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Dahlia Hassani, MD

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NCBI: db=pubmed; Term=(hassani d[Author]) AND (John Peter Smith[Affiliation] OR JPS Health Network[Affiliation] OR JPS [Affiliation] NOT Japan Pancreas Society[Affiliation])
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Mortality association between obesity and pneumonia using a dual restricted cohort model.

Tue, 07/28/2020 - 04:29
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Mortality association between obesity and pneumonia using a dual restricted cohort model.

Obes Res Clin Pract. 2020 Jul 16;:

Authors: Wang H, Lee CC, Chou EH, Hsu WT, Robinson RD, Su KY, Kirby JJ, Hassani D

Abstract
BACKGROUND: An obesity survival paradox has been reported among obese patients with pneumonia.
AIMS: To determine the impact of obesity on pneumonia outcomes and analyze the correlation between in-hospital all-cause mortality and obesity among patients with pneumonia.
METHODS: The United States Nationwide Readmissions Database (NRD) was retrospectively analyzed for patients with pneumonia from 2013 to 2014. We used a step-wise restricted and propensity score matching cohort model (dual model) to compare mortality rates and other outcomes among pneumonia patients based on BMI. Mortality was calculated by a Cox proportional hazard model, adjusted for potential confounders with propensity score matched analysis.
RESULTS: A total of 70,886,775 patients were registered in NRD during the study period. Of these, 7,786,913 patients (11.0%) were considered obese and 1,652,456 patients (2.3%) were admitted to the hospital with pneumonia. Based on the step-wise restricted cohort model, the hazard ratio comparing the mortality rates among obese pneumonia patients to mortality rates among normal BMI pneumonia patients was 0.75 (95% CI 0.60-0.94). The propensity score matched analysis estimated a hazard rate of 0.84 (95% CI 0.79-0.90) and the hazard ratio estimated from the dual model was 0.82 (95% CI 0.63-1.07).
CONCLUSIONS: With the application of a dual model, there appears to be no significant difference in mortality of obese patients with pneumonia compared to normal BMI patients with pneumonia.

PMID: 32684413 [PubMed - as supplied by publisher]

Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study.

Sun, 01/19/2020 - 10:08
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Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study.

PLoS One. 2020;15(1):e0227752

Authors: Chou EH, Mann S, Hsu TC, Hsu WT, Liu CC, Bhakta T, Hassani DM, Lee CC

Abstract
PURPOSE: To determine the trends of infection sites and outcome of sepsis using a national population-based database.
MATERIALS AND METHODS: Using the Nationwide Inpatient Sample database of the US, adult sepsis hospitalizations and infection sites were identified using a validated approach that selects admissions with explicit ICD-9-CM codes for sepsis and diagnosis/procedure codes for acute organ dysfunctions. The primary outcome was the trend of incidence and in-hospital mortality of specific infection sites in sepsis patients. The secondary outcome was the impact of specific infection sites on in-hospital mortality.
RESULTS: During the 9-year period, we identified 7,860,687 admissions of adult sepsis. Genitourinary tract infection (36.7%), lower respiratory tract infection (36.6%), and systemic fungal infection (9.2%) were the leading three sites of infection in patients with sepsis. Intra-abdominal infection (30.7%), lower respiratory tract infection (27.7%), and biliary tract infection (25.5%) were associated with highest mortality rate. The incidences of all sites of infections were trending upward. Musculoskeletal infection (annual increase: 34.2%) and skin and skin structure infection (annual increase: 23.0%) had the steepest increase. Mortality from all sites of infection has decreased significantly (trend p<0.001). Skin and skin structure infection had the fastest declining rate (annual decrease: 5.5%) followed by primary bacteremia (annual decrease: 5.3%) and catheter related bloodstream infection (annual decrease: 4.8%).
CONCLUSIONS: The anatomic site of infection does have a differential impact on the mortality of septic patients. Intra-abdominal infection, lower respiratory tract infection, and biliary tract infection are associated with higher mortality in septic patients.

PMID: 31929577 [PubMed - in process]

Mortality association between obesity and pneumonia using a dual restricted cohort model.

Fri, 10/25/2019 - 19:28
Related Articles

Mortality association between obesity and pneumonia using a dual restricted cohort model.

Obes Res Clin Pract. 2019 Oct 18;:

Authors: Wang H, Lee CC, Chou EH, Hsu WT, Robinson RD, Su KY, Kirby JJ, Hassani D

Abstract
BACKGROUND: An obesity survival paradox has been reported among obese patients with pneumonia.
AIMS: To determine the impact of obesity on pneumonia outcomes and analyze the correlation between in-hospital all-cause mortality and obesity among patients with pneumonia.
METHODS: The United States Nationwide Readmissions Database (NRD) was retrospectively analyzed for patients with pneumonia from 2013 to 2014. We used a step-wise restricted and propensity score matching cohort model (dual model) to compare mortality rates and other outcomes among pneumonia patients based on BMI. Mortality was calculated by a Cox proportional hazard model, adjusted for potential confounders with propensity score matched analysis.
RESULTS: A total of 70,886,775 patients were registered in NRD during the study period. Of these, 7,786,913 patients (11.0%) were considered obese and 1,652,456 patients (2.3%) were admitted to the hospital with pneumonia. Based on the step-wise restricted cohort model, the hazard ratio comparing the mortality rates among obese pneumonia patients to mortality rates among normal BMI pneumonia patients was 0.75 (95% CI 0.60-0.94). The propensity score matched analysis estimated a hazard rate of 0.84 (95% CI 0.79-0.90) and the hazard ratio estimated from the dual model was 0.82 (95% CI 0.63-1.07).
CONCLUSIONS: With the application of a dual model, there appears to be no significant difference in mortality of obese patients with pneumonia compared to normal BMI patients with pneumonia.

PMID: 31635969 [PubMed - as supplied by publisher]

Predictors of early versus late mortality in pelvic trauma patients.

Wed, 01/30/2019 - 08:17
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Predictors of early versus late mortality in pelvic trauma patients.

Scand J Trauma Resusc Emerg Med. 2016 Mar 10;24:27

Authors: Wang H, Robinson RD, Moore B, Kirk AJ, Phillips JL, Umejiego J, Chukwuma J, Miller T, Hassani D, Zenarosa NR

Abstract
BACKGROUND: Risks of predicting time-related in-hospital mortality varies in pelvic trauma patients. We aim to identify potential independent risks predictive of time-related (early versus late) mortality among pelvic trauma patients.
METHODS: Local trauma registry data from 2004 through 2013 were reviewed. Mortality causes and timing of death were investigated. Multivariate logistic regression identified independent risks predictive of early versus late mortality in pelvic trauma patients while adjusting for patient demographics (age, sex, race), clinical variables (initial vital signs, mental status, injury severity, associated injuries, comorbidities), and hospital outcomes (surgical interventions, crystalloid resuscitations, blood transfusions).
RESULTS: We retrospectively collected data on 1566 pelvic trauma patients with a mortality rate of 9.96% (156/1566). Approximately 74% of patients died from massive hemorrhage within the first 24 h of hospitalization (early mortality). Revised trauma score (RTS), injury severity score (ISS), initial hemoglobin, direct transfer to operating room, and blood transfusion administration in the Emergency Department were considered independent risk factors predictive of early mortality. Age, ISS, and Glasgow Coma Scale (GCS) were deemed risk factors predictive of death after 24 h (late mortality).
DISCUSSION: Given the fact of a substantial number of patients died within the first 24 h of hospital arrival, it is reasonable to consider the first 24 h of hospitalization as the appropriate window within which early mortality may be expected to occur in pelvic trauma patients. The risk factors associated with massive hemorrhage were strong predictors of early mortality, whereas late mortality predictors were more closely linked with comorbidities or in-hospital complications.
CONCLUSIONS: While risk factors predictive of early versus late mortality vary, ISS seems to predict both early and late mortality accurately in pelvic trauma patients.

PMID: 26964737 [PubMed - indexed for MEDLINE]