Browsing by Author "Mathew, Joseph"

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    ItemOpen Access
    Association of Severe Acute Kidney Injury with Mortality and Healthcare Utilization Following Isolated Traumatic Brain Injury.
    (Neurocritical care, 2021-01-13) Luu, David; Komisarow, Jordan; Mills, Brianna M; Vavilala, Monica S; Laskowitz, Daniel T; Mathew, Joseph; James, Michael L; Hernandez, Adrian; Sampson, John; Fuller, Matt; Ohnuma, Tetsu; Raghunathan, Karthik; Privratsky, Jamie; Bartz, Raquel; Krishnamoorthy, Vijay

    Background/objective

    Traumatic brain injury (TBI) is a leading cause of morbidity, mortality, and disability in the USA. While cardiopulmonary dysfunction can result in poor outcomes following severe TBI, the impact of acute kidney injury (AKI) is poorly understood. We examined the association of severe AKI with hospital mortality and healthcare utilization following isolate severe TBI.

    Methods

    We conducted a retrospective cohort study using the National Trauma Data Bank from 2007 to 2014. We identified a cohort of adult patients with isolated severe TBI and described the incidence of severe AKI, corresponding to Acute Kidney Injury Network stage 3 disease or greater. We examined the association of severe AKI with the primary outcome of hospital mortality using multivariable logistic regression models. In secondary analyses, we examined the association of severe AKI with dialysis catheter placement, tracheostomy and gastrostomy utilization, and hospital length of stay.

    Results

    There were 37,851 patients who experienced isolated severe TBI during the study period. Among these patients, 787 (2.1%) experienced severe (Stage 3 or greater) AKI. In multivariable models, the development of severe AKI in the hospital was associated with in-hospital mortality (OR 2.03, 95% CI 1.64-2.52), need for tracheostomy (OR 2.10, 95% CI 1.52-2.89), PEG tube placement (OR 1.88, 95% CI 1.45-2.45), and increased hospital length of stay (p < 0.001).

    Conclusions

    The overall incidence of severe AKI is relatively low (2.1%), but is associated with increased mortality and multiple markers of increased healthcare utilization following severe TBI.
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    Infarct‐related structural disconnection and delirium in surgical aortic valve replacement patients
    (Annals of Clinical and Translational Neurology) Browndyke, Jeffrey N; Tomalin, Lewis E; Erus, Guray; Overbey, Jessica R; Kuceyeski, Amy; Moskowitz, Alan J; Bagiella, Emilia; Iribarne, Alexander; Acker, Michael; Mack, Michael; Mathew, Joseph; O'Gara, Patrick; Gelijns, Annetine C; Suarez-Farinas, Mayte; Messé, Steven R; Cardiothoracic Surgical Trials Network (CTSN) Investigators
    AbstractObjectiveAlthough acute brain infarcts are common after surgical aortic valve replacement (SAVR), they are often unassociated with clinical stroke symptoms. The relationship between clinically “silent” infarcts and in‐hospital delirium remains uncertain; obscured, in part, by how infarcts have been traditionally summarized as global metrics, independent of location or structural consequence. We sought to determine if infarct location and related structural connectivity changes were associated with postoperative delirium after SAVR.MethodsA secondary analysis of a randomized multicenter SAVR trial of embolic protection devices (NCT02389894) was conducted, excluding participants with clinical stroke or incomplete neuroimaging (N = 298; 39% female, 7% non‐White, 74 ± 7 years). Delirium during in‐hospital recovery was serially screened using the Confusion Assessment Method. Parcellation and tractography atlas‐based neuroimaging methods were used to determine infarct locations and cortical connectivity effects. Mixed‐effect, zero‐inflated gaussian modeling analyses, accounting for brain region‐specific infarct characteristics, were conducted to examine for differences within and between groups by delirium status and perioperative neuroprotection device strategy.Results23.5% participants experienced postoperative delirium. Delirium was associated with significantly increased lesion volumes in the right cerebellum and temporal lobe white matter, while diffusion weighted imaging infarct‐related structural disconnection (DWI‐ISD) was observed in frontal and temporal lobe regions (p‐FDR < 0.05). Fewer brain regions demonstrated DWI‐ISD loss in the suction‐based neuroprotection device group, relative to filtration‐based device or standard aortic cannula.InterpretationStructural disconnection from acute infarcts was greater in patients who experienced postoperative delirium, suggesting that the impact from covert perioperative infarcts may not be as clinically “silent” as commonly assumed.