Saint Joseph Hospital

474 Background: Metastatic non–clear cell renal cell carcinoma (nccRCC) is a rare, heterogeneous disease historically underrepresented in trials. Over the past two decades, systemic therapies including tyrosine kinase inhibitors (TKIs), immune checkpoint inhibitors (IO), and IO/TKI combinations have expanded, but their impact on survival in nccRCC remains poorly defined. Methods: We included patients diagnosed with metastatic nccRCC between 2004-2020 from National Cancer Database. We stratified patients based on therapy eras: pre-TKI, TKI, IO, and IO–TKI. We utilized Kaplan-Meier analysis and Cox proportional hazard models to study overall survival (OS)in patients with nccRCC. Results: We included 2,753 patients diagnosed with metastatic nccRCC from the NCDB. Among patients with nccRCC, those who did not receive systemic therapy had a median survival of 3.29 months (95% CI: 2.99–3.55 months). In contrast, patients who received systemic therapy had a longer median survival of 7.62 months (95% CI: 7.26–7.98 months). At 6 months, patients who did not receive systemic therapy had a survival probability of 32.9% (95% CI: 29.9–35.9%). By 12 months, survival declined further to 16.9% (95% CI: 14.7–19.5%). In contrast, patients who received systemic therapy demonstrated significantly better outcomes. At 6 months, survival probability was 62.1% (95% CI: 59.5–64.6%), and at 12 months, survival remained 27.6% (95% CI: 25.3–30.0%). Patients who received systemic therapy had 18% less risk of death compared to patients who did not receive systemic therapy. Additionally, each subsequent year of diagnosis had HR of 0.96 (95% CI: 0.95–0.97, p = 0.00) compared to previous year. Conclusions: Patients with metastatic nccRCC who received systemic therapy lived longer than those who did not (median 7.6 vs 3.3 months; ~18% lower mortality risk). Year-over-year survival gains (HR 0.96; p<0.001) align with wider use of TKIs, IO, and IO–TKI regimens. Given persistently modest survival, prioritizing enrollment in subtype-specific trials and ensuring timely access to active combinations should be central to care. Cox proportional hazards model evaluating factors associated with overall survival among patients with metastatic nccRCC. Variable Comparator HR (95% CI) P-value Age ≥65 years vs <65 years 1.02 (0.91–1.13) 0.78 Private insurance vs Uninsured 0.78 (0.60–1.01) 0.06 Non-academic facility vs Academic 1.13 (1.04–1.23) <0.001 Comorbidity ≥1 vs 0 1.07 (0.98–1.17) 0.13 Distance ≥50 miles vs <50 miles 0.87 (0.79–0.96) <0.001 Poor/Undifferentiated grade vs Well/Moderate 1.72 (1.50–1.97) <0.001 Cytoreductive nephrectomy: Yes vs No 0.46 (0.41–0.53) <0.001 Each Year of diagnosis vs Previous Year 0.96 (0.95–0.97) <0.001 Systemic therapy: Yes vs No 0.82 (0.76–0.89) <0.001

PurposeDespite the need for advanced hemodynamic monitoring, the role of the pulmonary artery catheter (PAC) in cardiogenic shock (CS) remains controversial due to conflicting evidence from previous studies.Material and MethodsThis single-center retrospective study utilized the MIMIC-IV database to assess the impact of PAC use on 30-day in-hospital mortality and clinical outcomes in CS patients admitted between 2008 and 2019. Propensity score matching (PS) and inverse propensity treatment weighting (IPTW) were employed to adjust for baseline differences. The primary outcome was 30-day in-hospital mortality; secondary outcomes included hospital and ICU length of stay and complications. Cox proportional hazard ratio analyses were performed to evaluate the association between PAC use and mortality outcomes.ResultsThe final cohort consisted of 1940 adult CS patients, with 134 receiving PAC and 1806 not. PAC use significantly reduced 30-day in-hospital mortality (PS-matched HR 0.57, 95% CI: 0.39-0.83; IPTW HR 0.58, 95% CI: 0.35-0.96) but was associated with longer hospital stays (16.47 vs 12.37 days) and ICU stays (9.26 vs 7.52 days).ConclusionPAC use in CS patients was associated with improved short-term survival but also with longer hospitalization and potential complications, underscoring the need for careful patient selection and further research.

Background: Penicillin allergy is the most frequently reported drug allergy, yet up to 90% of labels are inaccurate. These erroneous labels contribute to suboptimal antibiotic use, higher healthcare costs, and increased antimicrobial resistance. Despite growing evidence supporting delabeling, provider hesitancy and knowledge gaps persist.Objective: The purpose of this study is to evaluate the awareness, confidence, and clinical decision-making of internal medicine residents regarding penicillin allergy delabeling within a large community hospital setting. Specifically, we seek to identify existing knowledge gaps, provider attitudes, and institutional barriers that may hinder appropriate delabeling efforts.Methods: A cross-sectional, anonymous electronic survey was administered to internal medicine residents at Ascension Saint Joseph Hospital in Chicago. The survey included questions on allergy knowledge, delabeling practices, confidence in risk stratification, and perceived barriers. Responses were analyzed using descriptive statistics and chi-square tests.Results: Of 66 residents invited, 42.4% (n = 28) responded. While 60.7% (n = 17) reported self-perceived knowledge on how to stratify beta-lactam allergy risk, only 12% (n = 2) felt confident in doing so. Familiarity with the PEN-FAST score increased with training level (postgraduate year (PGY)1: 0%; PGY3: 77%; p = 0.017). Half of the respondents had removed a penicillin allergy label, with significant differences by training level (p = 0.048). Major barriers included lack of institutional protocols (n = 23, 82.14%), insufficient knowledge (n = 18, 64.3%), and time constraints (n = 12, 42.86%).Conclusions: Significant gaps exist in residents' knowledge and confidence regarding the delabeling of beta-lactam allergies. Lack of standardized training and protocols further hinders effective implementation. Structured educational interventions and institutional support are needed to promote safe and evidence-based delabeling practices as part of antimicrobial stewardship.

Introduction: Hemophilia is a rare bleeding disorder characterized by deficient clotting factors, which may increase perioperative risks in patients undergoing major cardiac surgery such as coronary artery bypass grafting (CABG). Data on in-hospital outcomes of hemophilic patients undergoing CABG remain scarce. Research Questions: We hypothesized that patients with hemophilia undergoing CABG experience worse in-hospital outcomes compared to their non-hemophilic counterparts. Objectives: To evaluate the impact of hemophilia on in-hospital mortality, length of stay (LOS), and hospitalization costs in patients undergoing CABG. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2016 to 2022. Adult patients undergoing CABG were identified using validated ICD-10-PCS codes. Patients with a diagnosis of hemophilia were matched to non-hemophilic patients using 4:1 propensity score matching (PSM) based on sociodemographic and clinical characteristics. Covariate balance was assessed using standardized mean differences. Conditional logistic regression was used to calculate odds ratios for in-hospital mortality, generalized linear models with a gamma distribution and a log-link function were used to evaluate differences in LOS and hospitalization costs. Results: A weighted total of 280 hospitalizations for coronary artery bypass grafting (CABG) among patients with hemophilia were identified. Following 4:1 PSM, the final cohort comprised 900 patients—180 with hemophilia and 720 without. The mean age was 63.2 years (SD 10.6), and 74.7% of patients were White. Hemophilia A accounted for 58.3% of the hemophilia patients, while Hemophilia B&C accounted for 14.4% and 27.3%, respectively. The overall in-hospital mortality rate was 4.2%. Mortality was significantly higher in the hemophilic group (10.6%) compared to the non-hemophilic group (2.6%) (OR: 4.5 (95% CI: 2.4–6.4). The median length of stay (LOS) for the entire cohort was 9 days (IQR: 8 days), and the median hospitalization cost was $46,440 (IQR: $42,654). Compared to non-hemophilic patients, those with hemophilia had a 33% longer LOS (β = 1.33 days; 95% CI: 1.18–1.49) and 62% higher hospitalization costs (β = 1.62; 95% CI: 1.43–1.84). Conclusion: Hemophilia is linked to higher in-hospital mortality, longer stays, and greater costs in patients undergoing CABG. These findings highlight the need for enhanced perioperative care and tailored management in this high-risk group.

BackgroundThe appropriate antithrombotic regimen for patients with chronic coronary syndrome who are at high atherothrombotic risk and receiving long-term oral anticoagulation remains unknown.MethodsWe conducted a multicenter, double-blind, randomized, placebo-controlled trial in France involving patients with chronic coronary syndrome who had undergone a previous stent implantation (>6 months before enrollment) and were at high atherothrombotic risk and currently receiving long-term oral anticoagulation. The patients were randomly assigned in a 1:1 ratio to receive aspirin (100 mg once daily) or placebo; all the patients continued to receive their current oral anticoagulation therapy. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, stroke, systemic embolism, coronary revascularization, or acute limb ischemia. The key safety outcome was major bleeding.ResultsA total of 872 patients underwent randomization; 433 were assigned to the aspirin group, and 439 to the placebo group. The trial was stopped early at the advice of the independent data and safety monitoring board after a median follow-up of 2.2 years because of an excess of deaths from any cause in the aspirin group. A primary efficacy outcome event occurred in 73 patients (16.9%) in the aspirin group and in 53 patients (12.1%) in the placebo group (adjusted hazard ratio, 1.53; 95% confidence interval [CI], 1.07 to 2.18; P=0.02). Death from any cause occurred in 58 patients (13.4%) in the aspirin group and in 37 (8.4%) in the placebo group (adjusted hazard ratio, 1.72; 95% CI, 1.14 to 2.58; P=0.01). Major bleeding occurred in 44 patients (10.2%) in the aspirin group and in 15 patients (3.4%) in the placebo group (adjusted hazard ratio, 3.35; 95% CI, 1.87 to 6.00; P<0.001). A total of 467 and 395 serious adverse events were reported in the aspirin group and placebo group, respectively.ConclusionsAmong patients with chronic coronary syndrome at high atherothrombotic risk who were receiving an oral anticoagulant, the addition of aspirin led to a higher risk of cardiovascular death, myocardial infarction, stroke, systemic embolism, coronary revascularization, or acute limb ischemia than placebo, as well as higher risks of death from any cause and major bleeding. (Funded by the French Ministry of Health and Bayer Healthcare; ClinicalTrials.gov number, NCT04217447.)

BackgroundSafety-net hospitals (SNH) provide care to a significant proportion of low-income, uninsured, and underserved populations disproportionately affected by the COVID-19 pandemic. We evaluated the impact of safety-net burden on outcomes of COVID-19 hospitalizations.MethodsWe identified patients aged ≥ 18 years hospitalized with COVID-19 from the nationwide inpatient database using the International Classification of Diseases, Tenth Edition (ICD-10-CM) code U07.1. The primary study outcomes were inpatient mortality, respiratory failure requiring mechanical ventilation, and tracheostomy use. Secondary outcomes were total hospitalization costs (THC) and length of hospital stay (LOS). Multivariable logistic regression was used to compare the primary and secondary outcomes in HBH and medium safety-net burden (MBH) with lower-burden hospitals (LBH) (reference).ResultsAn estimated 2,608,232 COVID-19 hospitalizations met the inclusion criteria, with 68.7% occurring in HBH, 22.8% in MBH, and 8.5% in LBH. On adjusted multivariable analysis, HBH was associated with increased odds of inpatient mortality (aOR 1.19, 95% CI 1.09-1.28) compared with LBH. Both HBH (aOR 1.30, 95% CI 1.21-1.40) and MBH (aOR 1.14, 95% CI 1.06-1.24) demonstrated increased odds of mechanical ventilation compared with LBH. THC was lower in HBH and MBH compared with LBH. The LOS was similar across safety net burden categories.ConclusionAfter adjusting for patient- and hospital-level factors, COVID-19 hospitalizations at HBH had inferior inpatient outcomes compared with LBH. Targeted policy reforms are needed to address the underlying causes of these disparities and increase our health systems' readiness for future crises, particularly in underserved communities.