scholarly journals Early Endoscopy Can Shorten the Duration of Hospitalization in Suspected Variceal Hemorrhage

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Hong-Lin Guan ◽  
Hsin-Yi Lin ◽  
Yi-Kung Lee ◽  
Chen-Yang Hsu ◽  
Yung-Cheng Su
Keyword(s):  
Propensity Score ◽  
Cox Regression ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Variceal Hemorrhage ◽  
Kaplan Meier ◽  
Early Endoscopy ◽  
Duration Of Hospitalization ◽  
Secondary Outcomes ◽  
Emergency Department Patients

Background. Endoscopic treatment in patients with acute variceal hemorrhage should be performed within 12 hours, but the recommendation is based on the experts’ opinion. Objective. Our study investigated if time to endoscopy was a significant factor that could alter the outcomes of patients with suspected variceal hemorrhage. The primary outcome was the length of hospital stay and the mortality. The secondary outcomes were complications during observation periods. Methods. Patients were included if variceal hemorrhage was suspected in the emergency department. Patients were further divided into early (receiving endoscopy within 12 hours) and delayed groups (receiving endoscopy after 12 hours), and each patient was matched using a standard propensity score greedy-matching algorithm. The primary and secondary outcomes were compared accordingly. Results. 1442 patients met our inclusion criteria and therefore were enrolled for further analysis. In the Cox regression model, log time to endoscopy was not a significant factor. In the propensity score assignment, 566 patients (283 in each group) were further selected into the subcohort (P value = 0.8001). Kaplan-Meier curves showed a discharge benefit favoring the early endoscopy over the control group. The mortality rates and complications were not statistically different between the two groups (P value = 0.0045). Conclusion. Early endoscopy before 12 hours in patients with suspected variceal hemorrhage could result in shorter length of hospitalization without increasing the mortalities and complications. The results would help emergency physicians in decisions making when these patients are encountered.

scholarly journals Varicella zoster virus infections increase the risk of disease flares in patients with SLE: a matched cohort study

2019 ◽  
Vol 6 (1) ◽  
pp. e000339 ◽  
Author(s):  
Fangfang Sun ◽  
Yi Chen ◽  
Wanlong Wu ◽  
Li Guo ◽  
Wenwen Xu ◽  
...  
Keyword(s):  
Propensity Score ◽  
Varicella Zoster Virus ◽  
Cox Regression ◽  
Control Period ◽  
Cox Regression Analysis ◽  
Varicella Zoster ◽  
Propensity Score Weighting ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Risk Of Disease

ObjectiveTo explore whether varicella zoster virus (VZV) infection could increase the risk of disease flares in patients with SLE.MethodsPatients who had VZV reactivations between January 2013 and April 2018 were included from the SLE database (n=1901) of Shanghai Ren Ji Hospital, South Campus. Matched patients with SLE were selected as background controls with a 3:1 ratio. Patients with SLE with symptomatic bacterial infections of the lower urinary tract (UTI) were identified as infection controls. Baseline period and index period were defined as 3 months before and after infection event, respectively. Control period was the following 3 months after the index period. Flare was defined by SELENA SLEDAI Flare Index. Kaplan-Meier analysis, Cox regression model and propensity score weighting were applied.ResultsPatients with VZV infections (n=47), UTI controls (n=28) and matched SLE background controls (n=141) were included. 16 flares (34%) in the VZV group within the index period were observed, as opposed to only 7.1% in UTI controls and 9.9% in background controls. Kaplan-Meier curve revealed that patients with a VZV infection had a much lower flare-free survival within the index period compared with the controls (p=0.0003). Furthermore, after adjusting for relevant confounders including baseline disease activity and intensity of immunosuppressive therapy, Cox regression analysis and propensity score weighting confirmed that VZV infection within 3 months was an independent risk factor for SLE flares (HR 3.70 and HR 4.16, respectively).ConclusionsIn patients with SLE, recent VZV infection within 3 months was associated with increased risk of disease flares.

scholarly journals The prognosis of hepatoid adenocarcinoma of the stomach: a propensity score-based analysis

2020 ◽  
Author(s):  
Kai Zhou ◽  
Anqiang Wang ◽  
Sheng Ao ◽  
Jiahui Chen ◽  
Ke Ji ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cox Regression ◽  
Radical Surgery ◽  
Survival Rates ◽  
Cancer Type ◽  
Radical Gastrectomy ◽  
Hepatoid Adenocarcinoma ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Propensity Matching

Abstract Background : To investigate whether there is a distinct difference in prognosis between hepatoid adenocarcinoma of the stomach ( HAS) and non-hepatoid adenocarcinoma of the stomach (non-HAS) and whether HAS can benefit from radical surgery. Methods : We retrospectively reviewed 722 patients with non-HAS and 75 patients with HAS who underwent radical gastrectomy between 3 November 2009 and 17 December 2018. Propensity score matching (PSM) analysis was used to eliminate the bias among the patients in our study. The relationships between gastric cancer type and overall survival (OS) were evaluated by the Kaplan-Meier method and Cox regression. Results : Our data demonstrate that there was no statistically significant difference in the OS between HAS and non-HAS {K-M, P=log rank (Mantel-Cox), (before PSM P=0.397); (1:1 PSM P=0.345); (1:2 PSM P=0.195)}. Moreover, there were no significant differences in the 1-, 2-, or 3-year survival rates between patients with non-HAS and patients with HAS (before propensity matching, after 1:1 propensity matching, and after 1:2 propensity matching). Conclusion : HAS was generally considered to be an aggressive gastric neoplasm, but its prognosis may not be as unsatisfactory as previously believed.

Etomidate Use for Rapid Sequence Intubation Is Not Associated With Nosocomial Infection

2020 ◽  
pp. 089719002097961
Author(s):  
Daniel Colon Hidalgo ◽  
Vishali Amin ◽  
Arushi Hukku ◽  
Kathryn Kutlu ◽  
Megan A. Rech
Keyword(s):  
Hospital Stay ◽  
Secondary Infection ◽  
Length Of Hospital Stay ◽  
Adrenal Suppression ◽  
Rapid Sequence Intubation ◽  
Control Group ◽  
Secondary Infections ◽  
Rapid Sequence ◽  
Significant Difference ◽  
Secondary Outcomes

Introduction: Etomidate is commonly used for induction of anesthesia for rapid sequence intubation (RSI). It has little impact on hemodynamic status, making it a widely used agent. Due to the inhibition of cortisol production, etomidate causes adrenal suppression. The purpose of this study is to determine whether there is a correlation with etomidate use and the incidence of secondary infections. Methods: This was a retrospective cohort of hospitalized patients who received either etomidate or control (ketamine, propofol, or no agent) for RSI. The primary endpoint was the incidence of secondary infections. Secondary outcomes included number of mechanical ventilator-free days within 28 days, 30-day mortality, length of hospital stay, and length of intensive care unit stay. Results: A total of 434 patients were reviewed, of which 129 (29.7%) met the study criteria (n = 94 etomidate; n = 35 control). The incidence of secondary infection was numerically higher in the etomidate group compared with the control group, though this was not statistically significant (38.7% vs. 28.6%, p = 0.447). Also, though the secondary outcomes showed no statistically significant difference between the groups, the patients in the control group had a longer hospital stay (14.0 vs. 18.1, p = 0.20) and a longer ICU stay (11.0 vs. 14.1, p = 030). Furthermore, the etomidate group had a non-statistically significant higher incidence of bacteremia (8 vs. 0, p = 0.17) Conclusion: The use of etomidate was not associated with increased incidence of secondary infection. To fully understand the effects of etomidate use and its subsequent adrenal suppression, larger studies are needed.

scholarly journals Effects of Sugammadex on Post-Operative Pulmonary Complications in Laparoscopic Gastrectomy: A Retrospective Cohort Study

2020 ◽  
Vol 9 (4) ◽  
pp. 1232
Author(s):  
Jiwon Han ◽  
Jung-Hee Ryu ◽  
Bon-Wook Koo ◽  
Sun Woo Nam ◽  
Sang-Il Cho ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Laparoscopic Gastrectomy ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Laboratory Findings ◽  
Residual Neuromuscular Blockade ◽  
Initial Cohort ◽  
Secondary Outcomes

The use of sugammadex can reduce post-operative residual neuromuscular blockade, which is known to increase the risk of post-operative respiratory events. However, its effect on post-operative pulmonary complications is not obvious. This study was performed to evaluate the effects of sugammadex on post-operative pulmonary complications in patients undergoing laparoscopic gastrectomy between 2013 and 2017. We performed propensity score matching to correct for selection bias. Post-operative pulmonary complications (i.e., pneumonia, respiratory failure, pleural effusion, atelectasis, pneumothorax, and aspiration pneumonitis) were evaluated from the radiological and laboratory findings. We also evaluated admission to the intensive care unit after surgery, re-admission or an emergency room visit within 30 days after discharge, length of hospital stay, re-operation, and mortality within 90 days post-operatively as secondary outcomes. In the initial cohort of 3802 patients, 541 patients were excluded, and 1232 patients were analyzed after propensity score matching. In the matched cohort, pleural effusion was significantly reduced in the sugammadex group compared to the neostigmine group (neostigmine 23.4% vs. sugammadex 18%, p = 0.02). Other pulmonary complications and secondary outcomes were not significantly different between the groups. In comparison to neostigmine, the use of sugammadex was associated with a lower incidence of post-operative pleural effusion in laparoscopic gastrectomy.

scholarly journals De Ritis Ratio (Aspartate Transaminase/Alanine Transaminase) as a Significant Prognostic Factor in Patients Undergoing Radical Cystectomy with Bladder Urothelial Carcinoma: A Propensity Score-Matched Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Hyeong Dong Yuk ◽  
Chang Wook Jeong ◽  
Cheol Kwak ◽  
Hyeon Hoe Kim ◽  
Ja Hyeon Ku
Keyword(s):  
Prognostic Factor ◽  
Propensity Score ◽  
Radical Cystectomy ◽  
Cox Regression ◽  
Alanine Transaminase ◽  
Significant Prognostic Factor ◽  
Aspartate Transaminase ◽  
Cancer Specific Survival ◽  
T Stage ◽  
Kaplan Meier

Introduction. To investigate the correlation between preoperative De Ritis ratio (aspartate transaminase (AST)/alanine transaminase (ALT)) and postoperative outcome in patients with urothelial cell carcinoma (UC) treated with radical cystectomy. Materials and Methods. We analyzed the clinical and pathological data of 771 patients who underwent radical cystectomy for bladder UC. Patients were divided into two groups according to the optimal value of AST/ALT ratio. The effect of the AST/ALT ratio was analyzed using the Kaplan–Meier method and Cox regression hazard models for patients’ cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS). In addition, propensity score matching of 1 : 1 was performed between the two groups. Results. Median follow-up was 84.0 (36–275) months. Mean age was 64.8±10.0 years. According to the receiver operating characteristic (ROC) analysis, the optimal threshold of the AST/ALT ratio was 1.1. In Kaplan–Meier analyses, the high AST/ALT group showed worse outcomes in CSS and OS (all P<0.001). Also, RFS (P=0.001) in the Cox regression models of clinical and pathological parameters was used to predict CSS, OS, and AST/ALT ratio (HR 2.15, 95% CI 1.23-3.73, P=0.007) and pathological T stage (HR 4.80, 95% CI 1.19-19.28, P=0.003). To predict OS and AST/ALT ratio (HR 2.05, 95% CI 1.65–2.56, P<0.001), pathological T stage (HR 2.96, 95% CI 0.57–17.09, P=0.037) and positive lymph node (HR 1.71, 95% CI 1.50–1.91, P=0.021) were determined as independent prognostic factors. Conclusion. Preoperative AST/ALT ratio could be an independent prognostic factor in patients with UC treated with radical cystectomy.

Effect of Epoetin beta on Survival, Tumor Progression and Thromboembolic Events in Patients with Lymphoid Malignancies Receiving Chemotherapy: A Meta-Analysis of Controlled Clinical Studies.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3149-3149 ◽  
Author(s):  
Bertrand Coiffier ◽  
Marc Boogaerts ◽  
Anders Österborg ◽  
Hans-Ulrich Burger
Keyword(s):  
Tumor Progression ◽  
Disease Progression ◽  
Hematological Malignancies ◽  
Cox Regression ◽  
Meta Analysis ◽  
Control Group ◽  
Thromboembolic Events ◽  
Treatment Groups ◽  
Epoetin Beta ◽  
Kaplan Meier

Abstract BACKGROUND: Epoetin beta (NeoRecormon®) 30 000 IU/week raises hemoglobin levels, reduces transfusion need and improves quality of life in patients with cancer. Recent studies have also suggested that epoetin therapy may impact upon outcomes in these patients. A meta-analysis was performed to investigate the effects of epoetin beta on survival, tumor progression and thromboembolic events in patients with hematological malignancies receiving chemotherapy. METHODS: Data were pooled from all five randomized, controlled (placebo or standard care) clinical trials of epoetin beta that included anemic patients with hematological malignancies receiving chemotherapy. The study that showed epoetin beta once weekly to be as effective with the same safety profile as a three times weekly regimen was excluded from this analysis because of the lack of a non-epoetin-treated group. These studies were not designed to assess duration of survival and in all except one there was no follow-up beyond the duration of study treatment plus an additional 4-week period. Deaths reported during the study plus 4 weeks were therefore recorded in this analysis. All adverse event reports were assessed for evidence of disease progression or thromboembolism. Data were analyzed by standard Kaplan-Meier methods, Cox regression and log-rank tests. RESULTS: A total of 791 patients with hematological malignancies were included (epoetin beta, n=461; control, n=330) (the difference in number was due to two of the five studies containing multiple epoetin beta treatment groups versus one control group). The majority was diagnosed with lymphoma (56%) or multiple myeloma (42%); the remaining patients (2%) were diagnosed with acute myeloid leukemia. Treatment groups were well balanced with regard to baseline demographic characteristics. There were no obvious differences in baseline tumor stage between treatment groups, although these data were not consistently collected across studies. The median weekly dose of epoetin beta was 30 000 IU. Death rates were similar in both the epoetin beta and control groups (0.39 vs 0.37 deaths/patient year). There was no indication of a difference in survival with epoetin beta compared with control (relative risk 1.04, 95% CIs 0.69, 1.55, p=0.86). The rate of disease progression was lower in the epoetin beta group compared with the control group (0.69 vs 0.81 events/patient year). The results from Kaplan-Meier estimates and Cox regression did not indicate an increased risk of disease progression with epoetin beta compared with control (relative risk 0.84, 95% CIs 0.62, 1.13, p=0.25). In fact, the hazard rate of 0.84 indicated a 16% reduction in the risk of an event when treated with epoetin beta. Thromboembolic event rates were also similar in the epoetin beta and control groups (0.17 vs 0.14 events/patient year), corresponding to crude rates of 5.4% and 4.8% (observation times: 147 and 112 patient years). These event rates are well within the range of those reported in the literature. CONCLUSIONS: Epoetin beta has no effect on short-term survival, tumor progression or thromboembolic events when used to treat anemic patients with hematological malignancies, and the risk-to-benefit ratio of epoetin beta therapy remains favorable.

Outcomes of patients (pts) with BRAF mutated (BRAF MT) Colorectal Cancer (CRC): The Royal Marsden Experience.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 644-644 ◽  
Author(s):  
Hamzeh Kayhanian ◽  
Emily Goode ◽  
Joo Ern Ang ◽  
David Gonzalez de Castro ◽  
Francesco Sclafani ◽  
...  
Keyword(s):  
Cox Regression ◽  
De Novo ◽  
Early Stage ◽  
Progression Free Survival ◽  
Control Group ◽  
Tertiary Centre ◽  
Kaplan Meier ◽  
Time Period ◽  
Treatment Data ◽  
First Time

644 Background: BRAF MT metastatic CRC (mCRC) is associated with a poor prognosis. For the first time, we report outcomes for BRAF MT mCRC at a single tertiary centre, compared to a matched control group, since introduction of routine somatic BRAF and RAS mutation testing. Methods: Pts with BRAF MT mCRC (diagnosed Oct 2010-Nov 2014) were compared to a matched group of BRAF wildtype (WT) pts treated in same time period who were randomly selected after matching for age, sex and stage. Demographic, tumour characteristic and treatment data were collected. Overall (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method and comparisons made using χ² test or Cox regression. Results: Of 503 pts tested, 59 (11.7%) had BRAF MT tumours (16 early stage, 16 recurrent and 27 de novo metastatic). Median age (years) at diagnosis was 68 (27-85) compared with 70 (29-85) for BRAF WT pts (p = 0.995). Median OS for pts with mCRC was 18.2 months (m) for BRAF MT and 41.1m for BRAF WT pts (HR 2.73 P < 0.01). For BRAF MT and BRAF WT pts with mCRC, median PFS on first-line treatment (1L) was 8.1m (n = 37) and 9.2m (n = 81) respectively (HR = 1.10 [P = 0.69]), PFS on 2L was 5.1m (n = 21) and 9.0m (n = 49) respectively (HR = 1.84 [P = 0.03]) while PFS on 3L was 1.7m (n = 10) and 6.6m (n = 20) respectively (HR = 2.75 [P = 0.02]). Fluoropyrimidine based doublet regimens were used in 94.6%, 85.7% and 20% of BRAF MT pts in 1L, 2L and 3L respectively compared with 87.2%, 92.5% and 52.4% in BRAF WT pts. Pts with localised disease had a recurrence rate of 50% (16/32) for pts with BRAF MT compared with 52.4% (33/63) for BRAF WT pts (p = 0.83). Conclusions: In this case-control study, poor OS of pts with BRAF MT mCRC is associated with reduced clinical benefit beyond 1L. Sequential doublet chemotherapy remains a reasonable option in these pts. The role of BRAF mutation in predicting recurrence of early CRC warrants further study. [Table: see text]

scholarly journals Spironolactone Treatment and Effect on Survival in Chronic Heart Failure Patients with Reduced Renal Function: A Propensity-Matched Study

2017 ◽  
Vol 7 (2) ◽  
pp. 128-136 ◽  
Author(s):  
Viera Stubnova ◽  
Ingrid Os ◽  
Morten Grundtvig ◽  
Dan Atar ◽  
Bård Waldum-Grevbo
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Propensity Score ◽  
Renal Dysfunction ◽  
Cox Regression ◽  
Independent Effect ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Baseline Characteristics ◽  
Matched Study

Background/Aims: Spironolactone may be hazardous in heart failure (HF) patients with renal dysfunction due to risk of hyperkalemia and worsened renal function. We aimed to evaluate the effect of spironolactone on all-cause mortality in HF outpatients with renal dysfunction in a propensity-score-matched study. Methods: A total of 2,077 patients from the Norwegian Heart Failure Registry with renal dysfunction (eGFR <60 mL/min/1.73 m2) not treated with spironolactone at the first visit at the HF clinic were eligible for the study. Patients started on spironolactone at the outpatient HF clinics (n = 206) were propensity-score-matched 1:1 with patients not started on spironolactone, based on 16 measured baseline characteristics. Kaplan-Meier and Cox regression analyses were used to investigate the independent effect of spironolactone on 2-year all-cause mortality. Results: Propensity score matching identified 170 pairs of patients, one group receiving spironolactone and the other not. The two groups were well matched (mean age 76.7 ± 8.1 years, 66.4% males, and eGFR 46.2 ± 10.2 mL/min/1.73 m2). Treatment with spironolactone was associated with increased potassium (delta potassium 0.31 ± 0.55 vs. 0.05 ± 0.41 mmol/L, p < 0.001) and decreased eGFR (delta eGFR -4.12 ± 12.2 vs. -0.98 ± 7.88 mL/min/1.73 m2, p = 0.006) compared to the non-spironolactone group. After 2 years, 84% of patients were alive in the spironolactone group and 73% of patients in the non-spironolactone group (HR 0.59, 95% CI 0.37-0.92, p = 0.020). Conclusion: In HF outpatients with renal dysfunction, treatment with spironolactone was associated with improved 2-year survival compared to well-matched patients not treated with spironolactone. Favorable survival was observed despite worsened renal function and increased potassium in the spironolactone group.

scholarly journals Relationship between formulaic breast volume and risk of breast cancer based on linear measurement

2020 ◽  
Author(s):  
xiaoxia li ◽  
Chunlan Zhou ◽  
Yanni Wu ◽  
Xiaohong Chen
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Cox Regression ◽  
Conditional Logistic Regression ◽  
Control Group ◽  
Breast Volume ◽  
Linear Measurements ◽  
Significant Difference

Abstract Background: Whether breast volume is a risk factor for breast cancer is controversial. This study aimed to evaluate whether a significant association between breast volume and risk of breast cancer, based on linear measurements,was present by applying propensity score matching (PSM).Methods: The study was designed as a hospital-based case-control study. Between March 2018 and May 2019, 208 cases and 340 controls were retrospectively reviewed. Information on menarche, smoking, feeding mode, oral contraceptives, reproductive history and family history was obtained through a structured questionnaire. Breast volume was calculated using a formula based on linear measurements of breast parameters. Cox regression and PSM were used to estimate odds ratios and 95% confidence intervals for breast cancer using risk factors adjusted for potential confounders. Results: There was a significant difference in breast volume between the two groups before propensity score matching(P = 0.014) . Binary logistic regression showed that the risk of breast cancer was slightly higher in the case group with larger breast volumes than in the control group（P = 0.009, OR = 1.002， 95%CI：1.000~1.003). However, there was no significant statistical difference between the two groups using an independent sample Mann-Whitney U test (P = 0.438) or conditional logistic regression (P = 0.446). Conclusions: After PSM for potential confounding factors, the breast volume of cases did not differ from that of controls. The risk of breast cancer may not be related to breast volume in Chinese women.

scholarly journals Relationship Between Formulaic Breast Volume And Risk Of Breast Cancer Based On Linear Measurement

2020 ◽  
Author(s):  
xiaoxia li ◽  
Chunlan Zhou ◽  
Yanni Wu ◽  
Xiaohong Chen
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Cox Regression ◽  
Conditional Logistic Regression ◽  
Linear Measurement ◽  
Control Group ◽  
Breast Volume ◽  
Significant Difference

Abstract Background: Whether breast volume is a risk factor for breast cancer has been controversial. This study aimed to evaluate whether or not the significant association between breast volume and risk of breast cancer based on linear measurement by applying Propensity Score Matching (PSM) was present. Methods: The study was designed as a hospital-based case-control study. Between March 2018 and May 2019, 208 cases and 340 controls were retrospectively reviewed. Information on menarche, smoking, feeding mode, oral contraceptives, reproductive history and family history was obtained through a structured questionnaire. Calculate breast volume using formula based on the linear measurement of breast parameters. Cox regression and PSM were used to estimate odds ratios and 95% confidence intervals for breast cancer by risk factors adjusted for potential confounders. Results: There was a significant difference in breast volume between two groups before Propensity Score Matching(P=0.014) : P=0.009, OR=1.002, 95% CI: 1.000~1.003). Binary logistic regression showed that the risk of breast cancer was slightly higher in the case group with larger breast volume than in the control group（P=0.009, OR=1.002， 95%CI：1.000～1.003). However, there was no significant statistical difference between two groups in independent sample Mann-Whitney U test (P=0.438) and in conditional logistic regression (P=0.446). Conclusions: After PSM for the potential confounders factors, the breast volume of cases did not differ from that of controls. The risk of breast cancer may not related to breast volume in Chinese women.

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