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57. 13-year mortality trends among hospitalized patients with inflammatory bowel disease

Author

Sewell, Justin L, Sewell, Justin L, Yee, Hal F, Sewell, Justin L, Sewell, Justin L, and Yee, Hal F

Abstract

BackgroundStudies document increasing rates of hospitalization among patients with inflammatory bowel disease, but temporal trends for in-hospital mortality among patients with inflammatory bowel disease are not characterized. We sought to determine whether in-hospital mortality changed over a 13-year period among nationwide hospitalizations associated with inflammatory bowel disease. We additionally sought to identify factors correlated with mortality.MethodsWe used the National Hospital Discharge Survey, a large nationally representative database, for the years 1994 through 2006. Age- and mortality-adjusted rates of in-hospital mortality and standardized mortality ratios were calculated for four time periods. Logistic regression analysis was used to assess associations between advancing time and mortality in adjusted analyses.Results150 (0.9%) of 17,393 hospitalizations for patients with inflammatory bowel disease ended in death. Age-adjusted in-hospital mortality decreased from 3.6 deaths per 1,000 hospital days in 1994–96 to 2.4 per 1,000 in 2003–06; standardized mortality ratio decreased from 0.33 to 0.27. Similar trends were seen for patients with ulcerative colitis, but mortality did not change over time among patients with Crohn’s disease. Multivariable logistic regression analysis confirmed the significance of these changes in mortality, with 17% decreased odds of in-hospital death per three-year period (P = 0.012). Subject age (OR 1.06 per year, P < 0.001), Charlson comorbidity index (OR 1.29 per 1-point increase, P < 0.001), and diagnosis of ulcerative colitis (versus Crohn’s disease, OR 1.41, P = .042) were also associated with in-hospital mortality.ConclusionsThe odds of in-hospital mortality among hospitalized patients with inflammatory bowel disease decreased by 17% per 3-year period from 1994 to 2006 in analysis adjusted for age and comorbidity status, in this large, nationally representative database. Multiple factors likely contribute

Published
2012

58. Race and inflammatory bowel disease in an urban healthcare system.

Author

Sewell, Justin L, Sewell, Justin L, Inadomi, John M, Yee, Hal F, Sewell, Justin L, Sewell, Justin L, Inadomi, John M, and Yee, Hal F

Abstract

BackgroundInflammatory bowel disease (IBD) is increasingly common among non-Caucasian populations, but interracial differences in disease characteristics and management are not well-characterized.AimsWe tested the hypothesis that disease characteristics and management vary by race among IBD patients in an ethnically diverse healthcare system.MethodsA retrospective study of the safety net healthcare system of San Francisco, CA, from 1996 to 2009 was undertaken. Patient records with International Classification of Diseases, 9th Revision (ICD9) codes 555.xx, 556.xx, and 558.xx were reviewed. Adult patients with confirmed IBD diagnoses were included. Interracial variations in disease characteristics and management were assessed broadly; focused between-race comparisons identified specific differences.ResultsThe 228 subjects included 77 (33.4%) with Crohn's disease (CD), 150 (65.8%) with ulcerative colitis, and 1 (0.4%) with IBD, type unclassified. The race distribution included 105 (46.1%) white, 34 (14.9%) black, 35 (15.4%) Hispanic, and 51 (22.4%) Asian subjects. Asians and Hispanics were diagnosed at older ages (41.0 and 37.1 years, respectively) and had shorter disease durations (5.4 and 5.2 years, respectively) than whites (30.5 years at diagnosis and 8.6 years duration, P < 0.05) and blacks (31.7 years at diagnosis and 12.1 years duration, P < 0.05). CD was more common among blacks (50% of subjects) than Asians (25.5% of subjects, P = 0.015). The Montreal classification of IBD was similar among races. Hispanics were less likely than others to be treated with 5-aminosalicylates (5-ASA), immunomodulators, and steroids. Medical and surgical management was otherwise similar among races.ConclusionsModest race-based differences in IBD characteristics exist in this racially diverse healthcare system, but the management of IBD is similar among race groups.

Published
2010

66. Immunodominant HIV-Specific CD8 + T-Cell Responses Are Common to Blood and Gastrointestinal Mucosa, and Gag-Specific Responses Dominate in Rectal Mucosa of HIV Controllers

Author

Ferre, April L., primary, Lemongello, Donna, additional, Hunt, Peter W., additional, Morris, Megan M., additional, Garcia, Juan Carlos, additional, Pollard, Richard B., additional, Yee, Hal F., additional, Martin, Jeffrey N., additional, Deeks, Steven G., additional, and Shacklett, Barbara L., additional

Published
2010
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97. The effects of different types of acidosis and extracellular calcium on the mechanical activity of turtle atria

Author

Yee, Hal F. and Jackson, Donald C.

Abstract

The effects of acidosis and extracellular calcium were examined at 20°C in the isolated spontaneously contracting atria of the freshwater turtle (Chrysemys picta bellii). The atria were subjected to treatments of lactic acidosis, hypercapnic acidosis or chloride acidosis in the presence of both normal (2.0 mM) and high (10.0 mM) calcium, which simulated levels of acidosis and calcium observed in vivo. In all cases of acidosis, pH was reduced to 6.80 from a control pH of 7.80.

Published
1984
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98. Fatal Clostridium DifficileEnteritis After Total Abdominal Colectomy

Author

Yee, Hal F., Brown, Robert S., and Ostroff, James W.

Abstract

A 71-year-old man who had undergone an ileorectal anastomosis some years earlier, developed fulminant fatal Clostridium difficilepseudomembranous enteritis and proctitis after a prostatectomy. This case and three reports of C. difficileinvolvement of the small bowel in adults emphasize that the small intestine can be affected. No case like ours, of enteritis after colectomy from C. difficile, has hitherto been reported.

Published
1996

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