Effects of Polymyxin B Hemoperfusion on Septic Shock Patients Requiring Noradrenaline: Analysis of a Nationwide Administrative Database in Japan

Introduction: Polymyxin B hemoperfusion (PMX) reduces endotoxin in septic shock patients’ blood and can improve hemodynamics and organ functions. However, its effects on the reduction of septic shock mortality are controversial. Methods: Using the Japanese diagnosis procedure combination database from April 2016 to March 2019, we identified adult septic shock patients treated with noradrenaline. This study used propensity score matching to compare the outcome between PMX-treated and non-treated patients. The primary endpoint was 28-day mortality, counting from the day of noradrenaline initiation. The secondary endpoints were noradrenaline-, ventilator-, and continuous hemodiafiltration (CHDF)-free days at day 28. Results: Of 30,731 eligible patients, 4,766 received PMX. Propensity score matching produced a matched cohort of 4,141 pairs with well-balanced patient backgrounds. The 28-day survival rate was 77.9% in the PMX group and 71.1% in the control group (p < 0.0001). Median days of noradrenalin-, CHDF-, and ventilator-free days were 2 days (p < 0.0001), 2 days (p < 0.0001), and 6 days (p < 0.0001) longer in the PMX group than in the control group, respectively. When stratified with the maximum daily dose of noradrenaline, the PMX group showed a statistically significant survival benefit in the groups with noradrenaline dose <20 mg/day but not in the noradrenaline group dose ≥20 mg/day. Conclusion: Analysis of large Japanese databases showed that septic shock patients who received noradrenaline might benefit from PMX treatment.

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Effectiveness of polymyxin B hemoperfusion for sepsis depends on the baseline SOFA score: a nationwide observational study

Annals of Intensive Care ◽

10.1186/s13613-021-00928-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kenji Fujimori ◽

Kunio Tarasawa ◽

Kiyohide Fushimi

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Sofa Score ◽

Large Scale ◽

Polymyxin B ◽

Organ Support ◽

Continuous Hemodiafiltration ◽

Significant Difference ◽

Inpatient Database ◽

Polymyxin B Hemoperfusion

Abstract Background Polymyxin B hemoperfusion (PMX) aims to treat septic shock by removing endotoxin from the patient’s blood. However, the relationship between the severity of the patient's organ damage and the survival benefit of PMX treatment is not clear. Methods We analyzed the efficacy of PMX on adult sepsis patients using the propensity score matching method and the Japanese Diagnosis Procedure Combination (DPC) national inpatient database from April 2018 to March 2020. We stratified the patients into five categories based on their baseline Sequential Organ Failure Assessment (SOFA) score and compared the mortality between PMX-treated and non-treated groups in each category. We also compared continuous hemodiafiltration (CHDF)-, ventilator- and noradrenaline-free days between the groups. Results Of 44,177 patients included in the study, 2191 received PMX. After 1:1 propensity score matching, we created matched cohorts of 2033 pairs. PMX significantly improved the survival of the patients in the SOFA score categories of 7–9 and 10–12. On the other hand, there was no significant difference in the survival rate in SOFA score categories of 0–6, 13–15, and 16–24. In analyzing organ support-free days, PMX was also beneficial in the 7–9 and 10–12 SOFA categories compared to other categories. Conclusion Analysis of a large-scale Japanese inpatient database found a significant association between PMX efficacy and baseline SOFA score. This result indicates higher efficacy in patients with medium SOFA scores in the range of 7–12. The result provides a promising hypothesis for selecting appropriate patients for PMX and should be validated in future RCTs.

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Potential Survival Benefit of Polymyxin B Hemoperfusion in Septic Shock Patients on Continuous Renal Replacement Therapy: A Propensity-Matched Analysis

Blood Purification ◽

10.1159/000444474 ◽

2016 ◽

Vol 42 (1) ◽

pp. 9-17 ◽

Cited By ~ 23

Author(s):

Masao Iwagami ◽

Hideo Yasunaga ◽

Eisei Noiri ◽

Hiromasa Horiguchi ◽

Kiyohide Fushimi ◽

...

Keyword(s):

Septic Shock ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Survival Benefit ◽

Propensity Scores ◽

Polymyxin B ◽

Control Group ◽

Diagnosis Procedure Combination ◽

Polymyxin B Hemoperfusion

Background/Aims: We assessed the survival benefit of polymyxin B hemoperfusion (PMX) in septic shock patients starting continuous renal replacement therapy (CRRT), who are known to have an increased rate of mortality. Methods: Adult patients in the Japanese diagnosis procedure combination database satisfying the following criteria were enrolled: hospitalized in 2007-2012; diagnosed as having sepsis; required noradrenaline and/or dopamine; and started CRRT in intensive care unit. Propensity scores for receiving PMX were created from patient and hospital characteristics. Results: Of 3,759 eligible patients, 1,068 received PMX. Propensity-score matching produced a matched cohort of 978 pairs. The 28-day mortality was 40.2% (393/978) in the PMX group and 46.8% (458/978) in the control group (p = 0.003). Logistic regression analysis revealed a significant association between the use of PMX and decreased 28-day mortality (adjusted OR 0.75; 95% CI 0.62-0.91). Conclusion: This large retrospective study suggests that septic shock patients starting CRRT may benefit from PMX.

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Efficacy of Postoperative Polymyxin B Hemoperfusion in Secondary Peritonitis Patients with Septic Shock: A Propensity-Matched Analysis

The International Journal of Artificial Organs ◽

10.5301/ijao.5000549 ◽

2016 ◽

Vol 39 (12) ◽

pp. 603-610 ◽

Cited By ~ 2

Author(s):

Kuo-Ching Yuan ◽

Shang-Yu Wang ◽

Ming-Chin Yu ◽

Yu-Pao Hsu ◽

Heng-Chih Pan ◽

...

Keyword(s):

Septic Shock ◽

Disease Severity ◽

Organ Dysfunction ◽

Demographic Data ◽

Polymyxin B ◽

Small Sample ◽

Treatment Result ◽

Control Group ◽

Hemodynamic Status ◽

Polymyxin B Hemoperfusion

Introduction Severe sepsis and septic shock is still a challenge. Polymyxin B hemoperfusion (PMX) is a device designed to remove circulating endotoxin by adsorption, which is reported to improve treatment outcomes. This study aimed to further verify the efficacy of PMX on postoperative, peritonitis, septic shock patients. Methods This study prospectively analyzed 20 of 155 patients who presented with postoperative septic shock and were treated with PMX in a single institute during the period March 2013 to September 2014 (Clinical Trial Protocol number: ChiCTR-ONC-16008160). A control group (53 patients) was recruited from our own 2012 database using the propensity-matching score method. The data collection includes demographic data, postoperative organ dysfunction status, disease severity and treatment result. Results The 2 groups (treatment vs. control) were similar in demographic data, organ dysfunction status and disease severity. PMX use provides benefits for recovery of hemodynamic status and many other aspects, including better survival, but is not statistically significant. For survival factor analysis, PMX use is also not significant for patient survival in our study. Conclusions PMX provided some benefits to patients in the treatment for peritonitis septic shock. An improvement in hemodynamic status was mostly observed. Our study also supports the finding that PMX used as an auxiliary treatment provides improved survival but is not statistically significant, possibly due to the small sample size with multiple comorbidities.

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Effects of Polymyxin B Hemoperfusion in Patients with Sepsis Requiring Continuous Hemodiafiltration: Analysis of a Nationwide Administrative Database in Japan

Therapeutic Apheresis and Dialysis ◽

10.1111/1744-9987.13655 ◽

2021 ◽

Author(s):

Kenji Fujimori ◽

Kunio Tarasawa ◽

Kiyohide Fushimi

Keyword(s):

Polymyxin B ◽

Administrative Database ◽

Continuous Hemodiafiltration ◽

Polymyxin B Hemoperfusion

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Faculty Opinions recommendation of Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1163099.623758 ◽

2009 ◽

Author(s):

Martin Duenser

Keyword(s):

Septic Shock ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Polymyxin B ◽

Randomized Controlled ◽

Early Use ◽

Polymyxin B Hemoperfusion

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Bicyclol for the treatment of drug-induced liver injury: a propensity score matching analysis using a nationwide inpatient database

Journal of International Medical Research ◽

10.1177/03000605211005945 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052110059

Author(s):

Yongfeng Wang ◽

Rongtao Lai ◽

Peilan Zong ◽

Qingling Xu ◽

Jia Shang ◽

...

Keyword(s):

Liver Injury ◽

Propensity Score ◽

Propensity Score Matching ◽

Statistical Significance ◽

Control Group ◽

Time Interval ◽

Potential Candidate ◽

Drug Induced ◽

Drug Induced Liver Injury ◽

Propensity Score Matching Analysis

ObjectiveTo evaluate the efficacy and safety of bicyclol in patients with drug-induced liver injury (DILI) using a nationwide database.MethodsWe retrospectively analyzed the clinical data of DILI patients in the DILI-R database. Propensity score matching was performed to balance the bicyclol and control groups, and alanine aminotransferase (ALT) recovery was compared between the two groups. Factors associated with ALT recovery and safety were identified.ResultsThe analysis included the data of 25,927 patients. Eighty-seven cases were included in the bicyclol group, with 932 cases in the control group. One-to-one propensity score matching created 86 matched pairs. The ALT normalization rate in the bicyclol group was significantly higher than that in the control group (50.00% vs. 24.42%), and statistical significance was found in the superiority test. After adjustment of baseline ALT levels, baseline total bilirubin levels, sex, age, acute or chronic liver diseases, and suspected drugs in the multivariate logic regression analysis, the major influencing factors for ALT recovery included the time interval between ALT tests (days) and the group factor (bicyclol treatment). There were no differences in the proportion of renal function impairment or blood abnormalities between the two groups.ConclusionsBicyclol is a potential candidate for DILI.

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Comparison of Long-term outcomes between Lynch sydrome and sporadic colorectal cancer: a propensity score matching analysis

10.21203/rs.3.rs-130271/v1 ◽

2020 ◽

Author(s):

Yun Xu ◽

Cong Li ◽

Charlie Zhi-Lin Zheng ◽

Yu-Qin Zhang ◽

Tian-An Guo ◽

...

Keyword(s):

Colorectal Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Control Group ◽

Sporadic Colorectal Cancer ◽

Long Term Outcomes ◽

Term Survival ◽

Long Term Survival ◽

Tumor Stages

Abstract Background Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. Comparison of prognosis between LS and sporadic CRC (SCRC) were rare,with conflicting results. This study aimed to compare the long-term outcomes between patients with LS and SCRC. Methods Between June 2008 and September 2018, a total of 47 patients were diagnosed with LS by genetic testing at Fudan University Shanghai Cancer Center. A 1:2 propensity score matching was performed to obtain homogeneous cohorts from SCRC group. Thereafter, 94 SCRC patients were enrolled as control group. The long-term survival rates between the two groups were compared, and the prognostic factors were also analyzed. Results The 5-year OS rate of LS group was 97.6%, which was significantly higher than of 82.6% for SCRC group (p = 0.029). The 5-year PFS rate showed no significant differences between the two groups (78.0% for LS group vs. 70.6% for SCRC patients; p = 0.262). The 5-year TFS rates in LS group was 62.1% for LS patients, which were significantly lower than of 70.6% for SCRC group (p = 0.039). By multivariate analysis, we found that tumor progression of primary CRC and TNM staging were independent risk factors for OS. Conclusion LS patients have better long-term survival prognosis than SCRC patients. Strict regular follow-up monitoring, detection at earlier tumor stages, and effective treatment are key to ensuring better long-term prognosis.

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Impact of Dexmedetomidine On Secondary Hyperparathyroidism Recurrence In Uremic Patients Who Received Parathyroidectomy With Auto-Transplantation: A Retrospective Propensity-Matched Study

10.21203/rs.3.rs-1115740/v1 ◽

2021 ◽

Author(s):

Yun Wu ◽

Wei Han ◽

Peikun Li ◽

Xianwen Hu ◽

Ye Zhang

Keyword(s):

Quality Of Life ◽

Propensity Score ◽

Secondary Hyperparathyroidism ◽

Propensity Score Matching ◽

Mechanism Of Action ◽

Control Group ◽

Total Parathyroidectomy ◽

Uremic Patients ◽

The Difference

Abstract Background: Recurrence of secondary hyperparathyroidism (SHPT) remains a big challenge in uremic patients who underwent total parathyroidectomy with auto-transplantation (tPTX-AT). However, the relationship between perioperative intervention and recurrence of SHPT remains unclear. Dexmedetomidine has been used safely and effectively in uremic patients’ anesthesia. The aim of the study was to explore the effect of dexmedetomidine on the recurrence of SHPT and speculate the possible mechanism of action.Methods: Records of patients who underwent tPTX-AT between 2017 and 2018 were retrospectively analyzed. The study consisted of patients who received dexmedetomidine intra-operatively and the controls were patients who did not receive dexmedetomidine. The primary endpoint was the difference in the recurrence of SHPT one year after surgery between the two groups. The secondary endpoint was health-related quality of life scores. Analysis included propensity score matching and multivariable logistic regression. Results: Of 354 patients, 133 patients received dexmedetomidine intraoperatively, and the total recurrence rate of SHPT was 10.2%. After propensity score matching, patients who received dexmedetomidine had a 3.80-fold decreased risk of SHPT recurrence (odds ratio, 0.263; 95% confidence interval, 0.081 to 0.854; P=0.026) and exhibited a better quality of life in terms of physical functioning and general health, and less emotional role limitations compared with those in control group.Conclusion: In uremic patients who received tPTX-AT, there was an association between dexmedetomidine use and decreased risk of SHPT recurrence. Further studies are needed to accurately assess the effects and mechanism of action of dexmedetomidine on the prognosis of this population.

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Evaluación de la eficacia de un programa de tutoría formativa

Revista de Investigación Educativa ◽

10.6018/rie.37.1.322331 ◽

2018 ◽

Vol 37 (1) ◽

pp. 39-56

Author(s):

Renata Clerici ◽

Lorenza Da Re

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Statistical Technique ◽

Drop Out ◽

Control Group ◽

Educación Superior ◽

Central Process ◽

Educacion Superior ◽

Ex Post ◽

Selection Of

La tutoría universitaria es un proceso central en el Espacio Europeo de Educación Superior (EEES), en sus distintas modalidades y con sus distintas estrategias. Actualmente, en la educación superior coexiste una transformación basada en una renovada visión del pasado donde la atención personalizada ocupa un lugar privilegiado, con la finalidad de fomentar el desarrollo integral de los estudiantes, favoreciendo el aprendizaje y atenuando el abandono, y donde la tutoría universitaria tiene un papel decisivo. El presente estudio se centra en la evaluación de un programa de tutoría formativa en tres grados de la Universidad de Padua. Se realiza una verificación de la eficacia a través de la creación de un grupo control ex-post, compuesto por los sujetos no-tratados, cuyas características eran similares a las de los sujetos tratados. Se utiliza un procedimiento de propensity score matching. Los resultados muestran que la verificación contra-factual de las hipótesis de investigación acerca de la eficacia del programa da resultados significativos, en relación al abandono, se redujo a la mitad y el rendimiento académico mejoró, sobre todo en términos de resultados de aprendizaje. University tutoring is a central process in the European Higher Education Area (EHEA), with its different modalities and strategies. Nowadays, in post-secondary education a new attention to customer-tailored educational actions coexists with the goal to promote a wholeperson development of students in order to improve learning and contrast drop-outs: university tutoring plays a crucial role in this new vision. The study is focused on the evaluation of a programme of formative tutoring that involved three first-cycle degree courses at the University of Padova. The hypothesis of effectiveness, in particular, was verified by ex-post selection of a control group, composed of the most similar not treated students to treated ones. The selection of the control group members was carried out by propensity score matching, a statistical technique that predicts the probability to receive the treatment accounting for a set of students observable characteristics. This counter-factual causal analysis gave significant results: the drop-out rate fell by half, and performance increased in terms of learning outcomes.

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