Publications by authors named "Lawler P"
Anticoagulation Among Patients Hospitalized for COVID-19 : A Systematic Review and Prospective Meta-analysis.
Ann Intern Med
December 2024
Background: Reported results of clinical trials assessing higher-dose anticoagulation in patients hospitalized for COVID-19 have been inconsistent.
Purpose: To estimate the association of higher- versus lower-dose anticoagulation with clinical outcomes.
Data Sources: Randomized trials were identified from the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.
Neurological injury drives most deaths and morbidity among patients hospitalized for out-of-hospital cardiac arrest (OHCA). Despite its clinical importance, there are no effective pharmacological therapies targeting post-cardiac arrest (CA) neurological injury. Here, we analyzed circulating immune cells from a large cohort of patients with OHCA, finding that lymphopenia independently associated with poor neurological outcomes.
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- The study investigates the best revascularization method for diabetic patients with multivessel disease who experience a non-ST-segment elevation myocardial infarction (NSTEMI), comparing coronary artery bypass grafting (CABG) and multivessel percutaneous coronary intervention (PCI).
- It involves a large cohort of over 11,000 patients and reveals that CABG is linked to lower all-cause mortality than PCI, particularly in patients deemed potentially ineligible for CABG after a surgical consultation.
- The results suggest that while CABG is generally more beneficial for these patients, the advantage is more pronounced when comparing CABG to a specific group of PCI patients who had a surgical consultation beforehand.
Article Synopsis
- Community-acquired pneumonia (CAP) can lead to serious inflammatory and thrombotic responses, and the use of antiplatelet agents may positively influence patient outcomes, although their impact on non-COVID-19 CAP is unclear.
- A systematic review and meta-analysis examined the effects of antiplatelet agents on mortality in hospitalized patients with non-COVID-19 CAP, analyzing data from observational studies and randomized controlled trials (RCTs).
- The findings suggest that antiplatelet agents are linked to lower mortality in observational studies, but the evidence from RCTs is inconclusive and overall trust in the results is low due to potential biases.
Article Synopsis
- The study investigates how different conditions of the contralateral hip (normal, arthritic, replaced, and bilateral) affect changes in pelvic tilt (PT) during total hip arthroplasty based on radiographic analysis.
- It analyzed data from 193 hip surgeries, measuring PT changes pre- and post-operatively, finding significant differences depending on the contralateral hip condition.
- The findings suggest that understanding these PT changes is important for improving the positioning of hip implants to ensure better outcomes.
Aims: Hospitalized patients with heart failure (HF) are a heterogeneous population, with multiple phenotypes proposed. Prior studies have not examined the biological phenotypes of critically ill patients with HF admitted to the contemporary cardiac intensive care unit (CICU). We aimed to leverage unsupervised machine learning to identify previously unknown HF phenotypes in a large and diverse cohort of patients with HF admitted to the CICU.
View Article and Find Full Text PDFIntroduction: The apolipoprotein E gene (APOE) is an established central player in the pathogenesis of Alzheimer's disease (AD), with distinct apoE isoforms exerting diverse effects. apoE influences not only amyloid-beta and tau pathologies but also lipid and energy metabolism, neuroinflammation, cerebral vascular health, and sex-dependent disease manifestations. Furthermore, ancestral background may significantly impact the link between APOE and AD, underscoring the need for more inclusive research.
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- The study examined acute myocardial infarction (AMI) in young patients (ages 18-45) in Alberta, Canada, focusing on differences between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI).
- Out of 1,679 young patients, STEMI was more common (61%) and had a higher in-hospital mortality rate (1.7%) compared to NSTEMI (0%).
- Despite the initial higher mortality in STEMI patients, long-term outcomes (1 and 5 years) were similar for both groups among those who survived to hospital discharge, with smoking and dyslipidemia identified as significant risk factors.
Background: Inflammation is a sequela of cardiovascular critical illness and a risk factor for mortality.
Objectives: This study aimed to evaluate the association between white blood cell count (WBC) and mortality in a broad population of patients admitted to the cardiac intensive care unit (CICU).
Methods: This retrospective cohort study included patients admitted to the Mayo Clinic CICU between 2007 and 2018.
Background: Clinical trials suggest that therapeutic-dose heparin may prevent critical illness and vascular complications due to COVID-19, but knowledge gaps exist regarding the efficacy of therapeutic heparin including its comparative effect relative to intermediate-dose anticoagulation.
Objectives: The authors performed 2 complementary secondary analyses of a completed randomized clinical trial: 1) a prespecified per-protocol analysis; and 2) an exploratory dose-based analysis to compare the effect of therapeutic-dose heparin with low- and intermediate-dose heparin.
Methods: Patients who received initial anticoagulation dosed consistently with randomization were included.
Article Synopsis
- The study investigates sex-related differences in characteristics and outcomes of patients with cardiogenic shock (CS), particularly focusing on heart failure-related CS (HF-CS) versus acute myocardial infarction-related CS.
- Among patients with HF-CS, women had shorter lengths of stay in the Cardiac Intensive Care Unit (CICU) but were less likely to receive critical interventions like pulmonary artery catheters and mechanical support.
- In-hospital mortality rates were higher for women with HF-CS compared to men, even after controlling for factors like age and overall health status, highlighting a disparity in treatment and outcomes based on sex.
Article Synopsis
- The COVID-19 pandemic underscored the importance of efficient randomized clinical trials, and the Multiplatform Randomized Clinical Trial (mpRCT) utilized Bayesian methods for quicker decisions regarding drug efficacy and futility compared to traditional approaches.
- Bayesian methods involve translating prior beliefs about a treatment's effectiveness into hypothetical data, which are then combined with actual trial data to derive conclusions.
- The study found that the Bayesian efficacy boundary in the mpRCT closely aligns with the frequentist Pocock boundary, suggesting that the methods may yield similar outcomes in monitoring trial efficacy and futility.
Article Synopsis
- Clinical trials are increasingly adopting Bayesian methods for design and analysis, using simulation-based approaches like Markov Chain Monte Carlo (MCMC), which can be computationally expensive and complex.
- The Integrated Nested Laplace Approximations (INLA) algorithm offers a more efficient alternative to MCMC for approximate Bayesian inference without heavy simulation costs.
- Research using data from a COVID-19 trial will compare INLA and MCMC to assess INLA's feasibility and accuracy for Bayesian trial design, providing insights for trialists.
Article Synopsis
- A study assessed the link between preexisting diabetes and mortality, as well as organ support needs, in adults hospitalized for sepsis in Ontario, Canada, from 2008 to 2019.
- Among 503,455 participants, 36% had diabetes; results showed that having diabetes was associated with a lower risk of dying within 90 days, but an increased need for new kidney treatment.
- Additionally, prior use of metformin in diabetic patients played a role in reducing the mortality risk, indicating a potential area for further research on these observed associations.
Background: Anterior approach surgeons who utilize intraoperative fluoroscopy often try to match a preoperative radiograph as a reference for intraoperative cup position. Every degree of inaccuracy in tilt leads to a roughly 0.7° change in anteversion.
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- Limited research exists on the causes of death in patients with cardiogenic shock (CS), prompting a study by the Critical Care Cardiology Trials Network from October 2021 to September 2022.
- Among 1068 cases studied, 337 patients (31.6%) died, and 82.2% of these deaths were attributed to cardiovascular issues, primarily persistent cardiogenic shock.
- Key findings showed that patients with prior cardiac arrest had higher risks of dying from anoxic brain injury or arrhythmia, and those receiving temporary mechanical circulatory support (tMCS) often succumbed to persistent shock.
Article Synopsis
- The study aimed to evaluate the effectiveness of the IABP-SHOCK II risk score in predicting in-hospital mortality in cardiogenic shock (CS) patients from a North American cohort, comparing its performance to its original European context.
- The analysis included 5,340 admissions for CS across 35 medical centers, revealing that the IABP-SHOCK II score effectively identified different risk levels of mortality in both AMI-related and non-AMI-related CS patients.
- Overall, while the risk score demonstrated some predictive capability for in-hospital mortality in various CS types, its correlation with other mortality assessment tools was only moderate, indicating room for improvement in risk stratification methods.