Medicine, Charles R Drew University of Medicine and Science,. Los Angeles, CA). Background and Purpose: Severe acute pancreatitis occurs in about 10% of ...
2006 Congress of Epidemiology Abstracts S21
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ORGAN FAILURE ASSOCIATED WITH ACUTE PANCREATITIS IN AFRICAN AMERICAN AND HISPANIC PATIENTS. A Akhtar, *M Shaheen (Department of Internal Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA)
EFFECTS OF LEFT VENTRICULAR EJECTION FRACTION ON OUTCOMES IN AMBULATORY CHRONIC HEART FAILURE PATIENTS: A PROPENSITY SCORE ANALYSIS. *A Ahmed, G J Perry, T E Love, D W Kitzman, R M Allman, D C Goff, R C Bourge, L J Dell’Italia (Departments of Medicine and Epidemiology, University of Alabama at Birmingham and VA Medical Center, Birmingham, AL)
Background and Purpose: Severe acute pancreatitis occurs in about 10% of cases of acute pancreatitis, and is associated with high mortality. Many studies have been published about acute pancreatitis and organ failure, but few address this issue among African Americans and Hispanics. As most of our patients belong to these two ethnic groups, we studied the relationship between acute pancreatitis and organ failure in this population. Methods: Our study included all patients diagnosed with acute pancreatitis over 15 years. Medical records of 760 (417 African American & 343 Hispanic) patients, ages 19–85 years were reviewed retrospectively. We abstracted and analyzed data related to demographics, etiology and type of pancreatitis, organ failure, and mortality. Results: Of the 760 patient, 47% were male, 42% had biliary stones, 18% had necrotizing pancreatitis, and 24% had organ failure. Of the 182 patients with organ failure, 125 patients (69%) had multiple organ failure, whereas 57 patients (31%) had dysfunction of a single organ system. Cardiovascular system failure was the most common organ dysfunction (26%) among patients with single organ failure. The occurrence of organ failure varied significantly by age and type of pancreatitis (P < 0.001) being higher in older patients, and in those with necrotizing pancreatitis. There were no significant differences in the occurrence of organ failure by gender, race/ethnicity and etiology of pancreatitis (P > 0.05). Of the 760 patients, 109 patients (14.3%) died. Patients with organ failure had a higher mortality (34%) compared with those without organ failure (6%) (OR ¼ 23.7, 95% CI ¼ 13.7–41.2) (P < 0.001). Mortality was higher among those with multiple organ failure (38%) compared with those with single organ failure type (25%). Mortality varied significantly by type of organ failure, being highest among those with pulmonary dysfunction (60%), followed by central nervous system dysfunction (36%) (P ¼ 0.003). Conclusion: Organ failure is a serious complication in patients with acute pancreatitis. Patients with multiple organ failure and those with pulmonary failure have higher mortality relative to other groups. Prevention and active treatment of organ failure may improve the outcome of patients with acute pancreatitis.
Purpose: The effect of left ventricular ejection fraction (EF) independent of other covariates on heart failure (HF) outcomes is unknown. The objective of our study was to test the hypothesis that HF patients with EF > 45% have better outcomes compared with those with EF 45%. Methods: We analyzed the Digitalis Investigation Group trial data, focusing on 7617 patients without valvular heart disease. Using propensity scores, we matched 793 patients with EF > 45% with 2094 patients with EF 45%. We used Kaplan-Meier survival and multivariable Cox proportional hazard analyses to estimate the effect of EF on outcomes. Results: Overall, 827 (28.6%) died and 707 (24.5%) were hospitalized during a median 39-month follow up. Compared with 30.2% death in EF 45% patients, 23.6% of those with EF > 45% died (p ¼ 0.003). Respective proportions for HF hospitalization were 26.6% and 19.0% (p < 0.001). Patients with EF > 45% had a significant 19% decreased risk of death (unadjusted hazard ratio {HR} ¼ 0.81; 95% confidence interval {CI} ¼ 0.72–0.99) and a significant 32% reduced risk of hospitalization due to worsening HF (unadjusted HR ¼ 0.68; 95% CI ¼ 0.57–0.81). Adjustment for covariates and propensity score did not alter these associations. HF patients with EF > 45% were more likely to be hospitalized due to unstable angina (unadjusted HR ¼ 1.23.68; 95% CI ¼ 0.99–1.53). Conclusion: Patients with EF > 45% had improved survival and reduced HF hospitalization. However, they had a higher risk for hospitalization due to unstable angina, underscoring the progressive nature of atherosclerosis and ischemia in these patients.
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A SYSTEMATIC REVIEW OF THE QUALITY OF PUBLICATIONS REPORTING CORONARY ARTERY BYPASS GRAFTING (CABG) TRIALS. *F Farrokhyar, R Chu, R Whitlock, L Thabane (McMaster University, Hamilton, Ontario, Canada)
EMERGENCY DEPARTMENT VISITS FOR FOOD ALLERGY REACTIONS FROM THE NATIONAL ELECTRONIC INJURY SURVEILLANCE SYSTEM. *M Ross, D Street, M Ferguson, K Klontz, S Luccioli (FDA, Center for Food Safety and Applied Nutrition, College Park, MD 20740)
Purpose: Several studies have shown that the quality of reporting randomized controlled trials (RCT) is variable and often poor. Since the results of metaanalyses on the comparison of off-pump (OFCAB) and on-pump (ONCAB) techniques are controversial, we aimed to assess the reporting quality of the RCTs on comparing OFCAB and ONCAB surgery. Methods: RCTs published (2000 to 2004) comparing OFCAB and ONCAB were identified from electronic searches of the Medline, Cochrane, cinahl, HealthStar and EMBASE. Report quality was assessed with 35 items from the CONSORT statement and 53 additional indicators relevant to CABG surgery. Some of the indicators were composed of several small parts making the maximum possible total score greater than 88. Two authors independently reviewed to assess the reporting quality of each RCT and the level of agreement was assessed using kappa statistics. Disagreements were resolved upon consensus. Descriptive analyses are expressed as median [M] and (minimum [min]–maximum [max]). Pearson, spearman and partial correlation coefficients were used for data analysis. Results: Forty-three trials were included with a total of 4544 patients. The Kappa was greater than 0.6 for 67 of 104 (64.4%) indicators. The overall report quality varied between 35 (33.6%) and 80 (76.9%) of 104, with a median score of 51. The CONSORT score reporting quality varied between 17 (40.5%) and 37 (88.0%) of 42, with a median score of 25. The quality of reporting was poor and insufficient for methods (M: 17, min–max: 8–32 of 46) and discussion (4:2– 7 of 9) sections. The reporting quality of CABG trials had a strong and positive association with CONSORT score, allocation/blinding, results, protocol and statistical methods. The reporting quality had a strong and positive correlation with the size of trial but it was not correlated with the year of publication. Conclusion: The quality of publications reporting for methods and discussion sections was suboptimal. It is critical that in reporting surgical trials, authors follow CONSORT guidelines as well as consider the surgical factors.
Am J Epidemiol 2006;163(Suppl):S1–S258
The Consumer Product Safety Commission’s (CPSC) National Electronic Injury Surveillance System (NEISS) captures a nationally representative probability sample of adverse event data in the United States. In a pilot program with CPSC, the Food and Drug Administration used data from NEISS during August and September of 2003 to capture allergic reactions reportedly caused by food. We identified 173 visits due to food allergy reactions at 34 emergency departments that represent a probability sample of all U.S. and U.S. territory hospitals with at least 6 beds and 24-hour emergency services. The patients’ age range was 1 month–86 years (median 26 years); 15% of visits involved children under 5 years of age. Sixty-three percent of visits involved female patients and 58% involved white patients. Crustaceans and fish were most frequently reported by adults, and fruits and nuts were most often reported by children, as the foods responsible for triggering their allergic reactions. Skin system complaints were the most frequently reported signs and symptoms. There were five hospitalizations and no deaths. Using 2005 anaphylaxis symposium criteria to evaluate these visits, we identified 21 events that met the anaphylaxis criteria, 13 (62%) of which did not have the term ‘‘anaphylaxis’’ in the diagnosis section of the medical record. During the two-month study period, we estimate there were 20,821 emergency department visits for food allergy nationwide, including 2,301 patient-visits for anaphylaxis and 472 hospitalizations. The NEISS data are useful for monitoring food allergic events and allow approximation of serious health consequences due to food allergens in the U.S.
* ¼ Presenter; S ¼ The work was completed while the presenter was a student
