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Risk-adjusted Mortality (risk-adjusted + mortality)

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Medical Sciences	100%

Selected Abstracts

Deprivation, ethnicity and prematurity in infant respiratory failure in PICU in the UK

ACTA PAEDIATRICA, Issue 8 2010
DR O'Donnell
Abstract Aim:, To describe the epidemiology of infants admitted to Paediatric Intensive Care (PIC) with acute respiratory failure including bronchiolitis. Methods:, Data from all consecutive admissions from 2004 to 2007 in all 29 designated Paediatric Intensive Care Units (PICUs) in England and Wales were collected. Admission rates, risk-adjusted mortality, length of stay, ventilation status, preterm birth, deprivation and ethnicity were studied. Results:, A total of 4641 infants under 1 year of age had an unplanned admission to PIC with acute respiratory failure (ARF), an admission rate of 1.80 per 1000 infants per year. There was a reduced rate of admission with bronchiolitis in South Asian children admitted to PICU, which is not explained by case-mix. Children born preterm had a higher rate of admission and longer stay, but a similar low mortality. Risk-adjusted mortality was higher in South Asian infants and the highest in those with ARF (OR 1.76, 95% CI 1.20,2.57) compared with the rest of the PICU population. Conclusion:, Acute respiratory failure in infants causes most of the seasonal variation in unplanned admission to intensive care. Socioeconomic deprivation and prematurity are additional risk factors for admission. Fewer South Asian infants are admitted to PICU with a diagnosis of bronchiolitis, but risk-adjusted mortality is higher in South Asian infants overall. [source]

Short- and Long-Term Mortality after an Acute Illness for Elderly Whites and Blacks

HEALTH SERVICES RESEARCH, Issue 4 2008
Daniel Polsky
Objective. To estimate racial differences in mortality at 30 days and up to 2 years following a hospital admission for the elderly with common medical conditions. Data Sources. The Medicare Provider Analysis and Review File and the VA Patient Treatment File from 1998 to 2002 were used to extract patients 65 or older admitted with a principal diagnosis of acute myocardial infarction, stroke, hip fracture, gastrointestinal bleeding, congestive heart failure, or pneumonia. Study Design. A retrospective analysis of risk-adjusted mortality after hospital admission for blacks and whites by medical condition and in different hospital settings. Principal Findings. Black Medicare patients had consistently lower adjusted 30-day mortality than white Medicare patients, but the initial survival advantage observed among blacks dissipated beyond 30 days and reversed by 2 years. For VA hospitalizations similar patterns were observed, but the initial survival advantage for blacks dissipated at a slower rate. Conclusions. Racial disparities in health are more likely to be generated in the posthospital phase of the process of care delivery rather than during the hospital stay. The slower rate of increase in relative mortality among black VA patients suggests an integrated health care delivery system like the VA may attenuate racial disparities in health. [source]

The impact of serum sodium concentration on mortality after liver transplantation: A cohort multicenter study,

LIVER TRANSPLANTATION, Issue 8 2007
Muhammad F. Dawwas
Modification of the current allocation system for donor livers in the United States to incorporate recipient serum sodium concentration ([Na]) has recently been proposed. However, the impact of this parameter on posttransplantation mortality has not been previously examined in a large risk-adjusted analysis. We assessed the effect of recipient [Na] on the survival of all adults with chronic liver disease who received a first single organ liver transplant in the UK and Ireland during the period March 1, 1994 to March 31, 2005 (n = 5,152) at 3 years, during the first 90 days, and beyond the first 90 days, adjusting for a wide range of recipient, donor, and graft characteristics. Compared to those with normal [Na] (135,145 meq/L; n = 3,066), severely hyponatremic recipients ([Na] <130 meq/L, n = 541), had a higher risk-adjusted mortality at 3 years (hazard ratio [HR] 1.28; 95% confidence interval [CI], 1.04,1.59; P < 0.02). The excess mortality was, however, confined to the first 90 days (HR 1.55; 95% CI, 1.18,2.04; P < 0.002) with no significant difference thereafter. This was also true for hypernatremic recipients ([Na] >145 meq/L, n = 81), who had an even greater risk-adjusted mortality compared to normonatremic recipients (overall: HR 1.85; 95% CI, 1.25,2.73; P < 0.002; ,90 days: HR 2.29; 95% CI, 1.42,3.70; P < 0.001; >90 days: HR 1.12; 95% CI, 0.55,2.29; P = 0.8), whereas mildly hyponatremic recipients ([Na] 130,134 meq/L, n = 1,127) had similar risk-adjusted mortality to those with normal [Na] at the same time points. In conclusion, recipient [Na] is an independent predictor of death following liver transplantation. Attempts to correct the [Na] toward the normal reference range are an important aspect of pretransplantation management. Liver Transpl 13:1115,1124, 2007. © 2007 AASLD. [source]