Browsing by Author "Saraschandra Vallabhajosyula"
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Publication Metadata only Acute kidney injury among salicylate intoxication hospitalisations in the United States(2021-03-01) Charat Thongprayoon; Tananchai Petnak; Wisit Kaewput; Fawad Qureshi; Michael A. Mao; Aleksandra I. Pivovarova; Boonphiphop Boonpheng; Tarun Bathini; Saraschandra Vallabhajosyula; Juan Medaura; Wisit Cheungpasitporn; Faculty of Medicine Ramathibodi Hospital, Mahidol University; The University of Arizona; Phramongkutklao College of Medicine; Mayo Clinic; David Geffen School of Medicine at UCLA; University of Mississippi Medical Center; Emory University School of Medicine; Mayo Clinic in Jacksonville, FloridaBackground: This study aimed to evaluate the risk factors and the association of acute kidney injury (AKI) with outcomes, and resource utilisation in patients hospitalised because of salicylate intoxication in the United States. Methods: Hospitalised patients with a primary diagnosis of salicylate intoxication from 2003 to 2014 were identified in the National Inpatient Sample (NIS) database. End-stage kidney disease patients were excluded. The occurrence of AKI was identified using hospital diagnosis code. Clinical characteristics, in-hospital treatment, outcomes and resource utilisation were compared between patients with and without AKI. Results: A total of 13 787 eligible hospital admissions were included in the analysis. AKI occurred in 1279 (9.3%) admissions. Older age, male sex, more recent year of hospitalisation, anaemia, hypertension, congestive heart failure, chronic kidney disease, volume depletion, sepsis and ventricular arrhythmia/cardiac arrest were significantly associated with increased risk of AKI, whereas Hispanic race was associated with decreased risk. AKI was significantly associated with increased risk of organ failure, and in-hospital mortality. In addition, the need for ventilation support, blood component transfusion, renal replacement therapy, length of hospital stay and hospitalisation cost were higher in AKI patients. Conclusion: Approximately one tenth of salicylate intoxication patients developed AKI during hospitalisation. AKI was associated with higher morbidity, mortality and resource utilisations.Publication Metadata only Acute kidney injury in hospitalized patients with methanol intoxication: National Inpatient Sample 2003-2014(2021-08-01) Charat Thongprayoon; Tananchai Petnak; Wisit Kaewput; Michael A. Mao; Boonphiphop Boonpheng; Tarun Bathini; Saraschandra Vallabhajosyula; Ploypin Lertjitbanjong; Fawad Qureshi; Wisit Cheungpasitporn; Ramathibodi Hospital; The University of Arizona; Phramongkutklao College of Medicine; David Geffen School of Medicine at UCLA; Emory University School of Medicine; University of Tennessee Health Science Center; MN; FLBACKGROUND: This study aimed to 1) determine the incidence of acute kidney injury (AKI), 2) identify risk factors for AKI, and 3) evaluate the impact of AKI on in-hospital outcomes in hospitalized patients for methanol intoxication. METHODS: We searched the National Inpatient Sample Database for hospitalized patients from 2003 to 2014 with a primary diagnosis of methanol intoxication. We excluded patients with end-stage kidney disease. We identified the AKI using a discharge diagnosis code. We compared clinical characteristics, in-hospital treatment, outcomes, and resource use between AKI and non-AKI patients. RESULTS: A total of 603 hospital admissions for methanol intoxication were analyzed. AKI developed in 135 (22.4%) admissions. Anemia (OR 3.43 p < 0.001), hypertension (OR 1.86; p = 0.02), volume depletion (OR 3.46; p = 0.001), sepsis (OR 6.91; p < 0.001), rhabdomyolysis (OR 6.25; p = 0.003), and acute pancreatitis (OR 5.30; p = 0.004) were independent risk factors for AKI development. AKI was significantly associated with increased risk of in-hospital mortality and organ failure. AKI patients needed more mechanical ventilation, and extracorporeal therapy, had longer length of hospital stay, and higher hospitalization costs. CONCLUSION: Over one-fifth of methanol intoxication patients developed AKI during hospitalization. AKI was associated with higher morbidity, mortality, and resource utilization.Publication Metadata only Impact of anca-associated vasculitis on outcomes of hospitalizations for goodpasture’s syndrome in the united states: Nationwide inpatient sample 2003–2014(2020-03-01) Charat Thongprayoon; Wisit Kaewput; Boonphiphop Boonpheng; Patompong Ungprasert; Tarun Bathini; Narat Srivali; Saraschandra Vallabhajosyula; Jorge L. Castaneda; Divya Monga; Swetha R. Kanduri; Juan Medaura; Wisit Cheungpasitporn; St. Agnes Hospital; Faculty of Medicine, Siriraj Hospital, Mahidol University; The University of Arizona; Phramongkutklao College of Medicine; Mayo Clinic; David Geffen School of Medicine at UCLA; University of Mississippi Medical Center© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Background and objectives: Goodpasture’s syndrome (GS) is a rare, life-threatening autoimmune disease. Although the coexistence of anti-neutrophil cytoplasmic antibody (ANCA) with Goodpasture’s syndrome has been recognized, the impacts of ANCA vasculitis on mortality and resource utilization among patients with GS are unclear. Materials and Methods: We used the National Inpatient Sample to identify hospitalized patients with a principal diagnosis of GS from 2003 to 2014 in the database. The predictor of interest was the presence of ANCA-associated vasculitis. We tested the differences concerning in-hospital treatment and outcomes between GS patients with and without ANCA-associated vasculitis using logistic regression analysis with adjustment for other clinical characteristics. Results: A total of 964 patients were primarily admitted to hospital for GS. Of these, 84 (8.7%) had a concurrent diagnosis of ANCA-associated vasculitis. Hemoptysis was more prevalent in GS patients with ANCA-associated vasculitis. During hospitalization, GS patients with ANCA-associated required non-significantly more mechanical ventilation and non-invasive ventilation support, but non-significantly less renal replacement therapy and plasmapheresis than those with GS alone. There was no significant difference in in-hospital outcomes, including organ failure and mortality, between GS patients with and without ANCA-associated vasculitis. Conclusions: Our study demonstrated no significant differences between resource utilization and in-hospital mortality among hospitalized patients with coexistence of ANCA vasculitis and GS, compared to those with GS alone.Publication Metadata only Impact of rhabdomyolysis on outcomes of hospitalizations for heat stroke in the United States(2020-12-01) Charat Thongprayoon; Tananchai Petnak; Swetha R. Kanduri; Karthik Kovvuru; Wisit Cheungpasitporn; Boonphiphop Boonpheng; Api Chewcharat; Tarun Bathini; Juan Medaura; Saraschandra Vallabhajosyula; Wisit Kaewput; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; The University of Arizona; Phramongkutklao College of Medicine; Mayo Clinic; David Geffen School of Medicine at UCLA; University of Mississippi Medical CenterBACKGROUND: The objective of this study was to evaluate the predictors and associated outcomes of rhabdomyolysis in admitted patients for heat stroke in the United States. METHODS: The National Inpatient Sample was utilized to identify hospitalized patients with a primary diagnosis of heat stroke from the years 2003-2014. Rhabdomyolysis was identified using hospital diagnosis code. We compared the clinical characteristics, in-hospital treatment, complications, outcomes, and resource utilization between patients with and without rhabdomyolysis. RESULTS: A total of 3,372 hospital admissions for heat stroke were studied. Of these, rhabdomyolysis occurred in 1049 (31%) admissions. The risk factors for rhabdomyolysis were age 20-39 years, male sex, African American race, history of alcohol drinking, whereas age ≥60 years, smoking, history of diabetes mellitus, and hypertension were associated with lower risk of rhabdomyolysis. Patients with rhabdomyolysis had greater requirements for mechanical ventilation, blood component transfusion, and renal replacement therapy. Rhabdomyolysis was significantly associated with increased risk of hyponatremia, hypernatremia, hyperkalemia, hypocalcemia, serum phosphorus and magnesium derangement, metabolic acidosis, sepsis, ventricular arrhythmia or cardiac arrest, renal failure, respiratory failure, liver failure, neurological failure, hematologic failure, and in-hospital mortality. Length of hospital stay and hospitalization cost were higher when rhabdomyolysis occurred during hospital stay. CONCLUSION: Rhabdomyolysis occurred in about one-third of hospitalized patients for heat stroke and was associated with increased morbidity, mortality, and resource utilization.Publication Metadata only In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample(2021-12-07) Wisit Kaewput; Charat Thongprayoon; Carissa Y. Dumancas; Swetha R. Kanduri; Karthik Kovvuru; Chalermrat Kaewput; Pattharawin Pattharanitima; Tananchai Petnak; Ploypin Lertjitbanjong; Boonphiphop Boonpheng; Karn Wijarnpreecha; Jose L. Zabala Genovez; Saraschandra Vallabhajosyula; Caroline C. Jadlowiec; Fawad Qureshi; Wisit Cheungpasitporn; Ramathibodi Hospital; Siriraj Hospital; Wake Forest University School of Medicine; Mayo Clinic Scottsdale-Phoenix, Arizona; University of Michigan, Ann Arbor; Ochsner Health System; University of Washington; Faculty of Medicine, Thammasat University; Phramongkutklao College of Medicine; Mayo Clinic; University of Tennessee Health Science CenterBACKGROUND Hepatorenal syndrome (HRS) is a life-threatening condition among patients with advanced liver disease. Data trends specific to hospital mortality and hospital admission resource utilization for HRS remain limited. AIM To assess the temporal trend in mortality and identify the predictors for mortality among hospital admissions for HRS in the United States. METHODS We used the National Inpatient Sample database to identify an unweighted sample of 4938 hospital admissions for HRS from 2005 to 2014 (weighted sample of 23973 admissions). The primary outcomes were temporal trends in mortality as well as predictors for hospital mortality. We estimated odds ratios from multilevel mixed effect logistic regression to identify patient characteristics and treatments associated with hospital mortality. RESULTS Overall hospital mortality was 32%. Hospital mortality decreased from 44% in 2005 to 24% in 2014 (P < 0.001), while there was an increase in the rate of liver transplantation (P = 0.02), renal replacement therapy (P < 0.001), length of hospital stay (P < 0.001), and hospitalization cost (P < 0.001). On multivariable analysis, older age, alcohol use, coagulopathy, neurological disorder, and need for mechanical ventilation predicted higher hospital mortality, whereas liver transplantation, transjugular intrahepatic portosystemic shunt, and abdominal paracentesis were associated with lower hospital mortality. CONCLUSION Although there was an increase in resource utilizations, hospital mortality among patients admitted for HRS significantly improved. Several predictors for hospital mortality were identified.Publication Metadata only Inpatient burden and mortality of heatstroke in the United States(2021-04-01) Wisit Kaewput; Charat Thongprayoon; Tananchai Petnak; Liam D. Cato; Api Chewcharat; Boonphiphop Boonpheng; Tarun Bathini; Saraschandra Vallabhajosyula; Wisit Cheungpasitporn; University of California, Los Angeles; University Hospitals Birmingham NHS Foundation Trust; Faculty of Medicine Ramathibodi Hospital, Mahidol University; The University of Arizona; Phramongkutklao College of Medicine; Mayo ClinicBackground: This study aimed to assess inpatient prevalence, characteristics, outcomes, and resource utilisation of hospitalisation for heatstroke in the United States. Additionally, this study aimed to explore factors associated with in-hospital mortalities of heatstroke. Methods: The 2003-2014 National Inpatient Sample database was used to identify hospitalised patients with a principal diagnosis of heatstroke. The inpatient prevalence, clinical characteristics, in-hospital treatments, outcomes, length of hospital stay, and hospitalisation cost were studied. Multivariable logistic regression was performed to identify independent factors associated with in-hospital mortality. Results: A total of 3372 patients were primarily admitted for heatstroke, accounting for an overall inpatient prevalence of heatstroke amongst hospitalised patients of 36.3 cases per 1 000 000 admissions in the United States with an increasing trend during the study period (P <.001). Age 40-59 was the most prevalent age group. During the hospital stay, 20% required mechanical ventilation, and 2% received renal replacement therapy. Rhabdomyolysis was the most common complication. Renal failure was the most common end-organ failure, followed by neurological, respiratory, metabolic, hematologic, circulatory, and liver systems. The in-hospital mortality rate of heatstroke hospitalisation was 5% with a decreasing trend during the study period (P <.001). The presence of end-organ failure was associated with increased in-hospital mortality, whereas more recent years of hospitalisation was associated with decreased in-hospital mortality. The median length of hospital stay was 2 days. The median hospitalisation cost was $17 372. Conclusion: The inpatient prevalence of heatstroke in the United States increased, while the in-hospital mortality of heatstroke decreased.Publication Metadata only Inpatient Burden and Mortality of Methanol Intoxication in the United States(2021-01-01) Wisit Kaewput; Charat Thongprayoon; Tananchai Petnak; Api Chewcharat; Boonphiphop Boonpheng; Tarun Bathini; Saraschandra Vallabhajosyula; Wisit Cheungpasitporn; University of California, Los Angeles; Faculty of Medicine Ramathibodi Hospital, Mahidol University; The University of Arizona; Phramongkutklao College of Medicine; Mayo Clinic; University of Mississippi Medical CenterBackground: This study aimed to assess inpatient prevalence, characteristics, outcomes, and resource utilization of hospitalization for methanol intoxication in the United States. Materials and Methods: A total of 603 hospitalized patients with a primary diagnosis of methanol intoxication from 2003 to 2014 were identified in the National Inpatient Sample database. The inpatient prevalence, clinical characteristics, treatments, outcomes, resource utilization, were investigated. Multivariable logistic regression was performed to identify factors independently associated with in-hospital mortality. Results: The overall inpatient prevalence of methanol intoxication among hospitalized patients was 6.4 cases per 1,000,000 admissions in the United States. The mean age was 38±18 (range 0–86) years. 44% used methanol for suicidal attempts. 20% of admissions required mechanical ventilation, and 40% required renal replacement therapy. The three most common complications were metabolic acidosis (44%), hypokalemia (18%), and visual impairment or optic neuritis (8%). The three most common end-organ failures were renal failure (22%), respiratory failure (21%), and neurological failure (17%). 6.5% died in the hospital. Factors associated with increased in-hospital mortality included alcohol drinking, hypernatremia, renal failure, respiratory failure, circulatory failure, and neurological failure. The mean length of hospital stay was 4.0 days. The mean hospitalization cost per patient was $43,222 Conclusion: The inpatient prevalence of methanol intoxication in the United States was 6.4 cases per 1,000,000 admissions. The risk of in-hospital mortality mainly depended on the number of end-organ failures.Publication Metadata only Machine learning consensus clustering approach for hospitalized patients with phosphate derangements(2021-10-01) Charat Thongprayoon; Carissa Y. Dumancas; Voravech Nissaisorakarn; Mira T. Keddis; Andrea G. Kattah; Pattharawin Pattharanitima; Tananchai Petnak; Saraschandra Vallabhajosyula; Vesna D. Garovic; Michael A. Mao; John J. Dillon; Stephen B. Erickson; Wisit Cheungpasitporn; Ramathibodi Hospital; Wake Forest University School of Medicine; Mayo Clinic Scottsdale-Phoenix, Arizona; Faculty of Medicine, Thammasat University; Mayo Clinic; Harvard Medical School; Mayo Clinic in Jacksonville, FloridaBackground: The goal of this study was to categorize patients with abnormal serum phosphate upon hospital admission into distinct clusters utilizing an unsupervised machine learning approach, and to assess the mortality risk associated with these clusters. Methods: We utilized the consensus clustering approach on demographic information, comorbidities, principal diagnoses, and laboratory data of hypophosphatemia (serum phosphate ≤ 2.4 mg/dL) and hyperphosphatemia cohorts (serum phosphate ≥ 4.6 mg/dL). The standardized mean difference was applied to determine each cluster’s key features. We assessed the association of the clusters with mortality. Results: In the hypophosphatemia cohort (n = 3113), the consensus cluster analysis identified two clusters. The key features of patients in Cluster 2, compared with Cluster 1, included: older age; a higher comorbidity burden, particularly hypertension; diabetes mellitus; coronary artery disease; lower eGFR; and more acute kidney injury (AKI) at admission. Cluster 2 had a comparable hospital mortality (3.7% vs. 2.9%; p = 0.17), but a higher one‐year mortality (26.8% vs. 14.0%; p < 0.001), and five‐year mortality (20.2% vs. 44.3%; p < 0.001), compared to Cluster 1. In the hyperphosphatemia cohort (n = 7252), the analysis identified two clusters. The key features of patients in Cluster 2, compared with Cluster 1, included: older age; more primary admission for kidney disease; more history of hypertension; more end‐stage kidney disease; more AKI at admission; and higher admission potassium, magnesium, and phosphate. Cluster 2 had a higher hospital (8.9% vs. 2.4%; p < 0.001) one‐year mortality (32.9% vs. 14.8%; p < 0.001), and five‐year mortality (24.5% vs. 51.1%; p < 0.001), compared with Cluster 1. Conclusion: Our cluster analysis classified clinically distinct phenotypes with different mortality risks among hospitalized patients with serum phosphate derangements. Age, comorbidities, and kidney function were the key features that differentiated the phenotypes.Publication Metadata only Machine learning consensus clustering approach for patients with lactic acidosis in intensive care units(2021-11-01) Pattharawin Pattharanitima; Charat Thongprayoon; Tananchai Petnak; Narat Srivali; Guido Gembillo; Wisit Kaewput; Supavit Chesdachai; Saraschandra Vallabhajosyula; Oisin A. O’corragain; Michael A. Mao; Vesna D. Garovic; Fawad Qureshi; John J. Dillon; Wisit Cheungpasitporn; Ramathibodi Hospital; Wake Forest University School of Medicine; St. Agnes Hospital; Temple University Hospital; Faculty of Medicine, Thammasat University; Università degli Studi di Messina; Phramongkutklao College of Medicine; Mayo Clinic; Mayo Clinic in Jacksonville, FloridaBackground: Lactic acidosis is a heterogeneous condition with multiple underlying causes and associated outcomes. The use of multi-dimensional patient data to subtype lactic acidosis can personalize patient care. Machine learning consensus clustering may identify lactic acidosis subgroups with unique clinical profiles and outcomes. Methods: We used the Medical Information Mart for Intensive Care III database to abstract electronic medical record data from patients admitted to intensive care units (ICU) in a tertiary care hospital in the United States. We included patients who developed lactic acidosis (defined as serum lactate ≥ 4 mmol/L) within 48 h of ICU admission. We performed consensus clustering analysis based on patient characteristics, comorbidities, vital signs, organ supports, and laboratory data to identify clinically distinct lactic acidosis subgroups. We calculated standardized mean differences to show key subgroup features. We compared outcomes among subgroups. Results: We identified 1919 patients with lactic acidosis. The algorithm revealed three best unique lactic acidosis subgroups based on patient variables. Cluster 1 (n = 554) was characterized by old age, elective admission to cardiac surgery ICU, vasopressor use, mechanical ventilation use, and higher pH and serum bicarbonate. Cluster 2 (n = 815) was characterized by young age, admission to trauma/surgical ICU with higher blood pressure, lower comorbidity burden, lower severity index, and less vasopressor use. Cluster 3 (n = 550) was characterized by admission to medical ICU, history of liver disease and coagulopathy, acute kidney injury, lower blood pressure, higher comorbidity burden, higher severity index, higher serum lactate, and lower pH and serum bicarbonate. Cluster 3 had the worst outcomes, while cluster 1 had the most favorable outcomes in terms of persistent lactic acidosis and mortality. Conclusions: Consensus clustering analysis synthesized the pattern of clinical and laboratory data to reveal clinically distinct lactic acidosis subgroups with different outcomes.Publication Metadata only Machine learning prediction models for mortality in intensive care unit patients with lactic acidosis(2021-11-01) Pattharawin Pattharanitima; Charat Thongprayoon; Wisit Kaewput; Fawad Qureshi; Fahad Qureshi; Tananchai Petnak; Narat Srivali; Guido Gembillo; Oisin A. O’corragain; Supavit Chesdachai; Saraschandra Vallabhajosyula; Pramod K. Guru; Michael A. Mao; Vesna D. Garovic; John J. Dillon; Wisit Cheungpasitporn; Ramathibodi Hospital; Wake Forest University School of Medicine; St. Agnes Hospital; Temple University Hospital; UMKC School of Medicine; Faculty of Medicine, Thammasat University; Università degli Studi di Messina; Phramongkutklao College of Medicine; Mayo Clinic; Mayo Clinic in Jacksonville, FloridaBackground: Lactic acidosis is the most common cause of anion gap metabolic acidosis in the intensive care unit (ICU), associated with poor outcomes including mortality. We sought to compare machine learning (ML) approaches versus logistic regression analysis for prediction of mortality in lactic acidosis patients admitted to the ICU. Methods: We used the Medical Information Mart for Intensive Care (MIMIC-III) database to identify ICU adult patients with lactic acidosis (se-rum lactate ≥4 mmol/L). The outcome of interest was hospital mortality. We developed prediction models using four ML approaches consisting of random forest (RF), decision tree (DT), extreme gradient boosting (XGBoost), artificial neural network (ANN), and statistical modeling with for-ward stepwise logistic regression using the testing dataset. We then assessed model performance using area under the receiver operating characteristic curve (AUROC), accuracy, precision, error rate, Matthews correlation coefficient (MCC), F1 score, and assessed model calibration using the Brier score, in the independent testing dataset. Results: Of 1919 lactic acidosis ICU patients, 1535 and 384 were included in the training and testing dataset, respectively. Hospital mortality was 30%. RF had the highest AUROC at 0.83, followed by logistic regression 0.81, XGBoost 0.81, ANN 0.79, and DT 0.71. In addition, RF also had the highest accuracy (0.79), MCC (0.45), F1 score (0.56), and lowest error rate (21.4%). The RF model was the most well-calibrated. The Brier score for RF, DT, XGBoost, ANN, and multivariable logistic regression was 0.15, 0.19, 0.18, 0.19, and 0.16, respec-tively. The RF model outperformed multivariable logistic regression model, SOFA score (AUROC 0.74), SAP II score (AUROC 0.77), and Charlson score (AUROC 0.69). Conclusion: The ML prediction model using RF algorithm provided the highest predictive performance for hospital mortality among ICU patient with lactic acidosis.Publication Metadata only The prognostic importance of serum sodium levels at hospital discharge and one-year mortality among hospitalized patients(2020-01-01) Charat Thongprayoon; Wisit Cheungpasitporn; Tananchai Petnak; Ranine Ghamrawi; Sorkko Thirunavukkarasu; Api Chewcharat; Tarun Bathini; Saraschandra Vallabhajosyula; Kianoush B. Kashani; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; The University of Arizona; Mayo Clinic; University of Mississippi Medical Center© 2020 John Wiley & Sons Ltd Background: The optimal range of serum sodium at hospital discharge is unclear. Our objective was to assess the one-year mortality based on discharge serum sodium in hospitalized patients. Methods: We analyzed a cohort of hospitalized adult patients between 2011 and 2013 who survived hospital admission at a tertiary referral hospital. We categorized discharge serum sodium into five groups; ≤132, 133-137, 138-142, 143-147, and ≥148 mEq/L. We assessed one-year mortality risk after hospital discharge based on discharge serum sodium, using discharge sodium of 138-142 mEq/L as the reference group. Results: Of 55 901 eligible patients, 4.9%, 29.8%, 56.1%, 8.9%, 0.3% had serum sodium of ≤132, 133-137, 138-142, 143-147, and ≥148 mEq/L, respectively. We observed a U-shaped association between discharge serum sodium and one-year mortality, with nadir mortality in discharge serum sodium of 138-142 mEq/L. When adjusting for potential confounders, including admission serum sodium, one-year mortality was significantly higher in both discharge serum sodium ≤137 and ≥143 mEq/L, compared with discharge serum sodium of 138-142 mEq/L. The mortality risk was the most prominent in elevated discharge serum sodium of ≥148 mEq/L (HR 3.86; 95% CI 3.05-4.88), exceeding the risk associated with low discharge serum sodium of ≤132 mEq/L (HR 1.43; 95% CI 1.30-1.57). Conclusion: The optimal range of serum sodium at discharge was 138-142 mEq/L. Both hypernatremia and hyponatremia at discharge were associated with higher one-year mortality. The impact on higher one-year mortality was more prominent in hypernatremia than hyponatremia.Publication Metadata only Rhabdomyolysis among hospitalized patients for salicylate intoxication in the United States: Nationwide inpatient sample 2003–2014(2021-03-01) Wisit Kaewput; Charat Thongprayoon; Tananchai Petnak; Wisit Cheungpasitporn; Fawad Qureshi; Boonphiphop Boonpheng; Saraschandra Vallabhajosyula; Tarun Bathini; Sohail Abdul Salim; Tibor Fülöp; Ramathibodi Hospital; Medical University of South Carolina; The University of Arizona; Phramongkutklao College of Medicine; Mayo Clinic; David Geffen School of Medicine at UCLA; University of Mississippi Medical Center; Emory University School of Medicine; Ralph H. Johnson VA Medical CenterIntroduction This study aimed to assess the risk factors and impact of rhabdomyolysis on treatments, outcomes, and resource utilization in hospitalized patients for salicylate intoxication in the United States. Materials and methods The National Inpatient Sample was utilized to identify hospitalized patients with a primary diagnosis of salicylate intoxication from 2003–2014. Rhabdomyolysis was identified using hospital diagnosis code. We compared the clinical characteristics, in-hospital treatment, outcomes, and resource utilization between patients with and without rhabdomyolysis. Results A total of 13,805 hospital admissions for salicylate intoxication were studied. Of these, rhabdomyolysis developed in 258 (1.9%) admissions. The risk factors for rhabdomyolysis were age>20 years, male sex, volume depletion, hypokalemia, sepsis, and seizure. After adjustment for baseline clinical characteristics, salicylate intoxication patients with rhabdomyolysis required more invasive mechanical ventilation, and renal replacement therapy. Rhabdomyolysis was significantly associated with higher risk of failure of any organ systems, and in-hospital mortality. Length of hospital stay and hospitalization cost were higher when rhabdomyolysis occurred during hospital stay. Conclusions Rhabdomyolysis was not common in hospitalized patients for salicylate intoxication but it was associated with increased morbidity, mortality, and resource utilization.