Browsing by Author "Srivali, Narat"
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Item Open Access Acute Kidney Injury after Lung Transplantation: A Systematic Review and Meta-Analysis.(Journal of clinical medicine, 2019-10) Lertjitbanjong, Ploypin; Thongprayoon, Charat; Cheungpasitporn, Wisit; O'Corragain, Oisín A; Srivali, Narat; Bathini, Tarun; Watthanasuntorn, Kanramon; Aeddula, Narothama Reddy; Salim, Sohail Abdul; Ungprasert, Patompong; Gillaspie, Erin A; Wijarnpreecha, Karn; Mao, Michael A; Kaewput, WisitLung transplantation has been increasingly performed worldwide and is considered an effective therapy for patients with various causes of end-stage lung diseases. We performed a systematic review to assess the incidence and impact of acute kidney injury (AKI) and severe AKI requiring renal replacement therapy (RRT) in patients after lung transplantation. A literature search was conducted utilizing Ovid MEDLINE, EMBASE, and Cochrane Database from inception through June 2019. We included studies that evaluated the incidence of AKI, severe AKI requiring RRT, and mortality risk of AKI among patients after lung transplantation. Pooled incidence and odds ratios (ORs) with 95% confidence interval (CI) were obtained using random-effects meta-analysis. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42019134095). A total of 26 cohort studies with a total of 40,592 patients after lung transplantation were enrolled. Overall, the pooled estimated incidence rates of AKI (by standard AKI definitions) and severe AKI requiring RRT following lung transplantation were 52.5% (95% CI: 45.8-59.1%) and 9.3% (95% CI: 7.6-11.4%). Meta-regression analysis demonstrated that the year of study did not significantly affect the incidence of AKI (p = 0.22) and severe AKI requiring RRT (p = 0.68). The pooled ORs of in-hospital mortality in patients after lung transplantation with AKI and severe AKI requiring RRT were 2.75 (95% CI, 1.18-6.41) and 10.89 (95% CI, 5.03-23.58). At five years, the pooled ORs of mortality among patients after lung transplantation with AKI and severe AKI requiring RRT were 1.47 (95% CI, 1.11-1.94) and 4.79 (95% CI, 3.58-6.40), respectively. The overall estimated incidence rates of AKI and severe AKI requiring RRT in patients after lung transplantation are 52.5% and 9.3%, respectively. Despite advances in therapy, the incidence of AKI in patients after lung transplantation does not seem to have decreased. In addition, AKI after lung transplantation is significantly associated with reduced short-term and long-term survival.Item Open Access ACUTE PULMONARY EMBOLISM: Risk Of Venous Thromboembolism In Patients With Systemic Sclerosis: A Systematic Review And Meta-Analysis(American Journal of Respiratory and Critical Care Medicine) Srivali, Narat; Ungprasert, Patompong; Caples, Sean MBackground/Purpose: Deep venous thrombosis (DVT) and pulmonary embolism (PE), collectively known as venous thromboembolism (VTE), are common problems associated with significant morbidity and mortality. Chronic inflammation, though not generally regarded as traditional risk factor for VTE, is increasingly recognized as a potential predisposing factor. In fact, several chronic inflammatory disorders, such as rheumatoid arthritis and idiopathic inflammatory myopathy, have been shown to increase rates of VTE in large epidemiologic studies. However, the data on systemic sclerosis (SSc), a relatively uncommon chronic inflammatory disorder, remain unclear due to conflicting studies. To further investigate this possible association, we conducted a systematic review and meta-analysis of observational studies that compared the risk of VTE in patients with SSc versus those without it. Methods: Two investigators (N.S. and P.U.) independently searched published studies indexed in MEDLINE, EMBASE and the Cochrane database from inception to April 2014 using the terms for systemic sclerosis in conjunction with the terms “venous thromboembolism”, “pulmonary embolism” and “deep venous thrombosis”. A manual search of references of retrieved articles was also performed. The inclusion criteria were as follows: (1) observational studies published as original studies to evaluate the association between SSc and VTE and (2) odds ratios (OR’s), relative risk (RR’s) or hazard ratio (HR’s) or standardized incidence ratio (SIR’s) with 95% confidence intervals (CI’s) were provided. Study eligibility was independently determined by the two investigators noted above. Newcastle-Ottawa scale was used to assess the quality of included studies. RevMan 5.2 software was used for the data analysis. Point estimates and standard errors were extracted from individual studies and were combined by the generic inverse variance method of DerSimonian and Laird. Given the high likelihood of between study variance, we used a random-effect model rather than a fixed-effect model. Cochran’s Q test was used to determine the study’s statistical heterogeneity. Results: Out of 348 potentially relevant articles, four studies (three retrospective cohort studies and one case-control study) were identified that met the above criteria and were included in our analysis. The pooled risk ratio of VTE in patients with SSc is 1.89 (95% CI, 1.47 to 2.42). The statistical heterogeneity of this meta-analysis was high with an I2 of 78 %. Conclusion: Our study demonstrates an increased risk of VTE among patients with SSc. Clinicians should consider VTE when a patient with SSc presents with extremity and/or respiratory symptoms.Item Open Access Admission Serum Magnesium Levels Predict the Risk of Acute Respiratory Failure Requiring Mechanical Ventilation in Hospitalized Patients(Chest, 2015-10-01) Srivali, Narat; Thongprayoon, Charat; Thongprayoon, Charat; Erickson, StephenPURPOSE: The association between admission serum magnesium (Mg) levels and risk of acute respiratory failure (ARF) requiring mechanical ventilation in hospitalized patients is limited. The aim of this study was to assess the risk of developing ARF in all hospitalized patients with various admission Mg levels. METHODS: This is a single-center retrospective study conducted at a tertiary referral hospital. All hospitalized adult patients who had admission Mg available from January to December 2013 were analyzed in this study. Admission Mg was categorized based on its distribution into six groups (less than 1.5, 1.5 to 1.7, 1.7 to 1.9, 1.9 to 2.1, 2.1 to 2.3, and greater than 2.3 mg/dL). The primary outcome was in-hospital ARF requiring mechanical ventilation occurring after hospital admission. Logistic regression analysis was performed to obtain the odds ratio of ARF of various admission Mg levels using Mg of 1.7 to 1.9 mg/dL as the reference group. RESULTS: Of 9,780 patients enrolled, ARF occurred in 619 patients (6.3%). The lowest incidence of ARF was when serum Mg within 1.7-1.9 mg/dL. A U-shaped curve emerged demonstrating higher incidences of ARF associated with both hypoMg (<1.7) and hyperMg (>1.9). After adjusting for potential confounders, both hypoMg (<1.5 mg/dL) and hyperMg (>2.3 mg/dL) were associated with an increased risk of developing ARF requiring mechanical ventilation with odds ratios of 1.69 (95% CI 1.19-2.36) and 1.40 (95% CI 1.02-1.91), respectively. CONCLUSIONS: Both admission hypoMg and hyperMg were associated with an increased risk for in-hospital ARF requiring mechanical ventilation. CLINICAL IMPLICATIONS: Our study demonstrated that admission Mg level was correlated with the incidence of ARF requiring mechanical ventilation during hospitalization so physician should be awared and correct Mg level accordingly.Item Open Access An Uncommon Cause Of Altered Mental Status In A Patient With Systemic Lupus Erythematosus(American Journal of Respiratory and Critical Care Medicine) Ungprasert, Patompong; Leeaphorn, Napat; Srivali, Narat; Kittanamongkolchai, WonngarmIntroduction: Altered mental status is one of the most common presentations that leads to an admission to intensive care unit. Posterior reversible encephalopathy syndrome (PRES), which is commonly encountered in association with various medical conditions, is an uncommon but probably under-diagnosed cause of this presentation. Case report: A 51-year-old woman was admitted to our ICU because of alteration of consciousness. She was in her usual state of health the night before although she complained of a mild headache. She became unarousable on the following morning and her husband immediately brought her to our institution. She had a significant history of SLE that was diagnosed five years ago with malar rash, photosensitivity rash, polyarthritis, positive ANA and anti-smith antibody. Her only current medication was hydroxychloroquine. Upon admission, she was found to be hypertensive with BP of 170/90 mmHg. Neurological examination was remarkable for GCS of five without any focal neurological deficit. Laboratory investigations were remarkable for an elevation of creatinine (2.4 mg/dL from baseline of 1.0 mg/dL) and an abnormal urinalysis with numerous dysmorphic RBCs and WBCs. CT brain demonstrated ill-defined hypodensity in the subcortical white matter of both posterior parietal lobes. A subsequent MRI brain revealed T2 hyper-intense signal in cortex and subcortical white matter of the same lobes (Figure). She was diagnosed with PRES and was immediately treated with intravenous labetalol. Her BP gradually came down to normal range and her mental status gradually improved as she became completely alert and oriented on the fourth day of admission. She underwent renal biopsy during this admission which revealed type IV lupus nephritis. Treatment with steroid and cyclophosphamide was initiated. Comment: Patient with PRES usually presents with headache, seizure, nausea, confusion or coma in a more severe case. A broad range of medical conditions, including hypertension, eclampsia, use of immunosuppressive agent, and autoimmune disorders has been implicated as causes of this syndrome. Neuroimaging is crucial to the diagnosis. Typical findings include symmetrical edema of white matter predominantly in the parieto-occipital lobes. These abnormalities are best depicted by MRI (hyper-intense signal on T2 and FLAIR technique). Prognosis is favorable as the neurological deficit is usually reversible in days to weeks after blood pressure control, as seen in this patient. However, delay in initiating the appropriate treatment can lead to a permanent neurological damage. Thus, physician should have a high index of suspicion for this syndrome especially in patients with known associated illnesses.Item Open Access Assessing the impact of continuous positive airway pressure therapy on clinical outcomes in interstitial lung disease patients with coexisting obstructive sleep apnea: a systematic review.(Sleep Breath, 2024-05-08) Srivali, Narat; Thongprayoon, Charat; Cheungpasitporn, WisitPURPOSE: Interstitial lung disease (ILD) often coexists with obstructive sleep apnea (OSA), contributing to increased morbidity and mortality. However, the effectiveness of continuous positive airway pressure (CPAP) therapy in this population remains unclear. We conducted a systematic review to evaluate CPAP therapy's impact on clinical outcomes in patients with ILD and comorbid OSA. METHODS: Following PRISMA guidelines, we systematically searched multiple databases for studies assessing CPAP therapy's effects on ILD exacerbation, hospitalization, quality of life, and mortality in ILD-OSA patients. Studies were selected based on predefined inclusion criteria, and their quality was assessed using the Newcastle-Ottawa quality scale. RESULTS: Among 485 articles screened, 82 underwent full review, with four observational studies meeting inclusion criteria. CPAP therapy demonstrated potential benefits in improving quality of life and reducing ILD exacerbations in ILD-OSA patients. However, its impact on mortality was inconclusive due to variability in study definitions and methodology. CONCLUSION: CPAP therapy may improve outcomes in ILD-OSA patients, particularly in terms of quality of life and ILD exacerbations. Nonetheless, further research with standardized definitions and rigorous methodology is needed to confirm its efficacy, particularly regarding mortality outcome.Item Open Access Association Between Chronic Obstructive Pulmonary Disease And Psoriasis: A Systematic Review And Meta-Analysis(American Journal of Respiratory and Critical Care Medicine) Ungprasert, P; Cheungpasitporn, W; Thongprayoon, C; Sanguankeo, A; Srivali, NaratIntroduction: It was hypothesized that chronic obstructive pulmonary disease (COPD) might be an autoimmune disease induced by cigarette smoking as emerging evidence has suggested that chronic systemic inflammation plays an important role in the pathogenesis of COPD. Several epidemiological studies have also demonstrated that patients with chronic inflammatory disorders, such as rheumatoid arthritis and systemic lupus erythematosus, have a significantly higher risk of developing COPD. However, the data on psoriasis, another common chronic inflammatory disorder, remain unclear due to conflicting studies. Thus, to further investigate this possible association, we conducted a systematic review and meta-analysis of observational studies that compared the risk of COPD in patients with psoriasis versus participants without it. Methods: Two investigators (P.U. and W.C.) independently searched published studies indexed in MEDLINE, EMBASE and the Cochrane database from inception to May 2014 using the terms for psoriasis and COPD . A manual search of references of selected retrieved articles was also performed. The inclusion criteria were as follows: (1) observational studies published as original studies to evaluate the association between psoriasis and COPD and (2) odds ratios (OR’s), relative risk (RR’s) or hazard ratio (HR’s) or standardized incidence ratio (SIR’s) with 95% confidence intervals (CI’s) were provided. Study eligibility was independently determined by the two investigators noted above. Newcastle-Ottawa scale was used to assess the quality of included studies. RevMan 5.3 software was used for the data analysis. Point estimates and standard errors were extracted from individual studies and were combined by the generic inverse variance method of DerSimonian and Laird. In light of the high likelihood of between study variance, we used a random-effect model rather than a fixed-effect model. The study’s statistical heterogeneity was assessed by Cochran’s Q test. Results: Out of 552 potentially relevant articles, seven studies (five case-control studies and two retrospective cohort studies) were identified and included in the data analysis. The pooled risk ratio of COPD in patients with psoriasis was 1.51 (95% CI, 1.23 to 1.85). The statistical heterogeneity of this meta-analysis was high with an I of 89%. 2 Conclusions: Our study demonstrated a statistically significant increased risk of COPD among patients with psoriasisItem Open Access Association of Periodic Limb Movements and Obstructive Sleep Apnea With Risk of Cardiovascular Disease and Mortality(Journal of the American Heart Association) Zinchuk, Andrey; Srivali, Narat; Qin, Li; Jeon, Sangchoon; Ibrahim, Ahmad; Sands, Scott A; Koo, Brian; Yaggi, Henry KBackground Obstructive sleep apnea is a well‐established risk factor for cardiovascular disease (CVD). Recent studies have also linked periodic limb movements during sleep to CVD. We aimed to determine whether periodic limb movements during sleep and obstructive sleep apnea are independent or synergistic factors for CVD events or death. Methods and Results We examined data from 1049 US veterans with an apnea‐hypopnea index (AHI) <30 events/hour. The primary outcome was incident CVD or death. Cox proportional hazards regression assessed the relationships between the AHI, periodic limb movement index (PLMI), and the AHI×PLMI interaction with the primary outcome. We then examined whether AHI and PLMI were associated with primary outcome after adjustment for age, sex, race and ethnicity, obesity, baseline risk of mortality, and Charlson Comorbidity Index. During a median follow‐up of 5.1 years, 237 of 1049 participants developed incident CVD or died. Unadjusted analyses showed an increased risk of the primary outcome with every 10‐event/hour increase in PLMI (hazard ratio [HR], 1.08 [95% CI, 1.05–1.13]) and AHI (HR, 1.17 [95% CI, 1.01– 1.37]). Assessment associations of AHI and PLMI and their interaction with the primary outcome revealed no significant interaction between PLMI and AHI. In fully adjusted analyses, PLMI, but not AHI, was associated with an increased risk of primary outcome: HR of 1.05 (95% CI, 1.00–1.09) per every 10 events/hour. Results were similar after adjusting with Framingham risk score. Conclusions Our study revealed periodic limb movements during sleep as a risk factor for incident CVD or death among those who had AHI <30 events/hour, without synergistic association between periodic limb movements during sleep and obstructive sleep apnea.Item Open Access Central sleep apnea due to high altitude periodic breathing(Sleep, 2023-05-09) Srivali, Narat; Tobias, LaurenIntroduction Many popular tourist destinations are at high-altitude. Visitors commonly report poor sleep quality during the first few nights after arriving, but some do not resolve over time and daytime symptoms may develop that require medical attention. Report of case(s) A previously healthy 76-year-old American man presented with progressive fatigue and frequent nocturnal awakenings to a clinic in Bogota, Columbia (altitude 2640 meters), where he had been living for eighteen months during the COVID-19 pandemic lockdown due to limited ability to travel. An arterial blood gas on room air revealed hypocapnia with a partial pressure of CO2 of 25 mmHg. A polysomnography (PSG) performed in Bogota demonstrated an apnea-hypopnea index (AHI) of 98 events/hour consisting of predominately central as well as obstructive respiratory disturbances (Figure 1). After a titration study, he was placed on treatment with continuous positive airway pressure (CPAP) at 10 cmH2O along with oxygen 1 L/min, but he had difficulty acclimating to treatment. The patient presented to our institution two months after returning to the USA with significantly improved symptoms despite remaining off CPAP. Repeat PSG revealed a substantial reduction in the AHI at 15 events/hour consisting of only central respiratory disturbances in the supine position during transitional N1/N2 sleep (Figure 2). Positional therapy was recommended. A repeat home sleep study performed three months later to reassess disease severity during non-supine sleep showed resolution of respiratory disturbances (Figure 3). High-altitude periodic breathing is a common phenomenon, characterized by alternating periods of absent respiratory efforts with periods of hyperventilation without another etiology (1, 2). It occurs due to the interaction of hypocapnia and increased loop-gain (2). Central sleep apnea (CSA) is considered a disorder only when associated with symptoms, not simply due to an elevated central apnea index (3). The more rapid ascent and the higher the altitude, the greater risk of developing periodic breathing. Descending to a lower altitude will often resolve apnea after few days but the phenomenon can persist for up to months (2, 4) as our patient. Conclusion CSA develops commonly upon ascent to high altitude. When feasible, symptomatic patients should be encouraged to descend to a lower altitude.Item Open Access CHANGING TRENDS IN THE USE OF VASOPRESSORS IN INTENSIVE CARE UNIT: A 7-YEAR STUDY(Critical Care Medicine, 2014-12) Srivali, Narat; Thongprayoon, Charat; Kittanamongkolchai, Wonngarm; Cheungpasitporn, Wisit; Erdogan, Aysen; Carrera, Perliveh; Kashani, KianoushLearning Objectives: The use of vasopressors was common in intensive care unit (ICU). Due to the lack of conclusive evidence in superiority in efficacy among various types of vasopressors, the choice of vasopressor use mainly depends on the physician preference. This study aims to describe the prevalence of vasopressor use and the trend in the use of each vasopressor medication in ICU over the past 7 years. Methods: This is a descriptive study conducted at a tertiary referral hospital. All ICU admissions, including both medical and surgical ICU, at our institution between January 2007 and December 2013 were included in this study. The use of vasopressors within given ICU day (12.00 am – 11.59 pm) during ICU stay was reviewed. Vasopressors were defined as the continuous intravenous administration of norepinephrine, epinephrine, dopamine, phenylephrine, or vasopressin regardless of duration and dosage. Results: A total of 52410 unique patients had 72005 ICU admissions in the course of study, (272271 patient*ICU day). Vasopressors were used in 17767 (24.7%) ICU admissions and on 53898 (19.8%) patient*ICU day, resulting in a total of 76564 vasopressor day. Vasopressin was used on 21955 (41%), epinephrine on 20958 (39%), norepinephrine on 17919 (33%), dopamine on 8636 (16%) and phenylephrine on 7096 (13%) patient*ICU day. Over 2007-2013, there was an upward trend in the use of norepinephrine (the proportion of ICU day on norepinephrine over total ICU day with vasopressor 0.24 in year 2007 to 0.45 in year 2013), and a downward trend in phenylephrine (the proportion of ICU day on phenylephrine over total ICU day with vasopressor 0.20 in year 2007 to 0.10 in year 2013). There was no specific trend in the usage of vasopressin, epinephrine, and dopamine. Conclusions: The vasopressors were used in about one fourth of ICU admission and about one fifth of ICU days. Vasopressin is the most commonly used vasopressor. The use of norepinephrine is in upward trajectory.Item Open Access Decreasing Rate of Chronic Obstructive Pulmonary Disease (COPD) Readmission In A Rural Health Care Network In Upstate NY(American Journal of Respiratory and Critical Care Medicine 2014;189:A5463) Srivali, Narat; Riesenfeld, ErikItem Open Access HYDRATION FOR CONTRAST-INDUCED ACUTE KIDNEY INJURY PREVENTION A META-ANALYSIS(Critical Care Medicine, 2014-12-01) Srivali, Narat; Cheungpasitporn, Wisit; Charat, Thongprayoon; Edmonds, Peter; O’Corragain, Oisin; Kittanamongkolchai, Wonngarm; Brabec, Brady; Erickson, StephenLearning Objectives: The reports on efficacy of oral hydration compared to intravenous hydration for the prevention of contrast-induced acute kidney injury (CIAKI) in radiological procedures and cardiac catheterization remains controversial. The objective of this meta-analysis was to assess the efficacy of these hydration regimens for prevention of CIAKI. Methods: Comprehensive literature searches for randomized controlled trials (RCTs) of outpatient oral hydration treatment was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews and clinicaltrials.gov from inception until July 4th, 2014. Primary outcome was the incidence of CIAKI. Results: Three prospective RCTs were included in our analysis. Of 242 patients undergoing procedures with contrast exposures, 22 patients (9%) had CIAKI. These 3 RCTs, however, included only patients with relatively normal kidney function to CKD stage 3 and excluded those who had contrast exposure for urgent indications. There was no significant increased risk of CIAKI in oral fluid regimen group compared to IV fluid regimen group (RR = 1.83, 95% CI = 0.41–8.21). Conclusions: According to our analysis, there is no evidence that oral fluid regimen is associated with more risk of CIAKI in patients with contrast exposures compared to IV fluid regimen. This finding suggests that the oral fluid regimen is a possible treatment option for CIAKI prevention in non-urgent procedures in patients with normal to moderately reduced kidney function.Item Open Access Impact of ANCA-Associated Vasculitis on Outcomes of Hospitalizations for Goodpasture's Syndrome in the United States: Nationwide Inpatient Sample 2003-2014.(Medicina (Kaunas, Lithuania), 2020-03) Thongprayoon, Charat; Kaewput, Wisit; Boonpheng, Boonphiphop; Ungprasert, Patompong; Bathini, Tarun; Srivali, Narat; Vallabhajosyula, Saraschandra; Castaneda, Jorge L; Monga, Divya; Kanduri, Swetha R; Medaura, Juan; Cheungpasitporn, WisitBackground and objectives: Goodpasture's syndrome (GS) is a rare, life-threatening autoimmune disease. Although the coexistence of anti-neutrophil cytoplasmic antibody (ANCA) with Goodpasture's syndrome has been recognized, the impacts of ANCA vasculitis on mortality and resource utilization among patients with GS are unclear. Materials and Methods: We used the National Inpatient Sample to identify hospitalized patients with a principal diagnosis of GS from 2003 to 2014 in the database. The predictor of interest was the presence of ANCA-associated vasculitis. We tested the differences concerning in-hospital treatment and outcomes between GS patients with and without ANCA-associated vasculitis using logistic regression analysis with adjustment for other clinical characteristics. Results: A total of 964 patients were primarily admitted to hospital for GS. Of these, 84 (8.7%) had a concurrent diagnosis of ANCA-associated vasculitis. Hemoptysis was more prevalent in GS patients with ANCA-associated vasculitis. During hospitalization, GS patients with ANCA-associated required non-significantly more mechanical ventilation and non-invasive ventilation support, but non-significantly less renal replacement therapy and plasmapheresis than those with GS alone. There was no significant difference in in-hospital outcomes, including organ failure and mortality, between GS patients with and without ANCA-associated vasculitis. Conclusions: Our study demonstrated no significant differences between resource utilization and in-hospital mortality among hospitalized patients with coexistence of ANCA vasculitis and GS, compared to those with GS alone.Item Open Access Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis.(Journal of clinical medicine, 2019-07) Thongprayoon, Charat; Cheungpasitporn, Wisit; Lertjitbanjong, Ploypin; Aeddula, Narothama Reddy; Bathini, Tarun; Watthanasuntorn, Kanramon; Srivali, Narat; Mao, Michael A; Kashani, KianoushAlthough acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%-72.4%) and 44.9% (95%CI: 40.8%-49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87-4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21-4.99). There was no publication bias as evaluated by the funnel plot and Egger's regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively. Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.Item Open Access Inpatient Burden and Mortality of Goodpasture's Syndrome in the United States: Nationwide Inpatient Sample 2003-2014.(Journal of clinical medicine, 2020-02) Kaewput, Wisit; Thongprayoon, Charat; Boonpheng, Boonphiphop; Ungprasert, Patompong; Bathini, Tarun; Chewcharat, Api; Srivali, Narat; Vallabhajosyula, Saraschandra; Cheungpasitporn, WisitBackground: Goodpasture's syndrome is a rare, life-threatening, small vessel vasculitis. Given its rarity, data on its inpatient burden and resource utilization are lacking. We conducted this study aiming to assess inpatient prevalence, mortality, and resource utilization of Goodpasture's syndrome in the United States. Methods: The 2003-2014 National Inpatient Sample was used to identify patients with a principal diagnosis of Goodpasture's syndrome. The inpatient prevalence, clinical characteristics, in-hospital treatment, end-organ failure, mortality, length of hospital stay, and hospitalization cost were studied. Multivariable logistic regression was performed to identify independent factors associated with in-hospital mortality. Results: A total of 964 patients were admitted in hospital with Goodpasture's syndrome as the principal diagnosis, accounting for an overall inpatient prevalence of Goodpasture's syndrome among hospitalized patients in the United States of 10.3 cases per 1,000,000 admissions. The mean age of patients was 54 ± 21 years, and 47% were female; 52% required renal replacement therapy, whereas 39% received plasmapheresis during hospitalization. Furthermore, 78% had end-organ failure, with renal failure and respiratory failure being the two most common end-organ failures. The in-hospital mortality rate was 7.7 per 100 admissions. The factors associated with increased in-hospital mortality were age older than 70 years, sepsis, the development of respiratory failure, circulatory failure, renal failure, and liver failure, whereas the factors associated with decreased in-hospital mortality were more recent year of hospitalization and the use of therapeutic plasmapheresis. The median length of hospital stay was 10 days. The median hospitalization cost was $75,831. Conclusion: The inpatient prevalence of Goodpasture's syndrome in the United States is 10.3 cases per 1,000,000 admissions. Hospitalization of patients with Goodpasture's syndrome was associated with high hospital inpatient utilization and costs.Item Open Access Machine Learning Consensus Clustering Approach for Patients with Lactic Acidosis in Intensive Care Units.(Journal of personalized medicine, 2021-11) Pattharanitima, Pattharawin; Thongprayoon, Charat; Petnak, Tananchai; Srivali, Narat; Gembillo, Guido; Kaewput, Wisit; Chesdachai, Supavit; Vallabhajosyula, Saraschandra; O'Corragain, Oisin A; Mao, Michael A; Garovic, Vesna D; Qureshi, Fawad; Dillon, John J; Cheungpasitporn, WisitLactic acidosis is a heterogeneous condition with multiple underlying causes and associated outcomes. The use of multi-dimensional patient data to subtype lactic acidosis can personalize patient care. Machine learning consensus clustering may identify lactic acidosis subgroups with unique clinical profiles and outcomes. We used the Medical Information Mart for Intensive Care III database to abstract electronic medical record data from patients admitted to intensive care units (ICU) in a tertiary care hospital in the United States. We included patients who developed lactic acidosis (defined as serum lactate ≥ 4 mmol/L) within 48 h of ICU admission. We performed consensus clustering analysis based on patient characteristics, comorbidities, vital signs, organ supports, and laboratory data to identify clinically distinct lactic acidosis subgroups. We calculated standardized mean differences to show key subgroup features. We compared outcomes among subgroups. We identified 1919 patients with lactic acidosis. The algorithm revealed three best unique lactic acidosis subgroups based on patient variables. Cluster 1 (n = 554) was characterized by old age, elective admission to cardiac surgery ICU, vasopressor use, mechanical ventilation use, and higher pH and serum bicarbonate. Cluster 2 (n = 815) was characterized by young age, admission to trauma/surgical ICU with higher blood pressure, lower comorbidity burden, lower severity index, and less vasopressor use. Cluster 3 (n = 550) was characterized by admission to medical ICU, history of liver disease and coagulopathy, acute kidney injury, lower blood pressure, higher comorbidity burden, higher severity index, higher serum lactate, and lower pH and serum bicarbonate. Cluster 3 had the worst outcomes, while cluster 1 had the most favorable outcomes in terms of persistent lactic acidosis and mortality. Consensus clustering analysis synthesized the pattern of clinical and laboratory data to reveal clinically distinct lactic acidosis subgroups with different outcomes.Item Open Access Machine Learning Prediction Models for Mortality in Intensive Care Unit Patients with Lactic Acidosis.(Journal of clinical medicine, 2021-10) Pattharanitima, Pattharawin; Thongprayoon, Charat; Kaewput, Wisit; Qureshi, Fawad; Qureshi, Fahad; Petnak, Tananchai; Srivali, Narat; Gembillo, Guido; O'Corragain, Oisin A; Chesdachai, Supavit; Vallabhajosyula, Saraschandra; Guru, Pramod K; Mao, Michael A; Garovic, Vesna D; Dillon, John J; Cheungpasitporn, WisitLactic acidosis is the most common cause of anion gap metabolic acidosis in the intensive care unit (ICU), associated with poor outcomes including mortality. We sought to compare machine learning (ML) approaches versus logistic regression analysis for prediction of mortality in lactic acidosis patients admitted to the ICU. We used the Medical Information Mart for Intensive Care (MIMIC-III) database to identify ICU adult patients with lactic acidosis (serum lactate ≥4 mmol/L). The outcome of interest was hospital mortality. We developed prediction models using four ML approaches consisting of random forest (RF), decision tree (DT), extreme gradient boosting (XGBoost), artificial neural network (ANN), and statistical modeling with forward stepwise logistic regression using the testing dataset. We then assessed model performance using area under the receiver operating characteristic curve (AUROC), accuracy, precision, error rate, Matthews correlation coefficient (MCC), F1 score, and assessed model calibration using the Brier score, in the independent testing dataset. Of 1919 lactic acidosis ICU patients, 1535 and 384 were included in the training and testing dataset, respectively. Hospital mortality was 30%. RF had the highest AUROC at 0.83, followed by logistic regression 0.81, XGBoost 0.81, ANN 0.79, and DT 0.71. In addition, RF also had the highest accuracy (0.79), MCC (0.45), F1 score (0.56), and lowest error rate (21.4%). The RF model was the most well-calibrated. The Brier score for RF, DT, XGBoost, ANN, and multivariable logistic regression was 0.15, 0.19, 0.18, 0.19, and 0.16, respectively. The RF model outperformed multivariable logistic regression model, SOFA score (AUROC 0.74), SAP II score (AUROC 0.77), and Charlson score (AUROC 0.69). The ML prediction model using RF algorithm provided the highest predictive performance for hospital mortality among ICU patient with lactic acidosis.Item Open Access Nonsteroidal Anti-inflammatory Drugs and Risk of Incident Heart Failure: A Systematic Review and Meta-analysis of Observational Studies.(Clinical cardiology, 2016-02) Ungprasert, Patompong; Srivali, Narat; Thongprayoon, CharatBackground
The association between the development of heart failure (HF) and use of nonsteroidal anti-inflammatory drugs (NSAIDs) is not well established.Hypothesis
Use of NSAIDs may increase the risk of incident HF.Methods
We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing risk of incident HF in NSAID users vs nonusers. Pooled risk ratios (RR) and 95% confidence intervals (CI) for all NSAIDs and both subclasses (conventional NSAIDs and highly selective cyclooxygenase-2 inhibitors [COXIBs]) were calculated using a random-effect, generic inverse variance method.Results
Seven studies with 7,543,805 participants were identified and included in our data analysis. Use of NSAIDs was associated with a significantly higher risk of developing HF, with a pooled RR of 1.17 (95% CI: 1.01-1.36). Subgroup analysis showed a significantly elevated risk among users of conventional NSAIDs (RR: 1.35, 95% CI: 1.15-1.57) but not users of COXIBs (RR: 1.03, 95% CI: 0.92-1.16).Conclusions
A significantly elevated risk of incident HF was observed among users of NSAIDs.Item Open Access Off-pump versus on-pump coronary artery bypass surgery: an updated meta-analysis of randomized controlled trials on acute kidney injury and mortality outcomes(Journal of the American College of Cardiology) Spanuchart, Ittikorn; Cheungpasitporn, Wisit; Thongprayoon, Charat; Ratanapo, Supawat; Srivali, NaratBackground: The risk of acute kidney injury (AKI) in patients undergoing coronary artery bypass surgery (CABG) with on-pump and off-pump techniques for ischemic heart disease is controversial. The objective of this meta-analysis was to compare these two techniques with respect to causing AKI. Methods: Comprehensive literature searches for randomized controlled trials (RCTs) of CABG with on-pump and off-pump was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews and clinicaltrials.gov from inception through August 2014. Primary outcome was the incidence of AKI. Results: Thirty one prospective RCTs (11,851 patients) were included in our analysis. By meta-analysis, patients in off-pump CABG group had overall lower incidence of AKI (19.1%) compared to on-pump CABG group (22.2%). There was a significant protective effect of off-pump CABG on the incidence of AKI compared to on-pump CABG group [risk ratios (RR): 0.87; 95% CI: 0.77-0.98, I2 of 5%]. The post hoc analysis assessing the mortality outcome demonstrated pooled RR of 0.97 (95% CI, 0.77-1.23) in off-pump vs on-pump CABGs. Conclusion: Our study demonstrates significantly beneficial effect of off-pump CABG on the incidence of AKI compared to conventional on-pump CABG. However, our meta-analysis does not show survival benefit among patients undergoing CABG.Item Open Access Periodic limb movements during sleep and hypertension: A systematic review and meta-analysis(Sleep, 2023-05-29) Srivali, Narat; Thongprayoon, Charat; Tangpanithandee, Supawit; Krisanapan, Pajaree; Zinchuk, Andrey; Koo, Brain; Cheungpasitporn, WisitIntroduction Several studies suggest an association between periodic limb movements during sleep (PLMS) and hypertension; however, a systematic evaluation of this relationship is lacking. Methods We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio, comparing the risk of hypertension in persons with PLMS (defined by the level of periodic limb movements per hour of sleep depended on individual studies) versus those without PLMS. After assessing heterogeneity and bias, the pooled risk ratio and 95% confidence intervals (CIs) were determined using a random-effect, generic inverse variance method of DerSimonian and Laird. Results Out of 572 potentially relevant articles, six eligible cross-sectional studies were included in the data analysis which included 8,949 participants. The statistical heterogeneity of this study was insignificant, with an I2 of 0%. A funnel plot showed no publication bias. The pooled risk ratio of hypertension in patients with PLMS was 1.26 (95% CI, 1.12–1.41). Conclusion Our analysis demonstrates an increased hypertension risk among patients with PLMS. Prospective or interventional studies are needed to confirm this association.Item Open Access Periodic limb movements during sleep and risk of hypertension: A systematic review.(Sleep medicine, 2023-02) Srivali, Narat; Thongprayoon, Charat; Tangpanithandee, Supawit; Krisanapan, Pajaree; Mao, Michael A; Zinchuk, Andrey; Koo, Brain B; Cheungpasitporn, WisitBackground
Several studies suggest an association between periodic limb movements during sleep (PLMS) and hypertension; however, a systematic evaluation of this relationship is lacking.Methods
We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio, comparing the risk of hypertension in persons with PLMS (defined by the level of periodic limb movements per hour of sleep depended on individual studies) versus those without PLMS. After assessing heterogeneity and bias, the pooled risk ratio and 95% confidence intervals (CIs) were determined using a random-effect, generic inverse variance method of DerSimonian and Laird.Results
Out of 572 potentially relevant articles, six eligible studies were included in the data analysis. Studies (6 cross-sectional) included 8949 participants. The statistical heterogeneity of this study was insignificant, with an I2 of 0%. A funnel plot and Egger's regression asymmetry test showed no publication bias with P-value ≥0.05. The pooled risk ratio of hypertension in patients with PLMS was 1.26 (95% CI, 1.12-1.41).Conclusions
Our analysis demonstrates an increased hypertension risk among patients with PLMS. Prospective or interventional studies are needed to confirm this association.