The Experts below are selected from a list of 189990 Experts worldwide ranked by ideXlab platform
Rahul Nanchal - One of the best experts on this subject based on the ideXlab platform.
-
Severe sepsis in Hematopoietic Stem Cell transplant recipients
Critical Care Medicine, 2015Co-Authors: Gagan Kumar, Shahryar Ahmad, Amit Taneja, Jayshil J. Patel, Achuta Kumar Guddati, Rahul NanchalAbstract:Severe sepsis requires timely management and has high mortality if care is delayed. Hematopoietic Stem Cell transplant recipients are more likely to be immunocompromised and are predisposed to serious infections. Reports of outcomes of severe sepsis in this population are limited to data from single, tertiary care centers, and national outcomes data are missing. Retrospective analysis of an administrative database. Twenty percent of community hospitals in United States, excluding federal hospitals. Patients with severe sepsis. None. We used International Classification of Diseases, 9th Edition, Clinical Modification codes indicating the presence of sepsis and organ syStem failure to identify hospitalizations for severe sepsis between 2000 and 2008. We also used International Classification of Diseases, 9th Edition, Clinical Modification codes to identify Hematopoietic Stem Cell transplant recipients. We compared outcomes of Hematopoietic Stem Cell transplant recipients with severe sepsis during engraftment and subsequent admissions with a non-Hematopoietic Stem Cell transplant cohort and excluded solid-organ transplantation from this cohort. We used mixed effect, multivariate logistic regression modeling with propensity score adjustment to examine factors associated with mortality of severe sepsis in Hematopoietic Stem Cell transplant recipients. A total of 21,898 Hematopoietic Stem Cell transplant recipients with severe sepsis were identified. The frequency of severe sepsis in Hematopoietic Stem Cell transplant recipients was five times higher when compared with the non-Hematopoietic Stem Cell transplant cohort. The unadjusted mortality was 32.9% in non-Hematopoietic Stem Cell transplant cohort, which was similar to autologous Hematopoietic Stem Cell transplant recipients (30.1%) and those who did not develop graft-versus-host disease (35%). Mortality was significantly higher in allogeneic transplants (55.1%, p < 0.001) and in those who developed graft-versus-host disease (47.9%, p < 0.001). After adjustment, during engraftment admission, the odds of in-hospital mortality in allogeneic Hematopoietic Stem Cell transplant (odds ratio, 3.81; 95% CI, 2.39-6.07) and autologous Hematopoietic Stem Cell transplant (odds ratio, 1.28; 95% CI, 1.06-1.53) recipients was significantly higher than non-Hematopoietic Stem Cell transplant patients. Similarly, in subsequent admissions, Hematopoietic Stem Cell transplant recipients with graft-versus-host disease (odds ratio, 2.14; 95% CI, 1.88-2.45) and without graft-versus-host disease (odds ratio, 1.35; 95% CI, 1.19-1.54) had significantly higher odds of mortality than non-Hematopoietic Stem Cell transplant patients. Among patients with Hematopoietic Stem Cell transplant, persons with autologous Hematopoietic Stem Cell transplant and those without graft-versus-host disease fared better as compared with their allogeneic and graft-versus-host disease counterparts. Hematopoietic Stem Cell transplant recipients are more likely to develop severe sepsis and die following a severe sepsis episode than nontransplant patients. Autologous Hematopoietic Stem Cell transplant recipients and those who do not develop graft-versus-host disease have significantly better outcomes than allogeneic and graft-versus-host disease patients.
-
Severe sepsis in Hematopoietic Stem Cell transplant recipients
Critical care medicine, 2015Co-Authors: Gagan Kumar, Shahryar Ahmad, Amit Taneja, Jayshil J. Patel, Achuta Kumar Guddati, Rahul NanchalAbstract:OBJECTIVE Severe sepsis requires timely management and has high mortality if care is delayed. Hematopoietic Stem Cell transplant recipients are more likely to be immunocompromised and are predisposed to serious infections. Reports of outcomes of severe sepsis in this population are limited to data from single, tertiary care centers, and national outcomes data are missing. DESIGN Retrospective analysis of an administrative database. SETTING Twenty percent of community hospitals in United States, excluding federal hospitals. SUBJECT Patients with severe sepsis. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS We used International Classification of Diseases, 9th Edition, Clinical Modification codes indicating the presence of sepsis and organ syStem failure to identify hospitalizations for severe sepsis between 2000 and 2008. We also used International Classification of Diseases, 9th Edition, Clinical Modification codes to identify Hematopoietic Stem Cell transplant recipients. We compared outcomes of Hematopoietic Stem Cell transplant recipients with severe sepsis during engraftment and subsequent admissions with a non-Hematopoietic Stem Cell transplant cohort and excluded solid-organ transplantation from this cohort. We used mixed effect, multivariate logistic regression modeling with propensity score adjustment to examine factors associated with mortality of severe sepsis in Hematopoietic Stem Cell transplant recipients. A total of 21,898 Hematopoietic Stem Cell transplant recipients with severe sepsis were identified. The frequency of severe sepsis in Hematopoietic Stem Cell transplant recipients was five times higher when compared with the non-Hematopoietic Stem Cell transplant cohort. The unadjusted mortality was 32.9% in non-Hematopoietic Stem Cell transplant cohort, which was similar to autologous Hematopoietic Stem Cell transplant recipients (30.1%) and those who did not develop graft-versus-host disease (35%). Mortality was significantly higher in allogeneic transplants (55.1%, p < 0.001) and in those who developed graft-versus-host disease (47.9%, p < 0.001). After adjustment, during engraftment admission, the odds of in-hospital mortality in allogeneic Hematopoietic Stem Cell transplant (odds ratio, 3.81; 95% CI, 2.39-6.07) and autologous Hematopoietic Stem Cell transplant (odds ratio, 1.28; 95% CI, 1.06-1.53) recipients was significantly higher than non-Hematopoietic Stem Cell transplant patients. Similarly, in subsequent admissions, Hematopoietic Stem Cell transplant recipients with graft-versus-host disease (odds ratio, 2.14; 95% CI, 1.88-2.45) and without graft-versus-host disease (odds ratio, 1.35; 95% CI, 1.19-1.54) had significantly higher odds of mortality than non-Hematopoietic Stem Cell transplant patients. Among patients with Hematopoietic Stem Cell transplant, persons with autologous Hematopoietic Stem Cell transplant and those without graft-versus-host disease fared better as compared with their allogeneic and graft-versus-host disease counterparts. CONCLUSIONS Hematopoietic Stem Cell transplant recipients are more likely to develop severe sepsis and die following a severe sepsis episode than nontransplant patients. Autologous Hematopoietic Stem Cell transplant recipients and those who do not develop graft-versus-host disease have significantly better outcomes than allogeneic and graft-versus-host disease patients.
Gagan Kumar - One of the best experts on this subject based on the ideXlab platform.
-
Severe sepsis in Hematopoietic Stem Cell transplant recipients
Critical Care Medicine, 2015Co-Authors: Gagan Kumar, Shahryar Ahmad, Amit Taneja, Jayshil J. Patel, Achuta Kumar Guddati, Rahul NanchalAbstract:Severe sepsis requires timely management and has high mortality if care is delayed. Hematopoietic Stem Cell transplant recipients are more likely to be immunocompromised and are predisposed to serious infections. Reports of outcomes of severe sepsis in this population are limited to data from single, tertiary care centers, and national outcomes data are missing. Retrospective analysis of an administrative database. Twenty percent of community hospitals in United States, excluding federal hospitals. Patients with severe sepsis. None. We used International Classification of Diseases, 9th Edition, Clinical Modification codes indicating the presence of sepsis and organ syStem failure to identify hospitalizations for severe sepsis between 2000 and 2008. We also used International Classification of Diseases, 9th Edition, Clinical Modification codes to identify Hematopoietic Stem Cell transplant recipients. We compared outcomes of Hematopoietic Stem Cell transplant recipients with severe sepsis during engraftment and subsequent admissions with a non-Hematopoietic Stem Cell transplant cohort and excluded solid-organ transplantation from this cohort. We used mixed effect, multivariate logistic regression modeling with propensity score adjustment to examine factors associated with mortality of severe sepsis in Hematopoietic Stem Cell transplant recipients. A total of 21,898 Hematopoietic Stem Cell transplant recipients with severe sepsis were identified. The frequency of severe sepsis in Hematopoietic Stem Cell transplant recipients was five times higher when compared with the non-Hematopoietic Stem Cell transplant cohort. The unadjusted mortality was 32.9% in non-Hematopoietic Stem Cell transplant cohort, which was similar to autologous Hematopoietic Stem Cell transplant recipients (30.1%) and those who did not develop graft-versus-host disease (35%). Mortality was significantly higher in allogeneic transplants (55.1%, p < 0.001) and in those who developed graft-versus-host disease (47.9%, p < 0.001). After adjustment, during engraftment admission, the odds of in-hospital mortality in allogeneic Hematopoietic Stem Cell transplant (odds ratio, 3.81; 95% CI, 2.39-6.07) and autologous Hematopoietic Stem Cell transplant (odds ratio, 1.28; 95% CI, 1.06-1.53) recipients was significantly higher than non-Hematopoietic Stem Cell transplant patients. Similarly, in subsequent admissions, Hematopoietic Stem Cell transplant recipients with graft-versus-host disease (odds ratio, 2.14; 95% CI, 1.88-2.45) and without graft-versus-host disease (odds ratio, 1.35; 95% CI, 1.19-1.54) had significantly higher odds of mortality than non-Hematopoietic Stem Cell transplant patients. Among patients with Hematopoietic Stem Cell transplant, persons with autologous Hematopoietic Stem Cell transplant and those without graft-versus-host disease fared better as compared with their allogeneic and graft-versus-host disease counterparts. Hematopoietic Stem Cell transplant recipients are more likely to develop severe sepsis and die following a severe sepsis episode than nontransplant patients. Autologous Hematopoietic Stem Cell transplant recipients and those who do not develop graft-versus-host disease have significantly better outcomes than allogeneic and graft-versus-host disease patients.
-
Severe sepsis in Hematopoietic Stem Cell transplant recipients
Critical care medicine, 2015Co-Authors: Gagan Kumar, Shahryar Ahmad, Amit Taneja, Jayshil J. Patel, Achuta Kumar Guddati, Rahul NanchalAbstract:OBJECTIVE Severe sepsis requires timely management and has high mortality if care is delayed. Hematopoietic Stem Cell transplant recipients are more likely to be immunocompromised and are predisposed to serious infections. Reports of outcomes of severe sepsis in this population are limited to data from single, tertiary care centers, and national outcomes data are missing. DESIGN Retrospective analysis of an administrative database. SETTING Twenty percent of community hospitals in United States, excluding federal hospitals. SUBJECT Patients with severe sepsis. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS We used International Classification of Diseases, 9th Edition, Clinical Modification codes indicating the presence of sepsis and organ syStem failure to identify hospitalizations for severe sepsis between 2000 and 2008. We also used International Classification of Diseases, 9th Edition, Clinical Modification codes to identify Hematopoietic Stem Cell transplant recipients. We compared outcomes of Hematopoietic Stem Cell transplant recipients with severe sepsis during engraftment and subsequent admissions with a non-Hematopoietic Stem Cell transplant cohort and excluded solid-organ transplantation from this cohort. We used mixed effect, multivariate logistic regression modeling with propensity score adjustment to examine factors associated with mortality of severe sepsis in Hematopoietic Stem Cell transplant recipients. A total of 21,898 Hematopoietic Stem Cell transplant recipients with severe sepsis were identified. The frequency of severe sepsis in Hematopoietic Stem Cell transplant recipients was five times higher when compared with the non-Hematopoietic Stem Cell transplant cohort. The unadjusted mortality was 32.9% in non-Hematopoietic Stem Cell transplant cohort, which was similar to autologous Hematopoietic Stem Cell transplant recipients (30.1%) and those who did not develop graft-versus-host disease (35%). Mortality was significantly higher in allogeneic transplants (55.1%, p < 0.001) and in those who developed graft-versus-host disease (47.9%, p < 0.001). After adjustment, during engraftment admission, the odds of in-hospital mortality in allogeneic Hematopoietic Stem Cell transplant (odds ratio, 3.81; 95% CI, 2.39-6.07) and autologous Hematopoietic Stem Cell transplant (odds ratio, 1.28; 95% CI, 1.06-1.53) recipients was significantly higher than non-Hematopoietic Stem Cell transplant patients. Similarly, in subsequent admissions, Hematopoietic Stem Cell transplant recipients with graft-versus-host disease (odds ratio, 2.14; 95% CI, 1.88-2.45) and without graft-versus-host disease (odds ratio, 1.35; 95% CI, 1.19-1.54) had significantly higher odds of mortality than non-Hematopoietic Stem Cell transplant patients. Among patients with Hematopoietic Stem Cell transplant, persons with autologous Hematopoietic Stem Cell transplant and those without graft-versus-host disease fared better as compared with their allogeneic and graft-versus-host disease counterparts. CONCLUSIONS Hematopoietic Stem Cell transplant recipients are more likely to develop severe sepsis and die following a severe sepsis episode than nontransplant patients. Autologous Hematopoietic Stem Cell transplant recipients and those who do not develop graft-versus-host disease have significantly better outcomes than allogeneic and graft-versus-host disease patients.
Thomas R. Spitzer - One of the best experts on this subject based on the ideXlab platform.
-
Hematopoietic Stem Cell transplant associated thrombotic microangiopathy current paradigm and novel therapies
Bone Marrow Transplantation, 2018Co-Authors: J Khosla, Thomas R. SpitzerAbstract:Hematopoietic Stem Cell transplant-associated thrombotic microangiopathy: current paradigm and novel therapies
David T Scadden - One of the best experts on this subject based on the ideXlab platform.
-
The Hematopoietic Stem Cell niche—home for friend and foe?†
Cytometry. Part B Clinical cytometry, 2012Co-Authors: Daniela S. Krause, David T Scadden, Frederic I. PrefferAbstract:The Hematopoietic Stem Cell (HSC) niche is involved in the maintainance and regulation of quiescence, self-renewal and differentiation of Hematopoietic Stem Cells and the fate of their progeny in mammals dealing with the daily stresses to the Hematopoietic syStem. From the discovery that perturbations of the HSC niche can lead to Hematopoietic disorders, we have now arrived at the prospect that the HSC niche may play a role in hematological malignancies and that this HSC niche may be a target for therapy. This review attempts to capture the discoveries of the last few years regarding the normal and malignant Hematopoietic Stem Cell niche and possible ways to target this niche. © 2012 International Clinical Cytometry Society
-
The Hematopoietic Stem Cell niche
Frontiers in Bioscience, 2012Co-Authors: Dongsu Park, David B Sykes, David T ScaddenAbstract:Hematopoietic Stem Cells (HSCs) possess the ability to self-renew and to differentiate to mature progeny along multiple different Hematopoietic lineages. The function of HSCs depends upon the signals from surrounding Cells found within the highly specialized microenvironment termed the Hematopoietic Stem Cell niche. Understanding and exploiting the HSC niche is a goal of basic scientists and clinicians alike. Recent studies have focused on defining the Cellular components and molecular factors critical to this microenvironment. Here we review recent findings, discuss unresolved questions, and examine the clinical implications of our current knowledge of the HSC niche.
Shahryar Ahmad - One of the best experts on this subject based on the ideXlab platform.
-
Severe sepsis in Hematopoietic Stem Cell transplant recipients
Critical Care Medicine, 2015Co-Authors: Gagan Kumar, Shahryar Ahmad, Amit Taneja, Jayshil J. Patel, Achuta Kumar Guddati, Rahul NanchalAbstract:Severe sepsis requires timely management and has high mortality if care is delayed. Hematopoietic Stem Cell transplant recipients are more likely to be immunocompromised and are predisposed to serious infections. Reports of outcomes of severe sepsis in this population are limited to data from single, tertiary care centers, and national outcomes data are missing. Retrospective analysis of an administrative database. Twenty percent of community hospitals in United States, excluding federal hospitals. Patients with severe sepsis. None. We used International Classification of Diseases, 9th Edition, Clinical Modification codes indicating the presence of sepsis and organ syStem failure to identify hospitalizations for severe sepsis between 2000 and 2008. We also used International Classification of Diseases, 9th Edition, Clinical Modification codes to identify Hematopoietic Stem Cell transplant recipients. We compared outcomes of Hematopoietic Stem Cell transplant recipients with severe sepsis during engraftment and subsequent admissions with a non-Hematopoietic Stem Cell transplant cohort and excluded solid-organ transplantation from this cohort. We used mixed effect, multivariate logistic regression modeling with propensity score adjustment to examine factors associated with mortality of severe sepsis in Hematopoietic Stem Cell transplant recipients. A total of 21,898 Hematopoietic Stem Cell transplant recipients with severe sepsis were identified. The frequency of severe sepsis in Hematopoietic Stem Cell transplant recipients was five times higher when compared with the non-Hematopoietic Stem Cell transplant cohort. The unadjusted mortality was 32.9% in non-Hematopoietic Stem Cell transplant cohort, which was similar to autologous Hematopoietic Stem Cell transplant recipients (30.1%) and those who did not develop graft-versus-host disease (35%). Mortality was significantly higher in allogeneic transplants (55.1%, p < 0.001) and in those who developed graft-versus-host disease (47.9%, p < 0.001). After adjustment, during engraftment admission, the odds of in-hospital mortality in allogeneic Hematopoietic Stem Cell transplant (odds ratio, 3.81; 95% CI, 2.39-6.07) and autologous Hematopoietic Stem Cell transplant (odds ratio, 1.28; 95% CI, 1.06-1.53) recipients was significantly higher than non-Hematopoietic Stem Cell transplant patients. Similarly, in subsequent admissions, Hematopoietic Stem Cell transplant recipients with graft-versus-host disease (odds ratio, 2.14; 95% CI, 1.88-2.45) and without graft-versus-host disease (odds ratio, 1.35; 95% CI, 1.19-1.54) had significantly higher odds of mortality than non-Hematopoietic Stem Cell transplant patients. Among patients with Hematopoietic Stem Cell transplant, persons with autologous Hematopoietic Stem Cell transplant and those without graft-versus-host disease fared better as compared with their allogeneic and graft-versus-host disease counterparts. Hematopoietic Stem Cell transplant recipients are more likely to develop severe sepsis and die following a severe sepsis episode than nontransplant patients. Autologous Hematopoietic Stem Cell transplant recipients and those who do not develop graft-versus-host disease have significantly better outcomes than allogeneic and graft-versus-host disease patients.
-
Severe sepsis in Hematopoietic Stem Cell transplant recipients
Critical care medicine, 2015Co-Authors: Gagan Kumar, Shahryar Ahmad, Amit Taneja, Jayshil J. Patel, Achuta Kumar Guddati, Rahul NanchalAbstract:OBJECTIVE Severe sepsis requires timely management and has high mortality if care is delayed. Hematopoietic Stem Cell transplant recipients are more likely to be immunocompromised and are predisposed to serious infections. Reports of outcomes of severe sepsis in this population are limited to data from single, tertiary care centers, and national outcomes data are missing. DESIGN Retrospective analysis of an administrative database. SETTING Twenty percent of community hospitals in United States, excluding federal hospitals. SUBJECT Patients with severe sepsis. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS We used International Classification of Diseases, 9th Edition, Clinical Modification codes indicating the presence of sepsis and organ syStem failure to identify hospitalizations for severe sepsis between 2000 and 2008. We also used International Classification of Diseases, 9th Edition, Clinical Modification codes to identify Hematopoietic Stem Cell transplant recipients. We compared outcomes of Hematopoietic Stem Cell transplant recipients with severe sepsis during engraftment and subsequent admissions with a non-Hematopoietic Stem Cell transplant cohort and excluded solid-organ transplantation from this cohort. We used mixed effect, multivariate logistic regression modeling with propensity score adjustment to examine factors associated with mortality of severe sepsis in Hematopoietic Stem Cell transplant recipients. A total of 21,898 Hematopoietic Stem Cell transplant recipients with severe sepsis were identified. The frequency of severe sepsis in Hematopoietic Stem Cell transplant recipients was five times higher when compared with the non-Hematopoietic Stem Cell transplant cohort. The unadjusted mortality was 32.9% in non-Hematopoietic Stem Cell transplant cohort, which was similar to autologous Hematopoietic Stem Cell transplant recipients (30.1%) and those who did not develop graft-versus-host disease (35%). Mortality was significantly higher in allogeneic transplants (55.1%, p < 0.001) and in those who developed graft-versus-host disease (47.9%, p < 0.001). After adjustment, during engraftment admission, the odds of in-hospital mortality in allogeneic Hematopoietic Stem Cell transplant (odds ratio, 3.81; 95% CI, 2.39-6.07) and autologous Hematopoietic Stem Cell transplant (odds ratio, 1.28; 95% CI, 1.06-1.53) recipients was significantly higher than non-Hematopoietic Stem Cell transplant patients. Similarly, in subsequent admissions, Hematopoietic Stem Cell transplant recipients with graft-versus-host disease (odds ratio, 2.14; 95% CI, 1.88-2.45) and without graft-versus-host disease (odds ratio, 1.35; 95% CI, 1.19-1.54) had significantly higher odds of mortality than non-Hematopoietic Stem Cell transplant patients. Among patients with Hematopoietic Stem Cell transplant, persons with autologous Hematopoietic Stem Cell transplant and those without graft-versus-host disease fared better as compared with their allogeneic and graft-versus-host disease counterparts. CONCLUSIONS Hematopoietic Stem Cell transplant recipients are more likely to develop severe sepsis and die following a severe sepsis episode than nontransplant patients. Autologous Hematopoietic Stem Cell transplant recipients and those who do not develop graft-versus-host disease have significantly better outcomes than allogeneic and graft-versus-host disease patients.