Abstract only Background: Thrombotic Microangiopathy (TMA) is a rare disorder affecting the coagulation system causing microangiopathic thrombus formation within various blood vessels including the ...cerebral arteries. It may be seen in association with thrombocytopenia, anemia, purpura and kidney failure as well as complications of various systemic viral illnesses. We sought to estimate the trends, predictors, and outcomes of CeVD in patients having ™ from a nationally representative database of the USA. Methods: In this cross-sectional study, we identified hospitalization with TM using ICD-9/10-CM from the National Inpatient Sample (NIS) for the years 2008-2017. Prevalence of CeVD was identified by validated ICD-9/10-CM codes. We utilized Cochran Armitage trend test and multivariable survey logistic regression models to analyze temporal trends, outcomes and predictors of any CeVD in TM patients. Results: Out of a total 58,850 hospitalizations among TMA patients, 4,668 (7.9%) developed CeVD. Prevalence of CeVD increased from 6.2% in 2008 to 8.2% in 2017 (pTrend<0.001). Patients who developed CeVD were older and more likely to be female. In multivariable regression analysis, increasing age (OR 1.2; 95%CI 1.1-1.2; p<0.0001); females (OR 1.3; 95%CI 1.1-1.6;p<0.0004); African American (OR 1.4; 95%CI 1.2-1.7;p<0.001) and hypertension (OR 1.3; 95%CI 1.1-1.6; p<0.0001). CeVD was also associated with higher length of stay (18 vs 12 days; p<0.001). Additionally, CeVD was associated with higher in-hospital mortality (aOR 2.1; 95%CI 1.7-2.5; p<0.001) and discharge to facility (aOR 3.0; 95%CI 2.4-3.5; p<0.001) after adjusting with confounders. Conclusion: We observed the mildly incremental prevalence of CeVD among TMA patients. We were able to identify the TMA patient population susceptible to CeVD, most commonly occurring in older, females and African Americans. CeVD was also associated with significantly poor outcomes in TM. These findings may pose similarities to other systemic viral illness-induced thrombotic microangiopathy such as COVID-19. Further studies are required to improve the outcomes of these susceptible patient populations.
Abstract only Objective: Primary aim of this study is to compare the prevalence of vascular events VEs - acute ischemic stroke (AIS), transient ischemic attack (TIA), acute myocardial infarction ...(AMI) and angina among patients with status migrainosus and intractable migraine (SM), migraine with aura (MWA), migraine without aura (MWOA) and non-migraineurs. Secondary aim of this study is to evaluate the linkage of VEs and associated disability with different migraine subtypes. Methods: A cross-sectional study was performed using National Inpatient Sample 2016-2017 for adult hospitalizations. We extracted a cohort of secondary diagnoses of specific migraine subtypes amongst which primary diagnoses of VEs were identified using ICD 10 code. Weighted analysis using chi-square and multivariable survey logistic regression was performed to identify prevalence of VEs and evaluate relationship and disability (using APRDRG Risk Severity Score) between VEs and migraine subtypes. Results: Out of total 58,259,589 US hospitalizations, 0.1%, 0.08% and 0.03% had SM, MWA and MWOA, respectively. Prevalence of AIS (5.5 vs 0.96 vs 1.96 vs 1.71%) and TIA (3.99 vs 1.07 vs 0.49 vs 0.38%) was higher amongst MWA in comparison with SM, MWOA and non-migraineurs, respectively. (p<.0001) Prevalence of AMI was lower amongst migraineurs (SM:0.40 vs MWA:0.86 vs MWOA:0.86 vs non-migraineurs:2.15%) but prevalence of angina was higher amongst MWOA (0.01 vs 0.07 vs 0.21 vs 0.06%). (p<.0001) MWA and MWOA were associated with higher odds of AIS MWA - aOR 3.7; 95%CI 3.4-4.1; MWOA - 1.7 (1.3-2.1) and TIA MWA - 11.8 (10.5-13.1); MWOA - 4.0 (2.9-5.6) compared to non-migraineurs. Angina was associated with MWOA 3.0 (1.4-6.8). AIS hospitalization with SM had 52% 1.52 (1.2-1.9) higher odds of extreme/severe disability compared to MWA. TIA patients with SM had higher odds of disability compared to MWA 3.0 (2.1-4.3) and non-migraineurs 1.9 (1.4-2.6). Angina with MWOA had a significant disability 1.5 (1.04-2.2) compared to non-migraineurs. Conclusion: SM and MWA had a significant role not only to predict AIS, TIA and angina but also increase disability. Early identification and management of these migraine subtypes may prevent VEs and mitigate disability associated with them.
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