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Article ; Online: Acute blood loss anemia in hospitalized patients is associated with adverse outcomes: An analysis of the Nationwide Inpatient Sample.

Dasarathy, Dhweeja / Attaway, Amy H

The American journal of the medical sciences

2024 Volume 367, Issue 4, Page(s) 243–250

Abstract: Background: Acute blood loss anemia is the most common form of anemia and often results from traumatic injuries or gastrointestinal bleeding. There are limited studies analyzing outcomes associated with acute blood loss anemia in hospitalized patients.!# ...

Abstract	Background: Acute blood loss anemia is the most common form of anemia and often results from traumatic injuries or gastrointestinal bleeding. There are limited studies analyzing outcomes associated with acute blood loss anemia in hospitalized patients. Methods: The Nationwide Inpatient Sample (NIS) was analyzed from 2010 to 2014 (n = 133,809). The impact of acute blood loss anemia on in-hospital mortality, length of stay (LOS), healthcare cost, and disposition was determined using regression modeling adjusted for age, gender, race, and comorbidities. Results: Hospitalized patients with acute blood loss anemia had significantly higher healthcare cost (adj OR 1.04; 95% CI: 1.04-1.05), greater lengths of stay (adj OR 1.18; 95% CI: 1.17-1.18), and were less likely to be discharged home compared to the general medical population (adj OR 0.27; 95% CI: 0.26-0.28). Acute blood loss anemia was associated with increased risk for mortality in unadjusted models (unadj 1.16; 95% CI: 1.12-1.20) but not in adjusted models (adj OR 0.91; 95% CI: 0.88-0.94). When analyzing comorbidities, a "muscle loss phenotype" had the strongest association with mortality in patients with acute blood loss anemia (adj OR 4.48; 95% CI: 4.35-4.61). The top five primary diagnostic codes associated with acute blood loss anemia were long bone fractures, GI bleeds, cardiac repair, sepsis, and OB/Gyn related causes. Sepsis had the highest association with mortality (18%, adj OR 2.59; 95% CI: 2.34-2.86) in those with acute blood loss anemia. Conclusions: Acute blood loss anemia is associated with adverse outcomes in hospitalized patients.
MeSH term(s)	Humans ; Inpatients ; Length of Stay ; Patient Discharge ; Anemia/complications ; Anemia/epidemiology ; Sepsis/complications ; Sepsis/epidemiology ; Retrospective Studies
Language	English
Publishing date	2024-01-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	82078-7
ISSN	1538-2990 ; 0002-9629
ISSN (online)	1538-2990
ISSN	0002-9629
DOI	10.1016/j.amjms.2024.01.003
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Article ; Online: The intersection of HIF-1α, O-GlcNAc, and skeletal muscle loss in chronic obstructive pulmonary disease.

Sekar, Jinendiran / Attaway, Amy H

Glycobiology

2023 Volume 33, Issue 11, Page(s) 873–878

Abstract: Sarcopenia, defined as the loss of muscle mass and strength, is a major cause of morbidity and mortality in COPD (chronic obstructive pulmonary disease) patients. However, the molecular mechanisms that cause sarcopenia remain to be determined. In this ... ...

Abstract	Sarcopenia, defined as the loss of muscle mass and strength, is a major cause of morbidity and mortality in COPD (chronic obstructive pulmonary disease) patients. However, the molecular mechanisms that cause sarcopenia remain to be determined. In this review, we will highlight the unique molecular and metabolic perturbations that occur in the skeletal muscle of COPD patients in response to hypoxia, and emphasize important areas of future research. In particular, the mechanisms related to the glycolytic shift that occurs in skeletal muscle in response to hypoxia may occur via a hypoxia-inducible factor 1-alpha (HIF-1α)-mediated mechanism. Upregulated glycolysis in skeletal muscle promotes a unique post-translational glycosylation of proteins known as O-GlcNAcylation, which further shifts metabolism toward glycolysis. Molecular changes in the skeletal muscle of COPD patients are associated with fiber-type shifting from Type I (oxidative) muscle fibers to Type II (glycolytic) muscle fibers. The metabolic shift toward glycolysis caused by HIF-1α and O-GlcNAc modified proteins suggests a potential cause for sarcopenia in COPD, which is an emerging area of future research.
MeSH term(s)	Humans ; Sarcopenia/metabolism ; Muscle, Skeletal/metabolism ; Hypoxia/metabolism ; Protein Processing, Post-Translational ; Pulmonary Disease, Chronic Obstructive/metabolism
Language	English
Publishing date	2023-10-08
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	1067689-2
ISSN	1460-2423 ; 0959-6658
ISSN (online)	1460-2423
ISSN	0959-6658
DOI	10.1093/glycob/cwad081
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Article ; Online: Hypoxic and Autonomic Mechanisms from Sleep-Disordered Breathing Leading to Cardiopulmonary Dysfunction.

Nathani, Avantika / Attaway, Amy / Mehra, Reena

Sleep medicine clinics

2024 Volume 19, Issue 2, Page(s) 229–237

Abstract: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder. Its prevalence has increased due to increasing obesity and improved screening and diagnostic strategies. OSA overlaps with cardiopulmonary diseases to promote intermittent ... ...

Abstract	Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder. Its prevalence has increased due to increasing obesity and improved screening and diagnostic strategies. OSA overlaps with cardiopulmonary diseases to promote intermittent hypoxia and autonomic dysfunction. Intermittent hypoxia increases the risk for oxidative stress and inflammation, which promotes endothelial dysfunction and predisposes to atherosclerosis and other cardiovascular complications. OSA is associated with an increased sympathetic nervous system drive resulting in autonomic dysfunction leading to worsening of cardiopulmonary diseases. Cardiovascular diseases are observed in 40% to 80% of OSA patients. Therefore, it is essential to screen and treat cardiovascular diseases.
MeSH term(s)	Humans ; Hypoxia/physiopathology ; Hypoxia/complications ; Sleep Apnea Syndromes/physiopathology ; Sleep Apnea Syndromes/complications ; Sleep Apnea Syndromes/therapy ; Cardiovascular Diseases/physiopathology ; Cardiovascular Diseases/complications ; Autonomic Nervous System/physiopathology ; Sleep Apnea, Obstructive/physiopathology ; Sleep Apnea, Obstructive/complications ; Sleep Apnea, Obstructive/therapy
Language	English
Publishing date	2024-03-07
Publishing country	United States
Document type	Journal Article ; Review
ISSN	1556-4088
ISSN (online)	1556-4088
DOI	10.1016/j.jsmc.2024.02.003
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Article: Management of patients with COPD during the COVID-19 pandemic

Attaway, Amy

Clevel. clin. j. med

Abstract: Patients with COPD have an increased risk for severity of COVID-19. Flu-like symptoms with dyspnea may distinguish COVID-19 infection from dyspnea due to a COPD-related exacerbation. Management of COPD with COVID-19 warrants standard-of-care treatment ... ...

Abstract	Patients with COPD have an increased risk for severity of COVID-19. Flu-like symptoms with dyspnea may distinguish COVID-19 infection from dyspnea due to a COPD-related exacerbation. Management of COPD with COVID-19 warrants standard-of-care treatment with antimicrobial agents and corticosteroids, though limiting the dose and duration of steroids use may be warranted due to the risk of increased viral shedding. Modalities to treat acute respiratory failure can be used with some caveats. Patients with COPD and COVID-19 infection who treat their illness at home should self-isolate, use nebulizers in ways that avoid viral aerosolization, and frequently disinfect room surfaces.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #32393594
Database	COVID19

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Article ; Online: When should we treat moderate hypoxaemia in patients with COPD?

Attaway, Amy / Haouzi, Philippe

The Lancet. Respiratory medicine

2022 Volume 10, Issue 11, Page(s) e97

MeSH term(s)	Humans ; Hypoxia/etiology ; Hypoxia/therapy ; Oxygen ; Pulmonary Disease, Chronic Obstructive/complications ; Pulmonary Disease, Chronic Obstructive/therapy
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2022-11-01
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	2686754-0
ISSN	2213-2619 ; 2213-2600
ISSN (online)	2213-2619
ISSN	2213-2600
DOI	10.1016/S2213-2600(22)00355-1
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Article ; Online: Reply to "A limitation regarding the association between intranasal corticosteroid use and better COVID-19 outcomes: Nasal symptoms matter".

Strauss, Ronald / Attaway, Amy H / Zein, Joe G

The journal of allergy and clinical immunology. In practice

2022 Volume 10, Issue 1, Page(s) 355–356

MeSH term(s)	Administration, Intranasal ; Adrenal Cortex Hormones/therapeutic use ; COVID-19 ; Humans ; Rhinitis, Allergic, Seasonal/drug therapy ; SARS-CoV-2
Chemical Substances	Adrenal Cortex Hormones
Language	English
Publishing date	2022-01-10
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2843237-X
ISSN	2213-2201 ; 2213-2198
ISSN (online)	2213-2201
ISSN	2213-2198
DOI	10.1016/j.jaip.2021.10.062
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Article ; Online: Management of patients with COPD during the COVID-19 pandemic.

Attaway, Amy / Hatipoğlu, Umur

Cleveland Clinic journal of medicine

2020

Abstract: Patients with COPD have an increased risk for severe COVID-19. Symptoms such as high-grade fever, anorexia, and myalgia may distinguish COVID-19 from dyspnea due to a COPD-related exacerbation. Management of COVID-19 in the patient with COPD may still ... ...

Abstract	Patients with COPD have an increased risk for severe COVID-19. Symptoms such as high-grade fever, anorexia, and myalgia may distinguish COVID-19 from dyspnea due to a COPD-related exacerbation. Management of COVID-19 in the patient with COPD may still warrant standard-of-care exacerbation treatment with antimicrobial agents and corticosteroids. Modalities to treat acute respiratory failure can be used with some caveats. Patients with COPD and COVID-19 infection who treat their illness at home should self-isolate, use nebulizers with precautions to avoid viral aerosolization, and frequently disinfect room surfaces.
Keywords	covid19
Language	English
Publishing date	2020-07-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	639116-3
ISSN	1939-2869 ; 0891-1150
ISSN (online)	1939-2869
ISSN	0891-1150
DOI	10.3949/ccjm.87a.ccc007
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Article ; Online: Muscle loss phenotype in COPD is associated with adverse outcomes in the UK Biobank.

Attaway, Amy H / Lopez, Rocio / Welch, Nicole / Bellar, Annette / Hatipoğlu, Umur / Zein, Joe / Engelen, Marielle Pkj / Dasarathy, Srinivasan

BMC pulmonary medicine

2024 Volume 24, Issue 1, Page(s) 186

Abstract: Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder with systemic consequences that can cause a muscle loss phenotype (MLP), which is characterized by the loss of muscle mass, muscle strength, or loss of both ... ...

Abstract	Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder with systemic consequences that can cause a muscle loss phenotype (MLP), which is characterized by the loss of muscle mass, muscle strength, or loss of both muscle and fat mass. There are limited data comparing the individual traits of MLP with clinical outcomes in a large unbiased cohort of COPD patients. Our aim was to determine the proportion of patients who met criteria for MLP in an unbiased sample of COPD patients at the population-level. We also determined if specific MLP features were associated with all-cause and COPD-related mortality. Methods: A retrospective population-based cohort analysis of the UK Biobank was performed. COPD was defined by a FEV1/FVC ratio < 0.7, physician established diagnosis of COPD, or those with a COPD-related hospitalization before baseline assessment. MLP included one or more of the following: 1) Low fat-free mass index (FFMI) on bioelectric impedance analysis (BIA) or 2) Appendicular skeletal muscle index (ASMI) on BIA, 3) Low muscle strength defined by handgrip strength (HGS), or 4) Low muscle and fat mass based on body mass index (BMI). Cox regression was used to determine the association between MLP and all-cause or COPD-related mortality. All models were adjusted for sex, age at assessment, ethnicity, BMI, alcohol use, smoking status, prior cancer diagnosis and FEV1/FVC ratio. Results: There were 55,782 subjects (56% male) with COPD followed for a median of 70.1 months with a mean(± SD) age at assessment of 59 ± 7.5 years, and FEV1% of 79.2 ± 18.5. Most subjects had mild (50.4%) or moderate (42.8%) COPD. Many patients had evidence of a MLP, which was present in 53.4% of COPD patients (34% by ASMI, 26% by HGS). Of the 5,608 deaths in patients diagnosed with COPD, 907 were COPD-related. After multivariate adjustment, COPD subjects with MLP had a 30% higher hazard-ratio for all-cause death and 70% higher hazard-ratio for COPD-related death. Conclusions: Evidence of MLP is common in a large population-based cohort of COPD and is associated with higher risk for all-cause and COPD-related mortality.
MeSH term(s)	Humans ; Male ; Female ; Retrospective Studies ; Hand Strength ; UK Biobank ; Biological Specimen Banks ; Pulmonary Disease, Chronic Obstructive ; Muscle, Skeletal ; Phenotype
Language	English
Publishing date	2024-04-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2059871-3
ISSN	1471-2466 ; 1471-2466
ISSN (online)	1471-2466
ISSN	1471-2466
DOI	10.1186/s12890-024-02999-7
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Article ; Online: Emergency services utilization by patients with alcohol-associated hepatitis: An analysis of national trends.

Sengupta, Shreya / Anand, Akhil / Lopez, Rocio / Weleff, Jeremy / Wang, Philip R / Bellar, Annette / Attaway, Amy / Welch, Nicole / Dasarathy, Srinivasan

Alcohol, clinical & experimental research

2024 Volume 48, Issue 1, Page(s) 98–109

Abstract: Background: Hospitalization and mortality in patients with alcohol-associated hepatitis (AH), a severe form of liver disease, continue to increase over time. Given the severity of the illness, most hospitalized patients with AH are admitted from the ... ...

Abstract	Background: Hospitalization and mortality in patients with alcohol-associated hepatitis (AH), a severe form of liver disease, continue to increase over time. Given the severity of the illness, most hospitalized patients with AH are admitted from the emergency department (ED). However, there are no data on ED utilization by patients with AH. Thus, the Nationwide Emergency Department Sample (NEDS) dataset was analyzed to determine the ED utilization for AH. Methods: Temporal trends (2016-2019) and outcomes of ED visits for AH were determined. Primary or secondary AH diagnoses were based on coding priority. Numbers of patients evaluated in the ED, severity of disease, complications of liver disease, and discharge disposition were analyzed. Crude and adjusted rates were examined, and temporal trends evaluated using logistic regression with orthogonal polynomial contrasts for each year. Results: There were 466,014,370 ED visits during 2016-2019, of which 448,984 (0.096%) were for AH, 85.0% of which required hospitalization. The rate of visits for AH (primary and secondary) between 2016 and 2019 increased from 85 to 106.8/100,000 ED visits. The rate of secondary AH increased more than the rate of primary AH (from 68.6 to 86.5 vs. from 16.4 to 20.3/100,000 ED visits). Patients aged 45-64 years had the highest rate of ED visits for AH, which decreased during the study period, while the rate of ED visits for AH increased in those aged 25-44 years (from 38.5% to 42.9%). The severity of disease (ascites, hepatic encephalopathy, and acute kidney injury) also increased over time. Medicaid and private insurance were the most common payors for patients seeking care in the ED for AH. Conclusions: Temporal trends show an overall increase in ED utilization rates for AH, more patients requiring hospitalization, and an increase in the proportion of younger patients presenting to the ED with AH.
Language	English
Publishing date	2024-01-09
Publishing country	United States
Document type	Journal Article
ISSN	2993-7175
ISSN (online)	2993-7175
DOI	10.1111/acer.15223
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Article: Management of patients with COPD during the COVID-19 pandemic

Attaway, Amy / Hatipoglu, Umur

Clevel. clin. j. med

Abstract	Patients with COPD have an increased risk for severe COVID-19. Symptoms such as high-grade fever, anorexia, and myalgia may distinguish COVID-19 from dyspnea due to a COPD-related exacerbation. Management of COVID-19 in the patient with COPD may still warrant standard-of-care exacerbation treatment with antimicrobial agents and corticosteroids. Modalities to treat acute respiratory failure can be used with some caveats. Patients with COPD and COVID-19 infection who treat their illness at home should self-isolate, use nebulizers with precautions to avoid viral aerosolization, and frequently disinfect room surfaces.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #251246
Database	COVID19

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