration of hydroxyethyl starch (HES) has been debated. We hypothesized that intraoperative use of HES is associated with postoperative acute kidney injury (AKI) following cardiopulmonary bypass (CPB).

Materials And Methods: Patients who underwent cardiothoracic surgery using CPB between 2007 and 2014 were retrospectively reviewed. The incidence of AKI within 7 days after surgery, defined by the Kidney Disease Improving Global Outcome criteria, was compared for patients who did or did not receive 6% (70/0.5) or 6% (130/0.4) HES for anesthesia management before or after CPB. Multivariable logistic regression and propensity matching analysis were performed to examine whether use of HES is associated with postoperative AKI. Outcomes comparing patients receiving HES ≥ 1000 mL and < 1000 mL were also compared.

Results: Data from 1976 patients were reviewed. All patients received 70/0.5 HES as a part of the priming solution for CPB. The incidence of postoperative AKI was 28.2% in patients who received HES and 26.0% in patients who did not ( = 0.33). In multivariable analysis, there was no correlation between the use of HES and the incidence of AKI (odds ratio 0.87, 95% CI 0.30-2.58,  = 0.81). Propensity matching showed that the incidence of AKI was not significantly different between 481 patients administered with HES and 962 patients (26.6% vs. 26.9%,  = 0.95) who did not receive HES for anesthesia management. However, peak creatinine levels, needed for renal replacement therapy, and in-hospital mortality were higher, and 28-day hospital-free days were lower in patients receiving HES ≥ 1000 mL than those receiving HES < 1000 mL ( < 0.05).

Conclusions: Intraoperative use of HES was not associated with postoperative AKI following CPB. However, administration of large volumes of HES may be associated with kidney-related adverse clinical outcomes.
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http://dx.doi.org/10.1186/s13741-019-0125-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822348PMC
October 2019
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