American journal of hospital medicine, volume 8, issue 2 (2024 April-June)

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https://hdl.handle.net/10355/107847

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    Serum albumin as a marker of metabolic response to injury and its role with calorie intake regarding length of stay, readmission rates and hospital survival
    (University of Missouri, Department of Medicine, Division of Hospital Medicine, 2024-06) Tayek, John A.
    Background: Studies have shown a relationship between albumin level and hospital mortality, but none have looked at low serum albumin, calorie intake and survival. Aim: To evaluate the relationship between serum albumin level, calorie intake, length of hospital stay (LOS), readmission rates and hospital mortality in a large population of disadvantaged and underinsured patients at a County of Los Angeles Medical Center. Design: Prospective observational study using data collected over a 6-year period of hospital survival, LOS and readmission rate in 11,441 patients. Calorie intake in those 400 patients with serum albumin [less than] 1.5 g/dL was collected. Our hypothesis was to test if the relationship of admission serum albumin to mortality was linear or exponential. In addition, in those with a serum albumin [less than] 1.5 g/dL, we evaluated calorie intake and hospital survival. Methods: A total of 11,441 patients were included in the dataset. ANOVA and regression analysis were performed. Calorie intake was extracted from dietary and intravenous intake data of each of the 400 patients with an albumin [less than] 1.5 g/dL. Results: Serum albumin was obtained within the first 7 days of admission in all patients. Mortality increased in patients with admission serum albumin [less than] 3.5 g/dL (8.8% vs 2.3%, p[less than]0.05). Serum albumin was exponentially related to mortality (mortality = 32 / albumin2; p [less than] 0.01). The group of patients with albumin [less than] 1.5 g/dL had the greatest mortality rate (18%), approximately seven times that of patients with normal serum albumin levels. These patients also had an average LOS of 14.7 days (p[less than]0.05), twice that of patients with normal albumin values. 30-day admission rates for this group were three times greater (6.3% vs. 1.9%, p[less than]0.05). Calorie intake was associated with a dose response curve with regards to hospital mortality. Conclusion: A single measurement of serum albumin identifies patients who are at high risk for prolonged hospital stay, readmission and mortality. Calorie intake may modify mortality risk, but prospective studies are needed.
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    Loneliness and its impact : an overlooked epidemic
    (University of Missouri, Department of Medicine, Division of Hospital Medicine, 2024-06) Chi, Cathy; Hoque, Farzana
    Approximately half of U.S. adults report experiencing measurable levels of loneliness.1 Loneliness is the feeling of being alone, irrespective of social contact, while social isolation is a lack of social connections. Therefore, social isolation may lead to loneliness for some, while others can feel lonely without being socially isolated. Both loneliness and social isolation are increasing exponentially. The U.S. Surgeon General, Dr. Vivek Murthy, recently declared loneliness and isolation as an underappreciated public health crisis, equating its impact on physical health to that of smoking 15 cigarettes per day.2 The primary method for measuring loneliness uses self-report surveys, where individuals evaluate their loneliness and social isolation by responding to statements about social interactions and emotions, indicating their agreement or frequency of these experiences. The UCLA Loneliness Scale is one of the most widely used tools which has 20 items, allowing individuals to subjectively assess their feelings on a scale from 1 to 4, covering aspects such as feeling excluded or having companionship. Scores ranging from 20 to 34 indicate a low level of loneliness, 35 to 49 indicate a moderate level, 50 to 64 reflect a moderately high level, and 65 to 80 indicate a high level of loneliness.3 Loneliness is inherently subjective, and individuals' perceptions of what constitutes loneliness can vary widely.
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    A case of disseminated cryptococcus in an HIV-positive patient
    (University of Missouri, Department of Medicine, Division of Hospital Medicine, 2024-06) Awolumate, Oluwatayo J.; Ngonge, Anthony Lyonga; Oni, Olanrewaju; Deonarine, Anand
    A 69-year-old male with a history of untreated Human Immunodeficiency Virus (HIV) was admitted to the emergency department for symptoms such as cough, shortness of breath, lethargy, and weight loss. His physical examination revealed severe wasting, oral thrush, and hypoxia. Chest imaging revealed cavitary lesions and blood work showed an absolute CD4 count of 23 cells/mm3. An IR-guided biopsy revealed abundant necrosis and scattered narrow- based fungal organisms consistent with Cryptococcus neoformans infection. The patient was treated with liposomal amphotericin B and flucytosine. Due to the increased risk of Immune Reconstitution Inflammatory Syndrome (IRIS), HIV treatment was deferred. The patient deteriorated, transitioned to comfort care, and unfortunately expired.