Daily Ards Research Analysis
Across three impactful studies, a large population-based cohort disentangles the contribution of parental infertility versus assisted reproduction procedures to adverse perinatal outcomes, a national dialysis cohort identifies higher sudden cardiac death risk with new haloperidol use compared to chlorpromazine, and a multi-hospital review of dengue fatalities in Nepal details critical care complications including ARDS. Together, these works inform counseling, prescribing, and triage strategies.
Summary
Across three impactful studies, a large population-based cohort disentangles the contribution of parental infertility versus assisted reproduction procedures to adverse perinatal outcomes, a national dialysis cohort identifies higher sudden cardiac death risk with new haloperidol use compared to chlorpromazine, and a multi-hospital review of dengue fatalities in Nepal details critical care complications including ARDS. Together, these works inform counseling, prescribing, and triage strategies.
Research Themes
- Perinatal epidemiology and assisted reproduction
- Medication safety in hemodialysis populations
- Severe dengue mortality drivers and critical care complications
Selected Articles
1. Perinatal risks associated with infertility and medically assisted reproduction: a population-based cohort study.
In a statewide cohort of 824,639 singletons, risks of preterm birth, NICU admission, and early-life hospitalization among ART-conceived infants were substantially attenuated when compared to naturally conceived infants of parents with infertility, indicating that underlying infertility drives much of the excess risk. Fresh embryo transfers carried higher risks than frozen transfers, whereas frozen transfers increased LGA risk.
Impact: This study rigorously separates infertility effects from ART procedure effects at population scale, refining risk counseling for patients considering ART. It also provides actionable insights on fresh versus frozen transfer trade-offs.
Clinical Implications: Counsel patients that much of the perinatal risk reflects underlying infertility; optimize treatment selection and perinatal surveillance accordingly. Prefer frozen transfers when appropriate to mitigate preterm risk, while monitoring for LGA after frozen transfer.
Key Findings
- Compared to NC-fertile, ART singletons had higher risks: preterm birth aRD 25.7/1000 (95% CI 21.3–30.0), NICU admission aRD 8.4/1000 (1.2–15.6), and hospital admission within 2 years aRD 24.6/1000 (17.2–32.0).
- These excess risks were markedly reduced versus NC-infertile: preterm birth aRD 9.5/1000 (4.8–14.2), NICU admission aRD −0.7/1000 (−8.0 to 6.6), and hospital admission aRD 10.6/1000 (2.5–18.7).
- Fresh transfers carried higher risks (e.g., preterm birth aRD 33.7/1000 vs NC-fertile), while frozen transfers showed substantially lower risks versus NC-infertile but increased LGA (aRD 28.5/1000, 95% CI 20.5–36.6).
- ICSI and IVF both showed elevated risks versus NC-fertile that diminished versus NC-infertile; stillbirth risk increased versus NC-fertile but attenuated versus NC-infertile.
Methodological Strengths
- Statewide, population-based cohort with very large sample (n=824,639)
- Inverse probability of treatment weighting and dual-comparator design (NC-fertile and NC-infertile)
- Granular subgroup analyses (ICSI vs IVF; fresh vs frozen transfer)
Limitations
- Observational design using administrative data risks misclassification and unmeasured confounding
- Singleton-only analysis; findings may not generalize to multiples
- NC-infertile comparator may have less severe infertility, potentially underestimating infertility’s contribution
Future Directions: Link clinical infertility phenotypes and ART protocols to perinatal outcomes; evaluate targeted interventions (e.g., embryo transfer strategy) in pragmatic trials; explore mechanisms underlying LGA after frozen transfer.
2. Comparative cardiac safety of haloperidol vs. chlorpromazine among people receiving hemodialysis.
In an active-comparator, new-user cohort of hemodialysis patients, initiating haloperidol was associated with a higher 1-year risk of sudden cardiac death than initiating chlorpromazine (aHR 1.38; similar pattern across other cardiac outcomes). Haloperidol was also the most frequently prescribed typical antipsychotic in this population.
Impact: Addresses a critical evidence gap in comparative safety of antipsychotics among hemodialysis patients, a group with very high baseline SCD risk. Findings can directly influence prescribing and monitoring strategies.
Clinical Implications: When antipsychotic therapy is indicated in hemodialysis, prefer agents with lower cardiac risk when feasible; if haloperidol is used, employ ECG/QT monitoring, correct electrolytes, and consider dose minimization. Shared decision-making is warranted.
Key Findings
- Among new users (n=10,225), 1-year SCD incidence was 9.9% with haloperidol vs 5.9% with chlorpromazine.
- Haloperidol initiation was associated with higher 1-year SCD risk vs chlorpromazine: aHR 1.38 (95% CI 1.21–1.59); aRD 2.62% (95% CI −0.27% to 5.51%).
- Similar elevated risks for other adverse cardiac outcomes were observed with haloperidol vs chlorpromazine.
- Haloperidol was the most commonly prescribed typical antipsychotic among U.S. maintenance hemodialysis patients (2007–2019).
Methodological Strengths
- Active comparator, new-user design reducing confounding by indication
- Use of IPTW Fine–Gray competing risk models with ITT approach
- Large, national registry data from the U.S. Renal Data System
Limitations
- Observational design; residual confounding cannot be excluded
- Administrative data may lack clinical detail (e.g., symptom burden, adherence)
- Adjusted risk difference CI included zero, warranting cautious interpretation
Future Directions: Prospective safety studies in dialysis populations, mechanistic work on QT dynamics under uremic conditions, and evaluations of alternative agents or dosing strategies.
3. Retrospective analysis of dengue-related fatalities in Nepal, 2022.
Among 88 dengue-related deaths in Nepal across 23 hospitals, critical complications prior to death included septic shock (26%), MODS (23%), cardiopulmonary arrest (20%), and ARDS (15%). Fatalities disproportionately involved older adults with comorbidities and co-infections; late presentation and rapid deterioration were common.
Impact: Provides multi-center, outbreak-period mortality profiling to guide early recognition, referral, and resource allocation in dengue, including the burden of ARDS and shock.
Clinical Implications: Prioritize early diagnosis and timely referral for high-risk patients (older age, comorbidities, co-infections). Prepare ICU capacity for shock, MODS, and ARDS; enhance public awareness of warning signs to reduce late presentation.
Key Findings
- Among 88 deaths, males 53.4% and females 46.6%.
- Pre-terminal complications: septic shock 26%, MODS 23%, cardiopulmonary arrest 20%, ARDS 15%, severe GI bleeding 5%.
- Attribution: severe dengue 52%, dengue with other diseases 26%, dengue with comorbidity complications 22%.
- Older adults with comorbidities and co-infections were disproportionately affected; late presentation and rapid deterioration were common.
Methodological Strengths
- Nationwide surveillance-linked, multi-center case review (23 hospitals)
- Systematic abstraction of medical records during a defined outbreak window
Limitations
- Retrospective design with potential reporting and selection biases
- Limited sample size (n=88) and restricted to reported deaths
- Lack of a control group limits causal inference
Future Directions: Prospective surveillance with standardized severity metrics, early warning triage tools, and evaluation of referral pathways to reduce pre-terminal deterioration.