IntroductionInfection is an important complication in cancer patients, which frequently leads to or prolongs hospitalization, and can also lead to acute organ dysfunction (severe sepsis) and eventually death. While cancer patients are known to be at higher risk for infection and subsequent complications, there is no national estimate of the magnitude of this problem. Our objective was to identify cancer patients with severe sepsis and to project these numbers to national levels.MethodsData for all 1999 hospitalizations from six states (Florida, Massachusetts, New Jersey, New York, Virginia, and Washington) were merged with US Census data, Centers for Disease Control vital statistics and National Cancer Institute, Surveillance, Epidemiology, and End Results initiative cancer prevalence data. Malignant neoplasms were identified by International Classification of Disease (ninth revision, clinical modification) (ICD-9-CM) codes (140–208), and infection and acute organ failure were identified from ICD-9-CM codes following Angus and colleagues. Cases were identified as a function of age and were projected to national levels.ResultsThere were 606,176 cancer hospitalizations identified, with severe sepsis present in 29,795 (4.9%). Projecting national estimates for the US population, cancer patients account for 126,209 severe sepsis cases annually, or 16.4 cases per 1000 people with cancer per year. The inhospital mortality for cancer patients with severe sepsis was 37.8%. Compared with the overall population, cancer patients are much more likely to be hospitalized (relative risk, 2.77; 95% confidence interval, 2.77–2.78) and to be hospitalized with severe sepsis (relative risk, 3.96; 95% confidence interval, 3.94–3.99). Overall, severe sepsis is associated with 8.5% (46,729) of all cancer deaths at a cost of $3.4 billion per year.ConclusionSevere sepsis is a common, deadly, and costly complication in cancer patients.

The relation of body mass index, cardiorespiratory fitness, and all-cause mortality in women. Obes Res. 2002;10:417-423. Objective: To examine the relation of body mass index (BMI), cardiorespiratory fitness (CRF), and all-cause mortality in women. Research Methods and Procedures:A cohort of women (42.9 Ϯ 10.4 years) was assessed for CRF, height, and weight. Participants were divided into three BMI categories (normal, overweight, and obese) and three CRF categories (low, moderate, and high). After adjustment for age, smoking, and baseline health status, the relative risk (RR) of all-cause mortality was determined for each group. Further multivariate analyses were performed to examine the contribution of each predictor (e.g., age, BMI, CRF, smoking status, and baseline health status) on all-cause mortality while controlling for all other predictors. Results: During follow-up (113,145 woman-years), 195 deaths from all causes occurred. Compared with normal weight (RR ϭ 1.0), overweight (RR ϭ 0.92) and obesity (RR ϭ 1.58) did not significantly increase all-cause mortality risk. Compared with low CRF (RR ϭ 1.0), moderate (RR ϭ 0.48) and high (RR ϭ 0.57) CRF were associated significantly with lower mortality risk (p ϭ 0.002). In multivariate analyses, moderate (RR ϭ 0.49) and high (RR ϭ 0.57) CRF were strongly associated with decreased mortality relative to low CRF (p ϭ 0.003). Compared with normal weight (RR ϭ 1.0), overweight (RR ϭ 0.84) and obesity (RR ϭ 1.21) were not significantly associated with all-cause mortality. Discussion: Low CRF in women was an important predictor of all-cause mortality. BMI, as a predictor of all-cause mortality risk in women, may be misleading unless CRF is also considered.

This large-scale, randomized, multicenter clinical trial in subjects with SHOX-D demonstrates marked, highly significant, GH-stimulated increases in height velocity and height SDS during the 2-yr study period. The efficacy of GH treatment in subjects with SHOX-D was equivalent to that seen in subjects with TS. We conclude that GH is effective in improving the linear growth of patients with various forms of SHOX-D.

No abstract

IntroductionThere has been dramatic improvement in survival for patients with HIV/AIDS; however, some studies on patients with HIV/AIDS and serious illness have reported continued low rates of intensive care. The purpose of this study was to examine patterns of care and outcomes for patients with severe sepsis and HIV/AIDS and compare them with those of patients with severe sepsis without HIV/AIDS.MethodsWe assessed data from all 1999 discharge abstracts from all non-federal hospitals in six US states. Patient demographic characteristics, discharge diagnoses, resource use, and outcomes were extracted. Analyses were performed using chi-square, Wilcoxon rank sum, or regression techniques, as appropriate.ResultsWe identified 74,020 patients with severe sepsis (7,638 (10.3%) had HIV/AIDS) using ICD-9-CM codes. Patients with severe sepsis and HIV/AIDS had a similar mean length of stay (16.9 days versus 17.7 days; p = 0.0669), had lower mean hospitalization cost ($24,382 versus $30,537; p < 0.0001), were less likely to be admitted to the intensive care unit (37% versus 56%; p < 0.0001), and had a greater mortality (29% versus 20%; p < 0.0001) than those without HIV/AIDS. After adjustment for cohort differences, patients with severe sepsis and HIV/AIDS had increased likelihood of death (OR (95% CI) = 2.41 (2.23–2.61)) and were substantially less likely to be admitted to the intensive care unit (OR (95% CI) = 0.54 (0.51–0.59)). When compared with those with severe sepsis and HIV/AIDS, patients with severe sepsis without HIV/AIDS were universally more likely to be admitted to the intensive care unit, even when they had comorbid illnesses with equal or worse expected in-hospital mortality (e.g., metastatic cancer).ConclusionFor patients with severe sepsis, there are differences in care and outcomes for those with HIV/AIDS. Further research is needed to examine the delivery of care for patients with severe sepsis and HIV/AIDS.