scholarly journals Outcomes of transported and in-house patients on extracorporeal life support: a propensity score-matching study

2019 ◽  
Author(s):  
Heemoon Lee ◽  
Kiick Sung ◽  
Gee Young Suh ◽  
Chi Ryang Chung ◽  
Jeong Hoon Yang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Kidney Injury ◽  
Limb Ischaemia ◽  
Serious Adverse Events ◽  
The Mean ◽  
Overall Mortality

Abstract OBJECTIVES Patients on extracorporeal life support (ECLS), like other critically ill patients, are transported to other institutions for various reasons. However, little has been reported concerning the characteristics and clinical outcomes of transported patients compared with those of in-house patients. METHODS A total of 281 adult patients received ECLS between January 2014 and August 2016. Patients who underwent cannulation at another institution by our team were excluded. Patients were divided into 2 groups: transported group (N = 46) and in-house group (N = 235). All 46 patients were safely transported without serious adverse events. The mean travel distance was 206±140 km, with a mean travel time of 78 ± 57 min. Following propensity score matching, 44 transported patients were matched to 148 in-house patients. RESULTS In the matched population, the mean age was 48 ± 13 years in the transported group and 49 ± 17 years in the in-house group (P = 0.70). The ECLS type (venoarterial/venovenous) comprised 35/9 (79.5/20.5%) in the transported group and 119/29 (80.4/19.6%) in the in-house group (P = 0.93). Seventeen (38.6%) extracorporeal cardiopulmonary resuscitations were performed in the transported group and 59 (39.9%) were performed in the in-house group (P = 0.91). The incidence of limb ischaemia and acute kidney injury was higher in the transported group (P = 0.007 and P = 0.001, respectively). However, the rate of survival to discharge did not differ between the groups (63.6% in the transported group vs 64.2% in the in-house group, P = 0.94) and there was no difference in overall mortality (P = 0.99). CONCLUSIONS Although transported patients had more complications than in-house ECLS patients, clinical outcomes were comparable in the matched population. Transporting ECLS patients to an experienced centre may be justified based on our experience.

scholarly journals Effects of Dexmedetomidine Administration on Outcomes in Critically Ill Patients with Acute Kidney Injury: A Propensity Score-Matching Analysis

2021 ◽  
Author(s):  
Aixiang Yang ◽  
Jing Yang ◽  
Biying Zhou ◽  
Jinxian Qian ◽  
Liyang Jiang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Information ◽  
Kidney Injury ◽  
Cox Proportional Hazards Model

Abstract Background Dexmedetomidine (DEX) had organ protection effects and could decrease mortality in animal models, but its association with mortality and length of stay (LOS) in ICU and hospital in critically ill patients was conflicting. Whether acute kidney injury (AKI) subgroup of critically ill patients could benefit from DEX was unknown. The present study aimed to evaluate the effects of DEX on clinical outcomes of critically ill patients with AKI. Methods Data were extracted from the Medical Information Mart for Intensive Care Ⅲ database (MIMIC Ⅲ). Propensity score matching (PSM) analysis (1:3), cox proportional hazards model, linear regression and logistic regression model were used to assess the effect of DEX on clinical outcomes. Results After PSM, 324 pairs of patients were matched between the patients with DEX administration and those without. DEX administration was associated with decreased in-hospital mortality [hazard ratio (HR) 0.287; 95% CI 0.151–0.542; P < 0.001] and 90-day mortality [HR 0.344; 95% CI 0.221–0.534; P < 0.001], and it was also associated with reduced length of stay (LOS) in ICU [4.54(3.13,7.72) versus 5.24(3.15,10.91), P < 0.001] and LOS in hospital [11.63(8.02,16.79) versus 12.09(7.83,20.44), P = 0.002]. Subgroup analysis showed the above associations existed only in mild and moderate AKI subgroups, but not in severe AKI subgroup. Nevertheless, DEX administration was not associated with the recovery of renal function [HR 1.199; 95% CI 0.851–1.688; P = 0.300]. Conclusions DEX administration improved outcomes in critically ill patients with mild and moderate AKI and could be a good choice of sedation.

Influenza in hospitalized cancer patients: A propensity score matching analysis.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 170-170
Author(s):  
Jiarui Li ◽  
Dingding Zhang ◽  
Lin Zhao ◽  
Zhao Sun ◽  
Chunmei Bai
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Influenza Infection ◽  
Kidney Injury ◽  
The United States ◽  
Influenza Viruses ◽  
Propensity Score Matching Analysis ◽  
The Impact

170 Background: Cancer patients are vulnerable to influenza viruses and are at great risk of developing related complications. However, few studies have assessed the impact of influenza infection among hospitalized cancer patients in the United States. Methods: We identified cancer-related hospitalizations from National Inpatient Sample between 2012 and 2014. A 1:1 propensity score matching analysis was conducted to compare the clinical outcomes between hospitalized cancer patients with and without influenza. Results: We identified 13,186,849 cancer-related hospitalizations, and 47,850 of them (0.36%) had a concomitant diagnosis of influenza. After propensity score matching, cancer patients with influenza had a higher mortality (5.4% vs. 4.2%; odds ratio [OR]: 1.3; 95% confidence interval [CI], 1.13 to 1.49; P < 0.001), longer length of stay (6.3 vs. 5.6 days; P < 0.001) but lower costs (14605.9 vs. 14625.5 dollars; P < 0.001) in hospital than those without influenza. In addition, patients with influenza had a higher incidence of pneumonia (18.4% vs. 13.2%; OR, 1.49; 95% CI, 1.37 to 1.62; P < 0.001), neutropenia (7.1% vs. 3.4%; OR, 2.18; 95% CI, 1.91 to 2.50; P < 0.001), sepsis (19.5% vs. 9.3%; OR, 2.36; 95% CI, 2.16 to 2.58; P < 0.001), dehydration (14.8% vs. 8.8%; OR, 1.80; 95% CI, 1.65 to 1.97; P < 0.001), and acute kidney injury (19.9% vs. 17.6%; OR, 1.16; 95% CI, 1.08 to 1.25; P < 0.001) than those without influenza. Conclusions: Influenza is associated with worse clinical outcomes among hospitalized cancer patients. Influenza vaccination is recommended in this population.

Nephrotoxicity of teicoplanin-based combination therapy: focus on piperacillin/tazobactam and other anti-pseudomonal β-lactams

2020 ◽  
Author(s):  
Chih-Hsun Tai ◽  
Chi-Hao Shao ◽  
Chi-Chuan Wang ◽  
Fang-Ju Lin ◽  
Jann-Tay Wang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Combination Therapy ◽  
Propensity Score Matching ◽  
Kidney Injury ◽  
Matched Cohort ◽  
Glycopeptide Antibiotic ◽  
Concurrent Use ◽  
Increased Risk ◽  
The Mean ◽  
Baseline Renal Function

Abstract Background The concurrent use of vancomycin and piperacillin/tazobactam increases the risk of acute kidney injury (AKI) compared with vancomycin use with other anti-pseudomonal β-lactams (OAPBs). Teicoplanin is a glycopeptide antibiotic with lower nephrotoxicity than that of vancomycin. Whether the concomitant use of teicoplanin and piperacillin/tazobactam also increases the risk of AKI remains unknown. Objectives To evaluate the AKI risk between teicoplanin–piperacillin/tazobactam and teicoplanin–OAPBs. Methods This was a retrospective, propensity score-matched cohort study. Adult patients receiving teicoplanin-based combination therapy were included. OAPBs included cefepime, cefoperazone/sulbactam, ceftazidime, doripenem, imipenem/cilastatin and meropenem. Propensity score matching was performed to balance demographic and confounding factors. The primary endpoint was AKI during combination therapy. Results After propensity score matching, 954 patients (teicoplanin–piperacillin/tazobactam: teicoplanin–OAPBs, 1:3 matched, 243 pairs in total) were included for analysis. The mean age was 66.3 years in the matched cohort and 17.1% of patients had shock. Use of nephrotoxic medications (45.7% versus 48.7%) and baseline renal function (78.88 ± 31.26 versus 81.05 ± 31.53 mL/min/1.73 m2) were similar in the two groups. The median teicoplanin dose was 10.7 mg/kg in both groups. The groups did not differ significantly in terms of AKI risk (14.8% versus 14.2%, P = 0.815). However, the time to AKI appeared shorter in the teicoplanin–piperacillin/tazobactam group (4.64 ± 2.33 versus 6.29 ± 4.72 days, P = 0.039). Conclusions The combination of teicoplanin and piperacillin/tazobactam was not associated with an increased risk of AKI compared with teicoplanin and OAPBs.

scholarly journals Health literacy and exercise interventions on clinical outcomes in Chinese patients with diabetes: a propensity score-matched comparison

2020 ◽  
Vol 8 (1) ◽  
pp. e001179
Author(s):  
Yan Wei ◽  
Yingyao Chen ◽  
Yingnan Zhao ◽  
Russell Rothman ◽  
Jian Ming ◽  
...  
Keyword(s):  
Health Literacy ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Literacy Intervention ◽  
Chinese Patients ◽  
Exercise Interventions ◽  
Patients With Diabetes

IntroductionPatients with diabetes in China have low health literacy, which likely leads to poor clinical outcomes. This study aimed to assess the effectiveness of health literacy and exercise interventions on clinical measurements in Chinese adults with type 2 diabetes mellitus (T2DM).Research design and methodsA cluster randomized controlled trial was conducted from February 2015 through April 2017 in Shanghai, China. 799 patients with T2DM aged 18 years or older recruited from eight Community Healthcare Centers were randomized into one control arm and three intervention arms receiving 1-year health literacy intervention, exercise intervention or both as the comprehensive intervention. Propensity score matching was employed to minimize potential imbalance in randomization. The intervention-attributable effects on main clinical outcomes were estimated using a difference-in-difference regression approach.ResultsAfter propensity score matching, 634 patients were included in the analysis. The three intervention groups had decreased hemoglobin A1c (A1c) level after 12 months of intervention. The largest adjusted decrease was observed in the health literacy group (−0.95%, 95% CI: −1.30 to −0.59), followed by the exercise group (−0.81%, 95% CI: −1.17 to −0.45). However, A1c was observed to increase in the health literacy and the comprehensive groups from 12 to 24 months. No obvious changes were observed for other measurements including high-density and low-density lipoprotein cholesterols, and systolic and diastolic blood pressures.ConclusionsHealth literacy and exercise-focused interventions improve glycemic control in Chinese patients with diabetes after 12 months of intervention, and the health literacy intervention shows the greatest effect. Our results suggest that the interventions may have the potential to improve diabetes self-management and reduce diabetes burden in China.Trial registration numberISRCTN76130594.

scholarly journals Minimally invasive versus standard extracorporeal circulation system in minimally invasive aortic valve surgery: a propensity score-matched study

2019 ◽  
Author(s):  
Paolo Berretta ◽  
Mariano Cefarelli ◽  
Luca Montecchiani ◽  
Jacopo Alfonsi ◽  
Walter Vessella ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Propensity Score ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Extracorporeal Circulation ◽  
Fast Track ◽  
Blood Transfusions ◽  
Track Management ◽  
To Receive

Abstract OBJECTIVES The impact of minimally invasive extracorporeal circulation (MiECC) systems on the clinical outcomes of patients undergoing minimally invasive aortic valve replacement (MI-AVR) has still to be defined. This study compared in-hospital and 1 year outcomes of MI-AVR interventions using MiECC systems versus conventional extracorporeal circulation (c-ECC). METHODS Data from 288 consecutive patients undergoing primary isolated MI-AVR using MiECC (n = 102) or c-ECC (n = 186) were prospectively collected. Treatment selection bias was addressed by the use of propensity score matching (MiECC vs c-ECC). After propensity score matching, 2 groups of 93 patients each were created. RESULTS Compared with c-ECC, MiECC was associated with a higher rate of autologous priming (82.4% vs 0%; P < 0.001) and a greater nadir haemoglobin (9.3 vs 8.7 g/dl; P = 0.021) level and haematocrit (27.9% vs 26.4%; P = 0.023). Patients who had MiECC were more likely to receive ultra-fast-track management (60.8% vs 26.9%; P < 0.001) and less likely to receive blood transfusions (32.7% vs 44%; P = 0.04). The in-hospital mortality rate was 1.1% in the MiECC group and 0% in the c-ECC group (P = 0.5). Those in the MiECC group had reduced rates of bleeding requiring revision (0% vs 5.3%; P = 0.031) and postoperative atrial fibrillation (AF) (30.1% vs 44.1%; P = 0.034). The 1-year survival rate was 96.8% and 97.5% for MiECC and c-ECC patients, respectively (P = 0.4). CONCLUSIONS MiECC systems were a safe and effective tool in patients who had MI-AVR. Compared with c-ECC, MiECC promotes ultra-fast-track management and provides better clinical outcomes as regards bleeding, blood transfusions and postoperative AF. Thus, by reducing surgical injury and promoting faster recovery, MiECC may further validate MI-AVR interventions.

P5504Comparison of in-hospital clinical outcomes of acute myocardial infarction between nonagenarians and octogenarians: a propensity-score matched analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Seguchi ◽  
K Sakakura ◽  
K Yamamoto ◽  
Y Taniguchi ◽  
H Wada ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Length Of Hospital Stay ◽  
Hospital Death ◽  
Very Elderly ◽  
Hospital Outcomes

Abstract Background Acute myocardial infarction (AMI) in the very elderly is associated with high morbidity and mortality. Because the majority of study population in clinical researches focusing on the very elderly with AMI were octogenarians, clinical evidences regarding AMI in nonagenarians are sparse. The aim of the present study was to compare in-hospital clinical outcomes of AMI between octogenarians and nonagenarians. Methods We included consecutive 415 very elderly (≥80 years) patients with AMI, and divided into the nonagenarian group (n=38) and the octogenarian group (n=377). Clinical characteristics and in-hospital outcomes were compared between the 2 groups. Furthermore, we used propensity-score matching to find the matched octogenarian group (n=38). Results Percutaneous coronary interventions (PCI) to the culprit of AMI were similarly performed between the nonagenarian (86.8%) and octogenarian (87.0%) groups The incidence of in-hospital death in the nonagenarian group (13.2%) was similar to that in the octogenarian group (14.6%) (P=0.811). The length of hospital stay was significantly shorter in the nonagenarian group (7.4±4.2 days) than that in the octogenarian group (15.4±19.4 days) (P<0.001). After using the propensity-score matching, the incidence of in-hospital death was less in the nonagenarian group (13.2%) than in the matched octogenarian group (21.1%) without reaching statistical significance (P=0.361). The length of hospitalization was significantly shorter in the nonagenarian group (7.4±4.2 days) than in the matched octogenarian group (17.8±37.0 days) (P=0.01). Clinical outcomes Nonagenarian group (n=38) Octogenarian group (n=377) P value In-hospital death, n (%) 5 (13.2) 55 (14.6) 0.811 Length of hospital stay (days) 7.4±4.2 15.4±19.4 <0.001 Length of CCU stay (days) 3.3±2.5 4.7±5.1 0.109 LVEF (%) 48.2±9.2 50.8±13.7 0.152 Peak CPK (U/L) 1424.8±1580.8 1640.1±2394.4 0.912 CCU indicates Coronary care unit; LVEF, Left ventricular ejection fraction; CPK, Creatine kinase. Flow-chart Conclusions The in-hospital mortality of nonagenarians with AMI was comparable to that of octogenarians with AMI. In-hospital outcomes in nonagenarians with AMI may be acceptable as long as acute medical management including PCI to the culprit of AMI is performed. Acknowledgement/Funding None

Sign in / Sign up

Export Citation Format

Share Document