Bundled skin antiseptic preparation for complex cardiac implantable electronic device infection: a propensity-score matching cohort study

Introduction: There are no randomized controlled trials that compared the outcomes of leadless pacemaker (L-PPM) implantation with transvenous pacemaker (TV-PPM) and there is scarcity of data on real world outcomes. Methods: We queried National Inpatient Sample to identify all adult patients who had primary discharge diagnosis of conduction disorders or tachy-arrhythmias and excluded patients who had a concomitant procedure for valve replacement, coronary artery bypass grafting, ablation and/or cardiac implantable electronic device removal so that complications can be attributed to the pacemaker implantation. We included only procedures from November 2016 to December 2017 as Micra was the only available L-PPM during that period. For the comparison cohort we selected patients, during the same time period, who had a procedure code for single chamber pacemaker implantation in conjunction with right ventricular lead placement. We performed 1:1 propensity score matching and the variables used for matching are marked with asterisk in Table 1. All the codes used to identify complications has been previously validated from the Micra Post-approval registry and Coverage with Evidence Study. Results: Total of 1,305 patients for L-PPM and 13,905 patients in the TV-PPM group were included. Baseline characteristics with standardized mean difference before and after matching are shown in Table 1. Briefly, patients in L-PPM group were younger but had higher co-morbidities compared to TV-PPM group. The complications before and after matching are shown in Table 2. Conclusions: In conclusion, we found no significant difference between in-hospital complications after propensity score matching, with the exception of deep venous thrombosis. There was no difference between length of stay but cost for L-PPM was significantly higher. In this real-world analysis, we found that the leadless PPM implantation is safe in comparison to transvenous PPM.

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Dialyzer Classification and Mortality in Hemodialysis Patients: A 3-Year Nationwide Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.740461 ◽

2021 ◽

Vol 8 ◽

Author(s):

Masanori Abe ◽

Ikuto Masakane ◽

Atsushi Wada ◽

Shigeru Nakai ◽

Kosaku Nitta ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Propensity Score Matching ◽

Subgroup Analysis ◽

Hemodialysis Patients ◽

Type I ◽

High Flux ◽

Type Iv ◽

Japanese Classification ◽

Type V

Background: Dialyzers are classified as low-flux, high-flux, and protein-leaking membrane dialyzers internationally and as types I, II, III, IV, and V based on β2-microglobulin clearance rate in Japan. Type I dialyzers correspond to low-flux membrane dialyzers, types II and III to high-flux membrane dialyzers, and types IV and V to protein-leaking membrane dialyzers. Here we aimed to clarify the association of dialyzer type with mortality.Methods: This nationwide retrospective cohort study analyzed data from the Japanese Society for Dialysis Therapy Renal Data Registry from 2010 to 2013. We enrolled 238,321 patients on hemodialysis who were divided into low-flux, high-flux, and protein-leaking groups in the international classification and into type I to V groups in the Japanese classification. We assessed the associations of each group with 3-year all-cause mortality using Cox proportional hazards models and performed propensity score matching analysis.Results: By the end of 2013, 55,308 prevalent dialysis patients (23.2%) had died. In the international classification subgroup analysis, the hazard ratio (95% confidence interval) was significantly higher in the low-flux group [1.12 (1.03–1.22), P = 0.009] and significantly lower in the protein-leaking group [0.95 (0.92–0.98), P = 0.006] compared with the high-flux group after adjustment for all confounders. In the Japanese classification subgroup analysis, the hazard ratios were significantly higher for types I [1.10 (1.02–1.19), P = 0.015] and II [1.10 (1.02–1.39), P = 0.014] but significantly lower for type V [0.91 (0.88–0.94), P < 0.0001] compared with type IV after adjustment for all confounders. These significant findings persisted after propensity score matching under both classifications.Conclusions: Hemodialysis using protein-leaking dialyzers might reduce mortality rates. Furthermore, type V dialyzers are superior to type IV dialyzers in hemodialysis patients.

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Edoxaban versus warfarin on stroke risk in patients with atrial fibrillation: a territory-wide cohort study

10.1101/2021.01.04.21249209 ◽

2021 ◽

Author(s):

Dicken Kong ◽

Jiandong Zhou ◽

Sharen Lee ◽

Keith Sai Kit Leung ◽

Tong Liu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Ischemic Stroke ◽

Propensity Score ◽

Ischaemic Stroke ◽

Propensity Score Matching ◽

Lower Risk ◽

Cox Regression ◽

Significant Risk ◽

Risk Predictors

AbstractBackgroundIn this territory-wide, observational, propensity score-matched cohort study, we evaluate the development of transient ischaemic attack and ischaemic stroke (TIA/Ischaemic stroke) in patients with AF treated with edoxaban or warfarin.MethodsThis was an observational, territory-wide cohort study of patients between January 1st, 2016 and December 31st, 2019, in Hong Kong. The inclusion were patients with i) atrial fibrillation, and ii) edoxaban or warfarin prescription. 1:2 propensity score matching was performed between edoxaban and warfarin users. Univariate Cox regression identifies significant risk predictors of the primary, secondary and safety outcomes. Hazard ratios (HRs) with corresponding 95% confidence interval [CI] and p values were reported.ResultsThis cohort included 3464 patients (54.18% males, median baseline age: 72 years old, IQR: 63-80, max: 100 years old), 664 (19.17%) with edoxaban use and 2800 (80.83%) with warfarin use. After a median follow-up of 606 days (IQR: 306-1044, max: 1520 days), 91(incidence rate: 2.62%) developed TIA/ischaemic stroke: 1.51% (10/664) in the edoxaban group and 2.89% (81/2800) in the warfarin group. Edoxaban was associated with a lower risk of TIA or ischemic stroke when compared to warfarin.ConclusionsEdoxaban use was associated with a lower risk of TIA or ischemic stroke after propensity score matching for demographics, comorbidities and medication use.

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Abstract 12672: Post-Implantation Hematoma Increases Risk of Cardiac Implantable Electronic Device Infection: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.12672 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jakrin Kewcharoen ◽

Chanavuth Kanitsoraphan ◽

Sittinun Thangjui ◽

Thiratest Leesutipornchai ◽

Leenhapong Navaravong

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Electronic Device ◽

Meta Analysis ◽

Case Control ◽

Cardiac Implantable Electronic Device ◽

Case Control Studies ◽

Randomized Controlled ◽

Device Infection ◽

Post Implantation

Introduction: Several studies have shown inconsistent relationship between post-implantation hematoma (PH) and cardiac implantable electronic device (CIED) infection. In this study, we performed a systematic review and meta-analysis to explore the effect of PH and the risk of CIED infection. Hypothesis: PH increases the risk of CIED infection. Methods: We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were cohort studies, case-control studies, cross-sectional studies and randomized controlled trials that reported incidence of PH and CIED infection during the follow-up period. CIED infection was defined as either a device-related local or systemic infection. Data from each study were combined using the random-effects, generic inverse variance method of Der Simonian and Laird to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: Fourteen studies from 2006 to 2018 were included, involving a total of 28,319 participants. There were 6 cohort studies, 7 case-control studies and 1 randomized controlled trial. In random-effect model, we found that PH significantly increases the risk of overall CIED infection (OR = 6.30, 95%CI: 3.87-10.24, I2=49.3%) (Figure 1). There was no publication bias observed in the funnel plot as well as no small-study effect observed in Egger’s test. Conclusions: Our meta-analysis demonstrated that PH significantly increases the risk of CIED infection. Precaution should be taken to during device implantation to reduce PH and subsequent CIED infection.

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Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: Report of an international multicenter cohort study with propensity score matching

Surgery ◽

10.1016/j.surg.2021.08.015 ◽

2021 ◽

Author(s):

Raffaele Brustia ◽

Alexis Laurent ◽

Claire Goumard ◽

Serena Langella ◽

Daniel Cherqui ◽

...

Keyword(s):

Cohort Study ◽

Liver Resection ◽

Propensity Score ◽

Propensity Score Matching ◽

Intrahepatic Cholangiocarcinoma ◽

Multicenter Cohort Study ◽

Open Liver Resection ◽

Multicenter Cohort ◽

International Multicenter

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Association of hypertension and incident diabetes in Chinese adults: a retrospective cohort study using propensity-score matching

10.21203/rs.3.rs-23730/v1 ◽

2020 ◽

Author(s):

Yang Wu ◽

Haofei Hu ◽

Jinlin Cai ◽

Runtian Chen ◽

Xin Zuo ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Propensity Score Matching ◽

Diabetes Risk ◽

Incident Diabetes ◽

Chinese Adults ◽

Hypertensive Patients ◽

Hypertensive Group ◽

High Propensity ◽

Doubly Robust Estimation

Abstract Background Previous studies have revealed that hypertension is one of major risk factors of incident diabetes. However, reliable quantification of the relationship between hypertension and diabetes risk is limited, especially in Chinese people. We aimed to investigate the association between hypertension and risk of incident diabetes in a large cohort of Chinese population. Methods This was a retrospective propensity score-matched cohort study. We enrolled 211809 Chinese adults without diabetes at baseline between 2010 and 2016. The target independent and dependent variable were hypertension at baseline and incident diabetes during follow-up respectively. The one to one propensity score matching using a non-parsimonious multivariable logistic regression was conducted to balance the confounders between 28,946 hypertensive patients and 28,946 non-hypertensive participants. The doubly robust estimation method was used to investigate the association between hypertension and incident diabetes. Result After propensity-score matching, the cumulative incidence of diabetes among hypertensive and non-hypertensive participants were 1627.690 per 100,000 person-years and 1414.422 per 100,000 person-years, respectively. In the propensity-score matching cohort, compared to the non-hypertensive participants, the risk of incident diabetes increased by 14.0% among hypertensive subjects (HR = 1.140, 95% confidence interval (CI): 1.058–1.229, P = 0.00063). After adjusting for the demographic and clinical covariates, diabetes risk increased by 13.1% in the hypertensive group (HR = 1.131, 95%CI: 1.049–1.220, P = 0.00143). And diabetes risk increased by 15.4% among hypertensive subjects after adjusting for the propensity score (HR = 1.154, 95%CI:1.070–1.244, P = 0.00019).In the subgroup analysis, compared to non-hypertensive participants with low propensity score, the risk of incident diabetes increased by 2.6 times among hypertensive patients with high propensity score (HR = 3.610,95%CI: 2.604–5.005,P < 0.00001). In the sensitivity analysis, the risk of diabetes in the hypertensive group increased by 11.7% in the original cohort (HR = 1.117༌95%CI: 1.044–1.196,P = 0.00134) and 19.9% in the weighted cohort(HR = 1.199༌95%CI: 1.149–1.250,P < 0.00001), respectively. Conclusion Hypertension was associated with a 13.1% increase in the risk of developing diabetes in Chinese adults. Additionally, compared to non-hypertensive participants with low propensity score, the risk of incident diabetes increased by 2.6 times among hypertensive patients with high propensity score.

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