Baylor University Medical Center Proceedings最新文献

Objectives: This study aimed to evaluate temporal trends in adult sickle cell disease (SCD) mortality in the United States from 1999 to 2020, stratified by age, sex, race, and geography, to identify disparities and guide targeted interventions.

Methods: A retrospective observational study was conducted using national mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database. The sample included adults aged ≥15 years who died from SCD between 1999 and 2020 (n = 17,443). Age-adjusted mortality rates (AAMRs) were calculated and stratified by demographic and geographic variables. Temporal trends were assessed using Mann-Kendall trend tests, and t-tests were applied to compare continuous variables across subgroups. Statistical significance was defined as P < 0.05.

Results: The AAMR for adult SCD increased by 132% over the study period (P = 0.014). The greatest rise in mortality was observed among adults aged ≥65 years (P = 0.008) and women (P = 0.015). Black individuals accounted for 97.5% of SCD-related deaths, underscoring severe racial disparities. Geographically, the Southern region exhibited the highest AAMR and was the only region with a statistically significant increase in mortality over time (P = 0.001).

Conclusions: Adult SCD mortality in the United States has risen significantly from 1999 to 2020, with disproportionate increases among older adults, women, and individuals in the Southern region. The findings highlight urgent needs for targeted national interventions, development of age-specific care models, and implementation of equity-focused health policies to address persistent racial and regional disparities in SCD outcomes.

Background: Anemia has been observed in up to 46% of individuals with acute brain injury. Blood transfusions are commonly performed to raise hemoglobin levels, so we aimed to compare the restrictive and liberal blood transfusion strategies in acute brain injury patients.

Methods: A systematic search was conducted on Web of Science, Embase, Scopus, Cochrane, and Medline/PubMed up to February 10, 2025. Continuous data were combined using mean differences (MD), and dichotomous outcomes were synthesized using risk ratios (RR); both were detailed with a 95% confidence interval (CI), applying R software (version 4.3). This study was registered and published with PROSPERO (ID CRD42025630392).

Results: The analysis incorporated six randomized controlled trials involving 2599 participants. There were no substantial variations between the liberal and restrictive transfusion groups in unfavorable neurological outcomes (RR: 0.90 [95% CI: 0.79-1.03]; P = 0.13), favorable neurological outcomes (RR: 1.16 [95% CI: 1.00-1.35]; P = 0.05), hospital length of stay (MD: -0.66 [95% CI: -2.48-1.16]; P = 0.48), or intensive care unit length of stay (MD: 0.15 [95% CI: -0.68-0.99]; P = 0.72). However, the liberal transfusion strategy was accompanied with an increased number of red cell units transfused (MD: 2.28, 95% CI: [1.75-2.80]; P < 0.01) and reduced sepsis or septic shock compared to the restrictive strategy (RR: 0.73 [95% CI: 0.56-0.96]; P = 0.02).

Conclusion: The liberal strategy of blood transfusion for patients with acute brain injury and anemia did not impact neurological outcomes. It reduced the incidence of sepsis or septic shock, but this came with an increase in the number of red blood cells transfused without affecting overall mortality or thrombotic events.

Background: Acute respiratory distress syndrome (ARDS) is a significant cause of morbidity and mortality, particularly among critically ill patients with limited treatment options. This study analyzed long-term trends in ARDS mortality in the US, focusing on racial disparities. By examining mortality rates across racial, regional, and gender groups, the study identified demographic and geographic inequalities to inform targeted interventions.

Methods: ARDS mortality data from 1999 to 2022 was obtained from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) were stratified by sex, race, and US census region. Joinpoint regression was used to calculate annual percentage changes (APCs) and average annual percent change (AAPC).

Results: The overall AAMR increased from 7.40 (1999) to a peak of 21.72 (2021) before declining to 8.49 (2022, AAPC: 2.92). American Indians had the highest AAMR, increasing from 13.8 (1999) to 18.89 (2022, AAPC: 4.37). Asians had the lowest AAMR, declining from 7.4 (1999) to 6.17 (2022). AAMRs declined from 1999 to 2017, surged from 2017 to 2020, and dropped after 2022. Regional disparities were notable among the Northeast and Midwest, with Black populations having higher mortality.

Conclusion: ARDS mortality trends worsened during the COVID-19 pandemic, disproportionately affecting American Indian and Black populations. Addressing these disparities requires equitable healthcare policies and further research into social determinants of health.

Background: Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are minimally invasive alternatives to surgery for gastrointestinal tumors, differing in technique, indications, and outcomes. This meta-analysis compared the efficacy and safety of ESD vs EMR.

Methods: Following PRISMA guidelines, PubMed, Cochrane, Google Scholar, and Scopus were searched. Binary outcomes were pooled as odds ratios (ORs) and continuous outcomes as standardized mean differences (SMDs), with 95% confidence intervals (CIs), using a random-effects model. Analyses were performed in R (v4.4.1), with significance set at P < 0.05.

Results: Twenty-five studies with 5283 patients (2234 ESD, 3049 EMR) were included. ESD achieved higher complete resection (OR, 5.77; 95% CI, 2.18-15.26; P < 0.001; I ² = 91%) and en bloc resection rates (OR, 13.46; 95% CI, 5.91-30.64; P < 0.001; I ² = 82%). It required longer procedural time (SMD, 1.73; 95% CI, 1.26-2.19; P < 0.01) but had lower piecemeal resection (OR, 0.06; 95% CI, 0.01-0.38; P = 0.003). Postendoscopic resection coagulation syndrome (PECS) was more frequent with ESD (OR, 2.40; 95% CI, 1.25-4.61; P = 0.008). No significant differences were found in delayed bleeding (P = 0.06) or recurrence (P = 0.61).

Conclusions: ESD provides superior complete and en bloc resection compared with EMR but involves longer procedures and higher PECS risk. Large-scale trials are needed to refine comparative outcomes.

Objective: Hyperkalemia is a potentially life-threatening electrolyte imbalance that contributes to increased morbidity and mortality in patients with heart failure (HF) and chronic kidney disease (CKD). Novel potassium binders (NPBs) have been shown to prevent hyperkalemia; however, their efficacy and safety have not been fully established.

Methods: We searched various electronic databases, including MEDLINE (via PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov, to retrieve randomized controlled trials comparing NPB to placebo in patients with chronic hyperkalemia due to HF or CKD.

Results: Our meta-analysis, including 12 studies involving 2517 patients, showed that NPBs, including patiromer and sodium zirconium cyclosilicate, were associated with significant mineralocorticoid receptor antagonist (MRA) optimization (relative risk [RR]: 1.28; 95% confidence interval [CI]: 1.14-1.43) as compared to placebo. The results were consistent for subgroups of sodium zirconium cyclosilicate, patiromer, CKD, and HF. NPBs also significantly reduced the incidence of hyperkalemia (RR: 0.37; 95% CI: 0.22-0.6). Additionally, NPBs reduced the mean serum potassium level from baseline as compared to placebo (mean difference: -0.46; 95% CI: -0.77 to -0.15) and MRA optimization at less than the target dose (RR: 0.62; 95% CI: 0.42-0.85). The risk of adverse events, serious adverse events, and all-cause mortality remained comparable between the two groups.

Conclusion: This meta-analysis highlights the potential of NPBs to facilitate MRA optimization, reduce hyperkalemic episodes, and maintain serum potassium levels in patients with hyperkalemia, without a corresponding increase in adverse events. However, further research through large-scale studies is needed to confirm the sustained clinical benefits of NPBs, establish standardized treatment protocols, and evaluate their effectiveness across diverse patient populations with CKD and HF.

Purpose: Barrett's esophagus (BE) is the main precursor to esophageal adenocarcinoma, a cancer with a significantly rising incidence. While proton-pump inhibitors (PPIs) are the standard therapy for managing BE, the chemopreventive role of aspirin is an area of growing interest with inconclusive evidence, particularly regarding its use in combination with PPIs. This study aimed to assess whether adding aspirin to PPI therapy reduces the incidence of esophageal cancer in patients with BE more than PPIs alone.

Methods: A nationwide retrospective cohort study was conducted using the TriNetX database. Adult patients with BE were divided into two cohorts: those receiving aspirin plus a PPI and those receiving a PPI only. Propensity score matching was used to balance baseline demographics and clinical comorbidities. The primary outcome was the incidence of malignant neoplasm of the lower third of the esophagus. Subgroup analyses were also performed for low-dose (81 mg) and high-dose (300-325 mg) aspirin.

Results: After matching, each cohort included 88,184 patients. The cohort receiving aspirin and PPIs had a lower risk of developing esophageal cancer compared to the PPI-only cohort (odds ratio [OR] 0.799, 95% CI: 0.679-0.941). The protective association was observed in both high-dose (OR 0.643) and low-dose (OR 0.664) aspirin subgroups, suggesting a potential dose-dependent effect.

Conclusion: This large, real-world analysis suggests that the concurrent use of aspirin with PPIs is associated with a reduced risk of esophageal cancer in patients with BE.