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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: 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: 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: Acute Responses to Oxygen Delivery via High Flow Nasal Cannula in Patients with Severe Chronic Obstructive Pulmonary Disease-HFNC and Severe COPD.

Attaway, Amy H / Faress, Jihane / Jacono, Frank / Dasarathy, Srinivasan

Journal of clinical medicine

2021 Volume 10, Issue 9

Abstract: Differences in oxygen delivery methods to treat hypoxemia have the potential to worsen ... ...

Abstract	Differences in oxygen delivery methods to treat hypoxemia have the potential to worsen CO
Language	English
Publishing date	2021-04-21
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm10091814
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Article ; Online: The Utility of Electronic Inhaler Monitoring in COPD Management: Promises and Challenges.

Attaway, Amy H / Alshabani, Khaled / Bender, Bruce / Hatipoğlu, Umur S

Chest

2020 Volume 157, Issue 6, Page(s) 1466–1477

Abstract: COPD is a common respiratory disorder that poses a major health-care burden with societal and financial ramifications. Although effective inhaled therapies are available, nonadherence is common among patients with COPD and potentially contributes to the ... ...

Abstract	COPD is a common respiratory disorder that poses a major health-care burden with societal and financial ramifications. Although effective inhaled therapies are available, nonadherence is common among patients with COPD and potentially contributes to the burden of this disease. Electronic inhaler monitoring (EIM) is a novel modality that enables real-time assessment of adherence to inhaled therapy and informs the assessment of treatment effectiveness. EIM can be combined with physician feedback, automated audiovisual reminders, and text messaging to bolster adherence. Clinical studies have suggested that EIM can diagnose nonadherence, improve adherence, and predict exacerbations. Using an EIM-guided protocol has the potential to avoid treatment escalation in the nonadherent. Coupling EIM to behavioral intervention is an area of ongoing research with mixed results, with some studies showing benefit and others showing minimal or no significant change in clinical outcomes. Further investigation is necessary to understand the incremental benefits of EIM features, delineate optimal program implementation, and target patient populations that would benefit the most from monitoring.
MeSH term(s)	Administration, Inhalation ; Bronchodilator Agents/administration & dosage ; Electronics ; Equipment Design ; Humans ; Medication Adherence ; Nebulizers and Vaporizers/statistics & numerical data ; Pulmonary Disease, Chronic Obstructive/drug therapy
Chemical Substances	Bronchodilator Agents
Language	English
Publishing date	2020-01-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2019.12.034
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Article ; Online: Inhaled corticosteroids do not adversely impact outcomes in COVID-19 positive patients with COPD: An analysis of Cleveland Clinic's COVID-19 registry.

Sen, Payal / Majumdar, Uddalak / Zein, Joe / Hatipoğlu, Umur / Attaway, Amy H

PloS one

2021 Volume 16, Issue 6, Page(s) e0252576

Abstract: Inhaled Corticosteroids (ICS) are commonly prescribed to patients with severe COPD and recurrent exacerbations. It is not known what impact ICS cause in terms of COVID-19 positivity or disease severity in COPD. This study examined 27,810 patients with ... ...

Abstract	Inhaled Corticosteroids (ICS) are commonly prescribed to patients with severe COPD and recurrent exacerbations. It is not known what impact ICS cause in terms of COVID-19 positivity or disease severity in COPD. This study examined 27,810 patients with COPD from the Cleveland Clinic COVID-19 registry between March 8th and September 16th, 2020. Electronic health records were used to determine diagnosis of COPD, ICS use, and clinical outcomes. Multivariate logistic regression was used to adjust for demographics, month of COVID-19 testing, and comorbidities known to be associated with increased risk for severe COVID-19 disease. Amongst the COPD patients who were tested for COVID-19, 44.1% of those taking an ICS-containing inhaler tested positive for COVID-19 versus 47.2% who tested negative for COVID-19 (p = 0.033). Of those who tested positive for COVID-19 (n = 1288), 371 (28.8%) required hospitalization. In-hospital outcomes were not significantly different when comparing ICS versus no ICS in terms of ICU admission (36.8% [74/201] vs 31.2% [53/170], p = 0.30), endotracheal intubation (21.9% [44/201] vs 16.5% [28/170], p = 0.24), or mortality (18.4% [37/201] vs 20.0% [34/170], p = 0.80). Multivariate logistic regression demonstrated no significant differences in hospitalization (adj OR 1.12, CI: 0.90-1.38), ICU admission (adj OR: 1.31, CI: 0.82-2.10), need for mechanical ventilation (adj OR 1.65, CI: 0.69-4.02), or mortality (OR: 0.80, CI: 0.43-1.49). In conclusion, ICS therapy did not increase COVID-19 related healthcare utilization or mortality outcome in patients with COPD followed at the Cleveland Clinic health system. These findings should encourage clinicians to continue ICS therapy for COPD patients during the COVID-19 pandemic.
MeSH term(s)	Administration, Inhalation ; Adrenal Cortex Hormones/administration & dosage ; Adrenal Cortex Hormones/pharmacology ; Adrenal Cortex Hormones/therapeutic use ; Adrenergic beta-2 Receptor Agonists/adverse effects ; Adult ; Aged ; COVID-19/complications ; COVID-19 Testing ; Female ; Forced Expiratory Volume ; Humans ; Male ; Middle Aged ; Muscarinic Antagonists/therapeutic use ; Nebulizers and Vaporizers ; Pandemics ; Pulmonary Disease, Chronic Obstructive/complications ; Pulmonary Disease, Chronic Obstructive/drug therapy ; Registries ; SARS-CoV-2/drug effects ; SARS-CoV-2/pathogenicity ; COVID-19 Drug Treatment
Chemical Substances	Adrenal Cortex Hormones ; Adrenergic beta-2 Receptor Agonists ; Muscarinic Antagonists
Language	English
Publishing date	2021-06-03
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0252576
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Article ; Online: Severe covid-19 pneumonia: pathogenesis and clinical management.

Attaway, Amy H / Scheraga, Rachel G / Bhimraj, Adarsh / Biehl, Michelle / Hatipoğlu, Umur

BMJ (Clinical research ed.)

2021 Volume 372, Page(s) n436

Abstract: Severe covid-19 pneumonia has posed critical challenges for the research and medical communities. Older age, male sex, and comorbidities increase the risk for severe disease. For people hospitalized with covid-19, 15-30% will go on to develop covid-19 ... ...

Abstract	Severe covid-19 pneumonia has posed critical challenges for the research and medical communities. Older age, male sex, and comorbidities increase the risk for severe disease. For people hospitalized with covid-19, 15-30% will go on to develop covid-19 associated acute respiratory distress syndrome (CARDS). Autopsy studies of patients who died of severe SARS CoV-2 infection reveal presence of diffuse alveolar damage consistent with ARDS but with a higher thrombus burden in pulmonary capillaries. When used appropriately, high flow nasal cannula (HFNC) may allow CARDS patients to avoid intubation, and does not increase risk for disease transmission. During invasive mechanical ventilation, low tidal volume ventilation and positive end expiratory pressure (PEEP) titration to optimize oxygenation are recommended. Dexamethasone treatment improves mortality for the treatment of severe and critical covid-19, while remdesivir may have modest benefit in time to recovery in patients with severe disease but shows no statistically significant benefit in mortality or other clinical outcomes. Covid-19 survivors, especially patients with ARDS, are at high risk for long term physical and mental impairments, and an interdisciplinary approach is essential for critical illness recovery.
MeSH term(s)	COVID-19/complications ; COVID-19/diagnosis ; COVID-19/therapy ; Humans ; Respiration, Artificial ; Respiratory Distress Syndrome/diagnosis ; Respiratory Distress Syndrome/therapy ; Respiratory Distress Syndrome/virology ; SARS-CoV-2/pathogenicity
Language	English
Publishing date	2021-03-10
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.n436
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Article ; Online: The relationship of asthma severity to COVID-19 outcomes.

Zein, Joe G / Mitri, Jad / Bell, Jordan M / Lopez, Diana / Strauss, Ronald / Attaway, Amy H

The journal of allergy and clinical immunology. In practice

2021 Volume 10, Issue 1, Page(s) 318–321.e2

MeSH term(s)	Asthma ; COVID-19 ; Hospitalization ; Humans ; SARS-CoV-2
Language	English
Publishing date	2021-10-27
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2843237-X
ISSN	2213-2201 ; 2213-2198
ISSN (online)	2213-2201
ISSN	2213-2198
DOI	10.1016/j.jaip.2021.10.041
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Article ; Online: Novel Machine Learning Can Predict Acute Asthma Exacerbation.

Zein, Joe G / Wu, Chao-Ping / Attaway, Amy H / Zhang, Peng / Nazha, Aziz

Chest

2021 Volume 159, Issue 5, Page(s) 1747–1757

Abstract: Background: Asthma exacerbations result in significant health and economic burden, but are difficult to predict.: Research question: Can machine learning (ML) models with large-scale outpatient data predict asthma exacerbations?: Study design and ... ...

Abstract	Background: Asthma exacerbations result in significant health and economic burden, but are difficult to predict. Research question: Can machine learning (ML) models with large-scale outpatient data predict asthma exacerbations? Study design and methods: We analyzed data extracted from electronic health records (EHRs) of asthma patients treated at the Cleveland Clinic from 2010 through 2018. Demographic information, comorbidities, laboratory values, and asthma medications were included as covariates. Three different models were built with logistic regression, random forests, and a gradient boosting decision tree to predict: (1) nonsevere asthma exacerbation requiring oral glucocorticoid burst, (2) ED visits, and (3) hospitalizations. Results: Of 60,302 patients, 19,772 (32.8%) had at least one nonsevere exacerbation requiring oral glucocorticoid burst, 1,748 (2.9%) requiring and ED visit and 902 (1.5%) requiring hospitalization. Nonsevere exacerbation, ED visit, and hospitalization were predicted best by light gradient boosting machine, an algorithm used in ML to fit predictive analytic models, and had an area under the receiver operating characteristic curve of 0.71 (95% CI, 0.70-0.72), 0.88 (95% CI, 0.86-0.89), and 0.85 (95% CI, 0.82-0.88), respectively. Risk factors for all three outcomes included age, long-acting β agonist, high-dose inhaled glucocorticoid, or chronic oral glucocorticoid therapy. In subgroup analysis of 9,448 patients with spirometry data, low FEV Interpretation: Models built with an ML algorithm from real-world outpatient EHR data accurately predicted asthma exacerbation and can be incorporated into clinical decision tools to enhance outpatient care and to prevent adverse outcomes.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asthma/physiopathology ; Electronic Health Records ; Female ; Humans ; Machine Learning ; Male ; Middle Aged ; Ohio ; Predictive Value of Tests ; Symptom Flare Up
Language	English
Publishing date	2021-01-10
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2020.12.051
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