Abstract P187: Pre-kidney Transplant Medical Arterial Calcification as a Risk for Post-transplant Mortality by a Propensity Score Weighting Analysis

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Ekamol Tantisattamo ◽  
Natnicha Leelaviwat ◽  
Chawit Lopimpisuth ◽  
Sakditad Saowapa ◽  
Natchaya Polpichai ◽  
...  
Keyword(s):  
Propensity Score ◽  
Arterial Calcification ◽  
Renal Transplant Recipients ◽  
Weighting Method ◽  
Post Transplant ◽  
Propensity Score Weighting ◽  
Increased Risk ◽  
Dialysis Vintage ◽  
Study Population ◽  
Medial Arterial Calcification

Introduction: Medial arterial calcification (MAC) detected in the breast by mammography (MG) is exclusively medial and associated with cardiovascular mortality in end-stage renal disease (ESRD). This association is unclear in renal transplant recipients (RTR). Hypothesis: By comparing groups of study population balanced by propensity score weighting method, MAC is associated with an increased risk of post-transplant mortality. Methods: Female RTR was divided into 2 groups per presence or absence of pre-transplant MAC examined from MG (MAC and non-MAC), and both groups was balanced with by PS weighting leading to a new study population. Association between MAC and post-transplant mortality of the new study population was examined by multi-variable logistic regression analysis. Results: Of 51 patients, mean age±SD was 57.08±10.47 years old. The majority were white (54.9%) followed by African American (35.3%) and others (9.8%). Incidence rate of mortality was 0.0307 person-years. Median time to follow-up was 3.95 years (range 0.22 to 6.37). Among 20 patients in MAC group, 5 patients died; whereas, only 1 out of 31 patients in non-MAC died (25% vs. 3.23%, p 0.029). Baseline characteristics of both groups were not equal. After using PS weights with generalized boosted modeling, new study population’s characteristics were balanced (Figure 1). MAC is associated with 5.97 times higer the odd of morality compared to non-MAC, but the association was not significant (OR 5.97; 95%CI 0.61, 58.77). After adjusted for age, race, causes of ESRD, dialysis modality, dialysis vintage, donor type, donor age, and type of immunosuppressive medications, the magnitude of the association was increased and becomes significant (OR 38.40; 95%CI 2.44, 604.54). Conclusions: Similar to ESRD, MAC remains associated with higher mortality in RTR and this association is confirmed by well-matched study population. Prevention of pre-transplant MAC should be pursued to mitigate poor post-transplant outcomes.

scholarly journals ASSOCIATION BETWEEN PRE-TRANSPLANT MEDIAL ARTERIAL CALCIFICATION AND EARLY POST-KIDNEY TRANSPLANT HYPERTENSION FROM A PROPENSITY SCORE WEIGHTING ANALYSIS

2021 ◽  
Vol 39 (Supplement 1) ◽  
pp. e295-e296
Author(s):  
Ekamol Tantisattamo ◽  
Natnicha Leelaviwat ◽  
Natchaya Polpichai ◽  
Chawit Lopimpisuth ◽  
Sakditad Saowapa ◽  
...  
Keyword(s):  
Propensity Score ◽  
Kidney Transplant ◽  
Arterial Calcification ◽  
Propensity Score Weighting ◽  
Medial Arterial Calcification

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 Atopic Disease and Anemia in Korean Patients: Cross-Sectional Study with Propensity Score Analysis

2020 ◽  
Vol 17 (6) ◽  
pp. 1978
Author(s):  
Kiyon Rhew ◽  
Joshua D Brown ◽  
Jung Mi Oh
Keyword(s):  
Allergic Rhinitis ◽  
Atopic Dermatitis ◽  
Propensity Score ◽  
Atopic Disease ◽  
Cross Sectional Study ◽  
Deficiency Anemia ◽  
Sectional Study ◽  
Cross Sectional ◽  
Propensity Score Weighting ◽  
Increased Risk

Atopic disease is associated with chronic inflammation, and anemia has been reported in patients with inflammatory disorders such as rheumatoid arthritis, chronic obstructive pulmonary disease, and irritable bowel disease. The objective of this study was to determine whether atopic disease is associated with an increased risk of anemia. A cross-sectional study with propensity score weighting was conducted using a health insurance review agency claims dataset comprised of randomized patients who used the Korean national health system at least once in 2016. The association between atopic disease (asthma, atopic dermatitis, allergic rhinitis) and anemia (iron deficiency anemia (IDA) and/or anemia of inflammation (AI)) was examined. A total of 1,468,033 patients were included in this study. The IDA/AI prevalence was 3.1% (45,681 patients). After propensity score weighting, there were 46,958 and 45,681 patients in the non-anemic and anemic groups, respectively. The prevalence of IDA/AI in patients with atopic dermatitis, allergic rhinitis, or asthma had an odds ratio (OR) of 1.40 (95% confidence interval (CI), 1.33–1.48; p < 0.001), 1.17 (95% CI, 1.14–1.21; p < 0.001), and 1.32 (95% CI, 1.28–1.36; p < 0.001), respectively. In addition, the prevalence of IDA increased with higher numbers of atopic diseases. In conclusion, the prevalence of IDA/AI was higher in patients with atopic disease, even after adjusting for demographic characteristics and other risk factors. Further study is needed to distinguish between IDA and AI and to enhance understanding of the etiology of anemia in patients with inflammatory conditions.

scholarly journals Applications of the propensity score weighting method in psychogeriatric research: correcting selection bias and adjusting for confounders

2017 ◽  
Vol 29 (5) ◽  
pp. 703-706 ◽  
Author(s):  
Chung-Chou H. Chang
Keyword(s):  
Propensity Score ◽  
Selection Bias ◽  
Weighting Method ◽  
Propensity Score Weighting ◽  
Confounding Variables ◽  
Exposure Variable

The propensity score (PS) weighting method is an analytic technique that has been applied in multiple fields for a number of purposes. Here, we discuss two common applications, which are (1) to correct for selection bias and (2) to adjust for confounding variables when estimating the effect of an exposure variable on the outcome of interest.

scholarly journals Initial mycophenolate dose in tacrolimus treated renal transplant recipients, a cohort study comparing leukopaenia, rejection and long-term graft function

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Vatsa Dave ◽  
Kevan R. Polkinghorne ◽  
Khai Gene Leong ◽  
John Kanellis ◽  
William R. Mulley
Keyword(s):  
Renal Function ◽  
Cohort Study ◽  
Renal Transplant ◽  
Graft Function ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Post Transplant ◽  
Increased Risk

Abstract The evidence supporting an initial mycophenolate mofetil (MMF) dose of 2 g daily in tacrolimus-treated renal transplant recipients is limited. In a non-contemporaneous single-centre cohort study we compared the incidence of leukopaenia, rejection and graft dysfunction in patients initiated on MMF 1.5 g and 2 g daily. Baseline characteristics and tacrolimus trough levels were similar by MMF group. MMF doses became equivalent between groups by 12-months post-transplant, driven by dose reductions in the 2 g group. Leukopaenia occurred in 42.4% of patients by 12-months post-transplant. MMF 2 g was associated with a 1.80-fold increased risk of leukopaenia compared to 1.5 g. Rejection occurred in 44.8% of patients by 12-months post-transplantation. MMF 2 g was associated with half the risk of rejection relative to MMF 1.5 g. Over the first 7-years post-transplantation there was no difference in renal function between groups. Additionally, the development of leukopaenia or rejection did not result in reduced renal function at 7-years post-transplant. Leukopaenia was not associated with an increased incidence of serious infections or rejection. This study demonstrates the initial MMF dose has implications for the incidence of leukopaenia and rejection. Since neither dose produced superior long-term graft function, clinical equipoise remains regarding the optimal initial mycophenolate dose in tacrolimus-treated renal transplant recipients.

Abstract 13571: Association Between Pre-kidney Transplantation Medial Arterial Calcification Andpost-transplant Visit-to-visit Blood Pressure Variability: A Propensity Score Matching Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ekamol Tantisattamo ◽  
Sakditad Saowapa ◽  
Natnicha Leelaviwat ◽  
Busara Songtanin ◽  
Chawit Lopimpisuth ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Blood Pressure Variability ◽  
Mineral Metabolism ◽  
Statistical Significance ◽  
Mean Difference ◽  
Absolute Difference ◽  
Arterial Calcification ◽  
Medial Arterial Calcification

Introduction: Arterial calcification is associated with vascular stiffness, which manifests with visit-to-visit blood pressure variability (VVBPV). Although media arterial calcification (MAC) is significantly associated with poor cardiovascular outcomes in kidney patients, the association in kidney transplant (KT) patients is unknown. Hypothesis: We hypothesize that MAC is associated with VVBPV in long-tern post-KT. Methods: Since MAC, which is detected from mammogram (MG) and determined by linear calcified breast arteries, is exclusively medial, female KT patients with ≥1 MG during pre-KT period were included in this study. VVBPV was examined by average successive variability (ASV), which is the average absolute difference between successive BP measured at 4, 12, 24, 36, and 48 weeks post-KT. After balancing patients with and without MAC by using propensity score matching based on age, diabetes, and obesity status, the association between MAC and systolic and diastolic VVBPV (VVSBPV and VVDBPV) at 48 weeks post-KT was tested by multiple linear regression (Figure1A&1B). Results: Of 51 patients, mean age±SD is 54±12 years, 21 had diabetes, and 21 were obese. Mean duration of follow-up was 47±9 years. Among 20 patients with MAC, mean VVSBPV was 20±14 mmHg; whereas, VVSBPV in non-MG group was 14±8 mmHg (mean difference -6± 3.0, p 0.06, 95%CI -12.03, 0.15). Mean VVDBPV in MG and non-MG groups were 12±5 and 11±5.6 mmHg, respectively (mean difference -1±1.6, p 0.41, 95%CI -4.44, 1.86). Laboratory-related bone and mineral metabolism were not different between both groups. On average, MG group had 8 mmHg higher VVSBPV compared to non-MG group (Coef. 3.62, p 0.02, 95%CI 1.16, 15.34). The MG group remained having higher VVDBPV but the magnitude of the association decreased and no statistical significance (Coef. 0.58, p 0.83, 95%CI -4.58, 5.73). Conclusions: Similar to non-transplant patients, KT recipients with pre-KT MAC had significant higher VVSBPV at the late post-KT.

scholarly journals 791. Evaluation of NSAID Exposure as a Risk Factor for Clostridium difficile infection: A Propensity-Score-Matched Case-Control Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S439-S439
Author(s):  
Adam M Ressler ◽  
Alieysa Patel ◽  
Krishna Rao
Keyword(s):  
Logistic Regression ◽  
Risk Factor ◽  
Propensity Score ◽  
Case Control Study ◽  
Case Control ◽  
Comorbid Disease ◽  
Retrospective Case ◽  
Increased Risk ◽  
Study Population ◽  
Control Study

Abstract Background Exposure to certain medications, particularly antibiotics and proton pump inhibitors, has been associated with increased risk for Clostridium difficile infection (CDI). Studies have suggested an increased risk for CDI associated with exposure to certain non-steroidal anti-inflammatory drugs (NSAIDs). We conducted a retrospective case-control study to evaluate the risk for CDI associated with NSAID use. Methods The population included 1338 patients tested for CDI from February–December 2016 at the University of Michigan. NSAID use within 30 days of CDI testing was determined by chart review. Both scheduled and as-needed NSAID use met the definition for exposure, but aspirin use alone did not. Additional clinical data such as comorbid disease and baseline laboratory parameters were extracted through electronic query. A random forest model imputed missing data. A propensity score for NSAID use was developed via logistic regression and included gender, back pain, baseline serum creatinine, osteoarthritis, rheumatoid arthritis, serum albumin, and use of anticoagulant or antiplatelet medications. Cases were matched 1:1 with C. difficile negative controls by propensity score, with a matching caliper of 0.2 x standard deviation of the logit of the score. The final study population consisted of 1256 cases and their matched controls, however 6 cases could not be matched to controls as none had scores within the matching caliper. Conditional logistic regression was used to compare cases to controls. Results NSAID use was similar between the two groups on unadjusted analyses. The adjusted, multivariable model demonstrates that non-aspirin NSAID use is not a significant risk factor for CDI (P =.816), after adjustment for comorbid disease burden, age, and history of prior CDI (Table). Older age and prior CDI were independent risk factors for CDI (Table). Table Study population and modeling results Conclusion In this retrospective case-control study, non-aspirin NSAID use was not associated with an increased risk of CDI. To our knowledge, this is the first study of NSAID use as a risk factor for CDI that accounted for bias due to treatment assignment using a propensity score. Future studies should account for frequency or chronicity of NSAID use, which may affect the results. Disclosures Krishna Rao, MD, MS, Bio-K+ International, Inc. (Consultant)Merck and Co., Inc. (Research Grant or Support)Roche Molecular Systems, Inc. (Consultant)

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