scholarly journals Higher Mortality of Ischaemic Stroke Patients Hospitalized with COVID-19 Compared to Historical Controls

2021 ◽  
pp. 1-6
Author(s):  
Stephanie L. Harrison ◽  
Elnara Fazio-Eynullayeva ◽  
Deirdre A. Lane ◽  
Paula Underhill ◽  
Gregory Y.H. Lip
Keyword(s):  
Propensity Score ◽  
Ischaemic Stroke ◽  
Propensity Score Matching ◽  
Rank Test ◽  
Chronic Obstructive ◽  
Healthcare Organizations ◽  
Stroke Patients ◽  
Obstructive Pulmonary Disease ◽  
Kaplan Meier ◽  
Historical Controls

<b><i>Introduction:</i></b> Increasing evidence suggests patients with coronavirus disease 2019 (COVID-19) may develop thrombosis and thrombosis-related complications. Some previous evidence has suggested COVID-19-associated strokes are more severe with worse outcomes for patients, but further studies are needed to confirm these findings. The aim of this study was to determine the association between COVID-19 and mortality for patients with ischaemic stroke in a large multicentre study. <b><i>Methods:</i></b> A retrospective cohort study was conducted using electronic medical records of inpatients from 50 healthcare organizations, predominately from the USA. Patients with ischaemic stroke within 30 days of COVID-19 were identified. COVID-19 was determined from diagnosis codes or a positive test result identified with CO­VID-19-specific laboratory codes between January 20, 2020, and October 1, 2020. Historical controls with ischaemic stroke without COVID-19 were identified in the period January 20, 2019, to October 1, 2019. 1:1 propensity score matching was used to balance the cohorts with and without CO­VID-19 on characteristics including age, sex, race and comorbidities. Kaplan-Meier survival curves for all-cause 60-day mortality by COVID-19 status were produced. <b><i>Results:</i></b> During the study period, there were 954 inpatients with ischaemic stroke and COVID-19. During the same time period in 2019, there were 48,363 inpatients with ischaemic stroke without COVID-19 (historical controls). Compared to patients with ischaemic stroke without COVID-19, patients with ischaemic stroke and COVID-19 had a lower mean age, had a lower prevalence of white patients, a higher prevalence of black or African American patients and a higher prevalence of hypertension, previous cerebrovascular disease, diabetes mellitus, ischaemic heart disease, atrial fibrillation, chronic kidney disease, chronic obstructive pulmonary disease, liver disease, neoplasms, and mental disorders due to known physiological conditions. After propensity score matching, there were 952 cases and 952 historical controls; cases and historical controls were better balanced on all included characteristics (all <i>p</i> &#x3e; 0.05). After propensity score matching, Kaplan-Meier survival analysis showed the survival probability was significantly lower in ischaemic stroke patients with COVID-19 (78.3% vs. 91.0%, log-rank test <i>p</i> &#x3c; 0.0001). The odds of 60-day mortality were significantly higher for patients with ischaemic stroke and COVID-19 compared to the propensity score-matched historical controls (odds ratio: 2.51 [95% confidence interval 1.88–3.34]). <b><i>Discussion/Conclusions:</i></b> Ischaemic stroke patients with COVID-19 had significantly higher 60-day all-cause mortality compared to propensity score-matched historical controls (ischaemic stroke patients without COVID-19).

scholarly journals Hospitalized Prognosis of Ischemic Stroke with COPD: A Propensity Score Matching Study

2021 ◽  
Author(s):  
Siyan Zhang ◽  
Qiong Zeng ◽  
Liling Wei ◽  
Kun Lin
Keyword(s):  
Ischemic Stroke ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Pulmonary Infection ◽  
Chronic Obstructive ◽  
Stroke Patients ◽  
Obstructive Pulmonary Disease ◽  
Medical College ◽  
Propensity Score Matching Analysis ◽  
Inpatient Outcomes

Abstract Purpose: The relationship between chronic obstructive pulmonary disease (COPD) and hospitalized prognosis, in ischemic stroke patients, as well as complications is not well understood. This study aimed to investigate the influence of COPD on inpatient outcomes among ischemic stroke patients.Methods: A retrospective investigation was conducted in 9260 patients with confirmed ischemic stroke, in the First Affiliated Hospital of Shantou University Medical College, from 2013 to 2020. After excluding patients with missing data or hospital discharge within 24 hours, we divided the eligible 9021 patients into two groups based on whether or not they had been diagnosed with COPD. After a 1:3 ratio propensity score matching (PSM) (n=290, COPD group vs n=856, non-COPD group), we compared hospitalized prognosis and complications between two groups.Results: Stroke patients with COPD had a significantly higher rate of non-recovered and deceased patients at discharge (4.1% vs 2.1%, OR=1.972, P=0.023), and a higher risk of infection (66.2% vs 48.3%, OR=2.10, P<0.001), especially pulmonary infection (48.1% vs 32.3%, OR=1.944, P<0.001), compared to stroke patients without COPD. After propensity score matching analysis, the differences were still statistically significant concerning inpatient non-recovery and death (4.1% vs 1.9%; OR=2.266, P=0.031), infection (66.2% vs 52.9%, OR=1.743, P<0.001) and pulmonary infection (48.3% vs 36.6%, OR=1.619, P<0.001).Conclusion: Stroke patients with COPD have poorer hospitalized prognosis, with a higher rate of non-recovered and deceased patients, as well as higher incidence of infection, compared with those without COPD.

Impact of morphine use on mortality in STEMI patients treated with primary PCI - preliminary data from a new registry

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
D Szabo ◽  
A Szabo ◽  
IF Edes ◽  
D Becker ◽  
B Merkely ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Survival Data ◽  
Preliminary Data ◽  
Laboratory Data ◽  
Rank Test ◽  
Primary Pci ◽  
Kaplan Meier ◽  
P2y12 Antagonists ◽  
Current Guidelines

Abstract Funding Acknowledgements Type of funding sources: None. Background Opioids decrease the effect of P2Y12 receptor inhibitors in vitro and observational reports suggest that morphine use is associated with larger infarct size. Our research group presented previously, using a prospective single-center registry, that periprocedural morphine use may have no impact on long-term mortality in STEMI patients treated with primary PCI and clopidogrel. Purpose Our purpose is to check this interaction using a new registry of patients treated according to the current guidelines, including novel antiplatelet agents. Methods From May until November 2020, we collected 196 STEMI patients treated with primary PCI. 88 (44.9%) of them got morphine during the prehospital and periprocedural care. Baseline demographic, anamnestic, procedural, and laboratory data were collected. Survival data were analysed using Kaplan-Meier survival curves and the log-rank test. To adjust for confounding, a 1:1 propensity score-matching analysis was performed using 114 cases. Results An adequate balance on baseline covariates was achieved during propensity score-matching. Kaplan-Meier analysis showed no difference in 30-days mortality of the patients treated with or without morphine neither in the original nor in the propensity score-matched population (p = 0.094 and p = 0.309, respectively). Conclusion Our preliminary data suggest that morphine may have no impact on mortality in STEMI patients treated with primary PCI and medical therapy according to the current guidelines including novel P2Y12 antagonists. Abstract Figure. Kaplan-Meier curves

scholarly journals Impact of Chronic Obstructive Pulmonary Disease on In-hospital Mortality in Patients with Aneurysmal Subarachnoid Hemorrhage: An Observational Cohort Study with Propensity Score Matching

2020 ◽  
Author(s):  
Yu Zhang ◽  
Linjie Li ◽  
Wei Yao ◽  
Xing Wang ◽  
Liyuan Peng ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cohort Study ◽  
Subarachnoid Hemorrhage ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Pulmonary Disease ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Objective: Chronic obstructive pulmonary disease (COPD) has been associated with several complications and mortality in acutely ill patients. For patients with aneurysmal subarachnoid hemorrhage (aSAH), the association between COPD and clinical outcomes remains unclear. Methods: In this retrospective cohort study, we analyzed consecutive aSAH patients admitted to the West China Hospital between 2009 and 2019. Propensity score matching was performed to obtain the adjusted odds ratios (ORs) with 95% CI. The primary outcome was in hospital mortality.Results: Using a ten-year clinical database from a large university medical center, 5643 patients with aSAH were identified, of whom 377 (7.9%) also had COPD. After matching, 289 patients were included in COPD group and 1156 in non-COPD groups. COPD was associated with increased in-hospital mortality (OR 1.63, 95% CI 1.02-2.62) and poor functional outcome at discharge (OR 1.37, 95% CI 1.04-1.80). Similarly, patients with COPD had significantly longer length of hospital stay, higher odds of seizure (OR 2.05, 95% CI 1.04-4.04), pneumonia (OR 3.10, 95% CI 2.38-4.04), intracranial infection (OR 1.62, 95% CI 1.14-2.29), urinary tract infection (OR 1.59, 95% CI 1.16-2.20) and bloodstream infection(OR 3.27, 95% CI 1.74-6.15). Conclusions: Among aSAH patients, COPD is associated with increased mortality. COPD represents a significant risk factor for pneumonia and seizure.

scholarly journals Laparoscopic right posterior sectionectomy versus laparoscopic right hemihepatectomy for hepatocellular carcinoma in posterior segments: Propensity Score Matching Analysis

2018 ◽  
Vol 108 (1) ◽  
pp. 23-29
Author(s):  
J. Rhu ◽  
G. S. Choi ◽  
J. M. Kim ◽  
C. H. D. Kwon ◽  
S. J. Kim ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Disease Free Survival ◽  
Rank Test ◽  
Free Survival ◽  
Right Hemihepatectomy ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Right Posterior Sectionectomy

Background and Aims: This study was designed to analyze the feasibility of laparoscopic right posterior sectionectomy compared to laparoscopic right hemihepatectomy in patients with hepatocellular carcinoma located in the posterior segments. Material and Methods: The study included patients who underwent either laparoscopic right posterior sectionectomy or laparoscopic right hemihepatectomy for hepatocellular carcinoma located in segment 6 or 7 from January 2009 to December 2016 at Samsung Medical Center. After 1:1 propensity score matching, patient baseline characteristics and operative and postoperative outcomes were compared between the two groups. Disease-free survival and overall survival were compared using Kaplan–Meier log-rank test. Results: Among 61 patients with laparoscopic right posterior sectionectomy and 37 patients with laparoscopic right hemihepatectomy, 30 patients from each group were analyzed after propensity score matching. After matching, baseline characteristics of the two groups were similar including tumor size (3.4 ± 1.2 cm in laparoscopic right posterior sectionectomy vs 3.7 ± 2.1 cm in laparoscopic right hemihepatectomy, P = 0.483); differences were significant before matching (3.1 ± 1.3 cm in laparoscopic right posterior sectionectomy vs 4.3 ± 2.7 cm in laparoscopic right hemihepatectomy, P = 0.035). No significant differences were observed in operative and postoperative data except for free margin size (1.04 ± 0.71 cm in laparoscopic right posterior sectionectomy vs 2.95 ± 1.75 cm in laparoscopic right hemihepatectomy, P < 0.001). Disease-free survival (5-year survival: 38.0% in laparoscopic right posterior sectionectomy vs 47.0% in laparoscopic right hemihepatectomy, P = 0.510) and overall survival (5-year survival: 92.7% in laparoscopic right posterior sectionectomy vs 89.6% in laparoscopic right hemihepatectomy, P = 0.593) did not differ between the groups based on Kaplan–Meier log-rank test. Conclusion: For hepatocellular carcinoma in the posterior segments, laparoscopic right posterior sectionectomy was feasible compared to laparoscopic right hemihepatectomy when performed by experienced laparoscopic surgeons.

scholarly journals Association of Diabetes and Outcomes in Patients with COVID-19: A Propensity Score Matched Analyses from a French Retrospective Cohort

2020 ◽  
Author(s):  
Willy Sutter ◽  
Baptiste Duceau ◽  
Aurélie Carlier ◽  
Antonin Trimaille ◽  
Thibaut Pommier ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Vital Signs ◽  
Patient Characteristics ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Patients With Diabetes

Abstract Background: To compare the clinical outcomes between patients with and without diabetes admitted to hospital with COVID-19.Methods: Retrospective multicentre cohort study from 24 academic tertiary medical centres in France including 2851 patients (675 with diabetes) hospitalised for COVID-19 between February 26 and April 20, 2020. A propensity score matching method (1:1 matching including patient characteristics, medical history, vital signs, and laboratory results) was used to compare patients with and without diabetes (n=603 in each group). The primary outcome was admission to intensive care unit (ICU) or in-hospital death. Results: Patients with diabetes were older (71 ± 13 vs. 65 ± 18 years; p<0.001), were less often female (38% vs. 44%; p<0.001) and more likely to have comorbidities: hypertension (79% vs 42%; p<0.001), coronary heart disease (23% vs 9%; p<0.001), stroke (13% vs 8%; p<0.001), heart failure (17% vs 9%; p<0.001), chronic kidney disease (26% vs 10%; p<0.001), and chronic obstructive pulmonary disease (7% vs 5%; p<0.05). The primary outcome occurred in 584 (36.4%) patients with diabetes compared to 246 (26.8%) in those without diabetes (p<0.001). After propensity score matching, the risk of primary outcome was similar in patients with and without diabetes (hazard ratio [HR] 1.16, 95%CI 0.95-1.41, p=0.14) and was 1.29 (95%CI 0.97 – 1.69) for in-hospital mortality, 1.26 (95%CI 0.93 – 1.72) for mortality without transfer in ICU, and 1.14 (95%CI 0.88 – 1.47) for transfer to ICU.Conclusions: In this retrospective cohort of patients hospitalised for COVID-19, diabetes was not significantly associated with a higher risk of COVID-19 severe outcomes after propensity score matching.Trial registration NCT04344327

scholarly journals The association of blood urea nitrogen levels upon emergency admission with mortality in acute exacerbation of chronic obstructive pulmonary disease

2021 ◽  
Vol 18 ◽  
pp. 147997312110600
Author(s):  
Lan Chen ◽  
Lijun Chen ◽  
Han Zheng ◽  
Sunying Wu ◽  
Saibin Wang
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Blood Urea Nitrogen ◽  
Regression Models ◽  
Chronic Obstructive ◽  
Urea Nitrogen ◽  
Obstructive Pulmonary Disease ◽  
Logistic Regression Models ◽  
Survivor Group

Background and purpose High blood urea nitrogen (BUN) is associated with an elevated risk of mortality in various diseases, such as heart failure and pneumonia. Heart failure and pneumonia are common comorbidities of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, data on the relationship of BUN levels with mortality in patients with AECOPD are sparse. The purpose of this study was to evaluate the correlation between BUN level and in-hospital mortality in a cohort of patients with AECOPD who presented at the emergency department (ED). Methods A total of 842 patients with AECOPD were enrolled in the retrospective observational study from January 2018 to September 2020. The outcome was all-cause in-hospital mortality. Receiver operating characteristic (ROC) curve analysis and logistic regression models were performed to evaluate the association of BUN levels with in-hospital mortality in patients with AECOPD. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics, and logistic regression models were also performed in the propensity score matching cohort. Results During hospitalization, 26 patients (3.09%) died from all causes, 142 patients (16.86%) needed invasive ventilation, and 190 patients (22.57%) were admitted to the ICU. The mean level of blood urea nitrogen was 7.5 ± 4.5 mmol/L. Patients in the hospital non-survivor group had higher BUN levels (13.48 ± 9.62 mmol/L vs. 7.35 ± 4.14 mmol/L, p < 0.001) than those in the survivor group. The area under the curve (AUC) was 0.76 (95% CI 0.73–0.79, p < 0.001), and the optimal BUN level cutoff was 7.63 mmol/L for hospital mortality. As a continuous variable, BUN level was associated with hospital mortality after adjusting respiratory rate, level of consciousness, pH, PCO2, lactic acid, albumin, glucose, CRP, hemoglobin, platelet distribution width, D-dimer, and pro-B-type natriuretic peptide (OR 1.10, 95% CI 1.03–1.17, p=0.005). The OR of hospital mortality was significantly higher in the BUN level ≥7.63 mmol/L group than in the BUN level <7.63 mmol/L group in adjusted model (OR 3.29, 95% CI 1.05–10.29, p=0.041). Similar results were found after multiple imputation and in the propensity score matching cohort. Conclusions Increased BUN level at ED admission is associated with hospital mortality in patients with AECOPD who present at the ED. The level of 7.63 mmol/L can be used as a cutoff value for critical stratification.

Abstract 37: Outcomes Associated With Intraventricular Thrombolysis Among Patients With Intracerebral Hemorrhage: Propensity Score Analysis of 10-Year Contemporary Real-World Data

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Farhaan S Vahidy ◽  
Jennifer Meeks ◽  
Thomas Potter ◽  
Osman Khan ◽  
Alan Pan ◽  
...  
Keyword(s):  
Propensity Score ◽  
Intracerebral Hemorrhage ◽  
Real World ◽  
Propensity Score Analysis ◽  
Rank Test ◽  
Matched Sample ◽  
Healthcare Organizations ◽  
Real World Data ◽  
Kaplan Meier ◽  
Icd 10

Introduction: Intraventricular thrombolysis (IVT) for hematoma evacuation among eligible intracerebral hemorrhage (ICH) patients is a promising modality to improve outcomes. Methods: We analyzed deidentified pooled data from a network of 40 healthcare organizations (Aug 2010 - Jul 2020). Using ICD-10 diagnosis / procedure, current procedural terminology codes, and medications; we identified index ICH events for extra ventricular drain (EVD) placement with or without IVT. Non adult (< 18 years) patients with thrombolysis use or conditions requiring thrombolysis (cerebral / myocardial infarction, pulmonary embolism, hemodialysis) within 3-days prior to the index event were excluded. IVT and non-IVT patients were propensity score (PS) matched for demographic, comorbidity and clinical variables. Match adequacy was assessed by standardized mean difference (SMD). Risk Ratios (RR), 95% Confidence Intervals (CI) were calculated for mortality at 7,30, and 90-days. Kaplan-Meier (KM) analysis with log rank test (LRT) was performed. Results: Among 109,754 patients with an index ICH event 76,608 met the inclusion criteria. Of whom, 7,539 (9.8%) were coded for EVD presence, and 1,688 (22.4%) received IVT. Significant differences in demographic and clinical parameters were observed between IVT and non-IVT groups (graphic). At 90-days 28.4% of non-IVT and 23.2% of IVT ICH patients had died. PS algorithm yielded a 1:1 optimally matched sample (94% SMD reduction) of 1,163 IVT and non-IVT ICH patients each, without significant differences across any co-variates. In the matched sample, the mortality risk was significantly lower for the IVT group at all three timepoints. RR (CI) for 7-day: 0.62(0.50 - 0.77), for 30-day: 0.76(0.65 - 0.88), and for 90-day 0.85(0.74 - 0.97). LRT p < 0.001 for all timepoints, KM curve for 30-day outcome shown in the graphic. Conclusion: Real world utilization of IVT for eligible ICH patients demonstrates significant reduction in early mortality.

Abstract 263: Evaluation of Survival Benefit of Statins in Patients with Pulmonary Hypertension and Chronic Obstructive Pulmonary Disease: A Propensity Score Matching Study

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Luise Holzhauser ◽  
Ninel Hovnanian ◽  
Parham Eshtehardi ◽  
Khalid Mojadidi ◽  
David Goodman-Meza ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Hypertension ◽  
Propensity Score ◽  
Statin Therapy ◽  
Propensity Score Matching ◽  
Survival Benefit ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Statin Group ◽  
All Cause Mortality

Background: Pulmonary hypertension (PH) is a multifactorial disease characterized by endothelial dysfunction and inflammation. In line with this, pleiotropic effects of statins have been found beneficial in PH resulting in hemodynamic improvement. However, the role of statins in subgroups of PH, especially inflammation triggered chronic obstructive pulmonary disease (COPD) is unknown and their effect on mortality has not yet been studied. Methods: Consecutive patients ≥18 years with severe PH (pulmonary artery systolic pressure ≥60 mmHg) and preserved left ventricular function (ejection fraction ≥50%) defined by transthoracic echocardiograms were included from January 2002 to August 2012. Patients were divided into two groups based on being on statin therapy for 12 consecutive months after diagnosis of PH. Propensity score matching was performed for all baseline demographics, comorbidities, labs, lipid profile, and medications with ratio matching of 1 (treated) to 5 (untreated controls). Subgroup analysis was done based on COPD status. Study endpoint was 1-year all-cause mortality. Results: 2,363 patients (age 71±16; 31% male) were included, 140 (6%) patients were on statin therapy. 1-year mortality for the entire population was 34%. Following propensity score matching, 137 patients on statin (statin group) and 625 patients not on statin (controls), all-cause mortality was significantly lower in statin group compared to controls (15.3% vs. 36.2%, HR 0.38 [95% CI 0.25, 0.60], p<0.001). After stratifying patients based on COPD status, while statins significantly reduced 1-year all-cause mortality in patients without COPD (HR 0.30 [95%CI 0.16, 0.56], p<0.001), patients with COPD did not show a survival benefit from statins (HR 0.54 [95%CI 0.28, 1.05], p=0.069). Conclusions: In this study, we identify statin therapy as an independent predictor of lower 1-year mortality in patients with severe PH but interestingly not in the subgroup of patients with COPD. This observation might be linked to the high severity of PH in our study population and less likely to the lack of anti-inflammatory effects. However the overall survival benefit in patients with severe PH is a novel and promising finding that needs to be confirmed in large randomized trials.

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