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 13: Sex Differences in Mortality Among Patients With Covid-19 Related Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Farhaan S Vahidy ◽  
Jennifer Meeks ◽  
Alan Pan ◽  
Thomas Potter ◽  
Osman Khan ◽  
...  
Keyword(s):  
Sex Differences ◽  
Sensitivity Analyses ◽  
Rank Test ◽  
P Value ◽  
Matched Sample ◽  
Healthcare Organizations ◽  
Time To Death ◽  
Kaplan Meier ◽  
Laboratory Confirmation ◽  
Icd 10

Introduction: Overall poor COVID-19 outcomes have been reported among males. We evaluated sex differences in mortality among patients with stroke related to COVID-19. Methods: Utilizing pooled deidentified data from 30 healthcare organizations, we identified COVID-19 patients via ICD-10 diagnosis or documented laboratory confirmation of SARS-CoV-2 RNA or antibodies. Patients with ICD-10 diagnoses of ischemic stroke or intracerebral hemorrhage within 30 days before or after the COVID-19 event were flagged. Male and female patients were propensity score (PS) matched on other demographic and comorbidity variables. Risk Ratio (RR) and 95% Confidence Interval (CI) for association between sex and 90-day mortality is reported. Kaplan-Meier analyses with log rank test (LRT) were conducted for time-to-death. As a sensitivity analysis, we only included a smaller sub-set with first instance of IS or ICH ± 30-days of COVID-19 diagnosis. Results: Among 149,410 COVID-19 patients, 1,618 (1.1%) had a stroke diagnosis ± 30-days of confirmed COVID-19. Of whom, 1,609 patients (847 males and 762 females) were included in primary analyses. Females were older (67.7 vs. 65.7 years) and were more likely to be of black race (34.1% vs. 27.6%). Females had a significantly higher proportion of chronic pulmonary disease (38.8% vs. 28.8%) and obesity (34.2% vs. 24.8%); whereas males had higher proportion of alcohol abuse (8.5% vs. 3.8%). A 1:1 PS algorithm yielded an optimally matched sample of 634 males and females each, balanced on all covariates. In the matched sample, 11.7% of females and 15.8% of males experienced 90-day mortality; RR (CI): 1.35 (1.02 - 1.78), LRT p value 0.04. Higher risk of 90-day mortality among males with COVID-19 and stroke was maintained in the sensitivity analyses, RR (CI): 1.47 (1.06 - 2.00), LRT p value = 0.03 (graphic). Conclusion: Future studies examining the socio-demographic and biological mechanisms for poor stroke outcomes among males with COVID-19 are needed.

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 P352 A propensity score-matched, real-world comparison of ustekinumab vs vedolizumab as a second-line treatment for Crohn’s disease. The Cross Pennine study II

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S372-S373
Author(s):  
M V Lenti ◽  
V Dolby ◽  
T Clark ◽  
V Hall ◽  
S Tattersall ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Propensity Score ◽  
Adverse Events ◽  
Clinical Response ◽  
Real World ◽  
Propensity Score Analysis ◽  
Physician Global Assessment ◽  
Real World Data ◽  
The Difference

Abstract Background The best choice of biological agents after failure to an anti-tumour necrosis factor (TNF)α agent in patients with Crohn’s disease (CD) is yet to be defined. Real-world data dealing with this issue are still emerging. Methods This is a multicentre retrospective study including eight UK hospitals (August 2014-April 2020). We retrospectively collected data of patients treated with ustekinumab. Clinical response and remission at 14 and 52 weeks evaluated through Physician Global Assessment (PGA) and adverse events were recorded. Predictors of clinical response were examined, and a propensity score-matched analysis with a cohort of patients treated with vedolizumab was performed. Results Overall, 282 patients (mean age 40±15, F:M ratio 1.7:1) treated with ustekinumab were included. Clinical response or remission was reached by 200/282 patients (70.9%) at 14 weeks, and by 162/259 patients (62.5%) at 52 weeks. The most common reason for discontinuation was either primary failure or loss of response, followed by the occurrence of adverse events and by the need for surgery. The rate of non-adherence was rather low (1.4%). Current smoking (OR 2.48, 95% CI 1.13-5.44; p=0.02), baseline PGA (OR 2.4, 95% CI 1.55-3.69, p&lt;0.001), and use of steroids (OR 2.42, 95% CI 1.26-4.65, p=0.008) were associated with 52-week treatment failure. Overall, 74 adverse events occurred, of which 26 were labelled as serious (8.3 per 100 person-year). After exclusion of patients without anti-TNFα exposure prior to starting ustekinumab or vedolizumab and exclusion of patients previously exposed to vedolizumab or ustekinumab, we analysed 275/282 patients (97.5%) from the ustekinumab cohort and 118/135 patients (87.4%) from the vedolizumab cohort. Propensity score analysis revealed that at 14 weeks, patients treated with ustekinumab were 38% (95% CI 25-50%; p&lt;0.001) more likely to achieve a clinical remission, while at 52 weeks, the difference of 9% (95% CI -15-33%; p=0.462) was not significant. Conclusion Ustekinumab was effective and well tolerated in this real-world cohort. While ustekinumab proved more effective at 14-week follow-up, we found no statistically significant differences in outcomes at 52 weeks.

scholarly journals Propensity score analysis of overall survival between first‐ and second‐generation EGFR‐TKIs using real‐world data

2020 ◽  
Vol 111 (10) ◽  
pp. 3705-3713
Author(s):  
Kentaro Ito ◽  
Kenta Murotani ◽  
Akihito Kubo ◽  
Eiji Kunii ◽  
Hirokazu Taniguchi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Real World ◽  
Second Generation ◽  
Propensity Score Analysis ◽  
Real World Data ◽  
World Data ◽  
Score Analysis ◽  
First And Second Generation ◽  
Egfr Tkis

scholarly journals Cohort study of the overall survival of patients with pancreatic cancer in a hospital of specialties of Quito-Ecuador in the period 2007–2017

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Andrés Moreno Roca ◽  
Luciana Armijos Acurio ◽  
Ruth Jimbo Sotomayor ◽  
Carlos Céspedes Rivadeneira ◽  
Carlos Rosero Reyes ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cohort Study ◽  
Survival Time ◽  
Univariate Analysis ◽  
Rank Test ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Icd 10 ◽  
The Difference ◽  
Clinical Records

Abstract Objectives Pancreatic cancers in most patients in Ecuador are diagnosed at an advanced stage of the disease, which is associated with lower survival. To determine the characteristics and global survival of pancreatic cancer patients in a social security hospital in Ecuador between 2007 and 2017. Methods A retrospective cohort study and a survival analysis were performed using all the available data in the electronic clinical records of patients with a diagnosis of pancreatic cancer in a Hospital of Specialties of Quito-Ecuador between 2007 and 2017. The included patients were those coded according to the ICD 10 between C25.0 and C25.9. Our univariate analysis calculated frequencies, measures of central tendency and dispersion. Through the Kaplan-Meier method we estimated the median time of survival and analyzed the difference in survival time among the different categories of our included variables. These differences were shown through the log rank test. Results A total of 357 patients diagnosed with pancreatic cancer between 2007 and 2017 were included in the study. More than two-thirds (69.9%) of the patients were diagnosed in late stages of the disease. The median survival time for all patients was of 4 months (P25: 2, P75: 8). Conclusions The statistically significant difference of survival time between types of treatment is the most relevant finding in this study, when comparing to all other types of treatments.

scholarly journals OP0211 TIME TO DISCONTINUATION OF TOFACITINIB AND TNF INHIBITORS IN RHEUMATOID ARTHRITIS PATIENTS WITH AND WITHOUT METHOTREXATE: DATA FROM A RHEUMATOID ARTHRITIS COHORT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 131.2-132
Author(s):  
M. Movahedi ◽  
A. Cesta ◽  
X. LI ◽  
E. Keystone ◽  
C. Bombardier
Keyword(s):  
Rheumatoid Arthritis ◽  
Propensity Score ◽  
Best Practice ◽  
Practice Research ◽  
Research Support ◽  
Real World Data ◽  
Kaplan Meier ◽  
Rheumatoid Arthritis Cohort ◽  
Research Initiative ◽  
Significant Difference

Background:Tofacitinib (TOFA) is an oral, small molecule drug used for rheumatoid arthritis (RA) treatment and is prescribed alone or with methotrexate (MTX). Tofa can be used as an alternative to biologic disease modifying antirheumatic drugs (bDMARDs) including tumor necrosis factor inhibitors (TNFi).Objectives:We aimed to evaluate the discontinuation rate of this drug, with and without concurrent MTX in comparison with TNFi, in patients with RA in the Ontario Best Practices Research Initiative (OBRI).Methods:RA patients enrolled in the OBRI initiating their TOFA or TNFi (adalimumab, certolizumab, etancercept, golimumab, and infliximab) within 30 days prior to or any time after enrolment between 1stJune 2014 (TOFA approval date in Canada) and 31stDec 2018 were included. Time to discontinuation (due to any reason) were assessed using Kaplan-Meier survival (adjusted for propensity score using inverse probability of treatment weight) to compare patients with and without MTX use at initiation of TOFA or TNFi.Results:A total of 565 patients initiated TOFA (n=208) or TNFi (n=357). Of those, 106 (51%) and 222 (62%) were treated with MTX in the TOFA and TNFi group, respectively and mean (SD) disease duration were 13.1 (9.4) and 9.5 (9.4) years. In the TOFA group, 86% were female and mean (SD) age at treatment initation was 60.4 (10.6) years. In the TNFi group 82% were female and mean age (SD) at treatment initation was 57.0 (12.6) years. The TOFA group was more likely to have prior biologic use (61.5%) compared with the TNFi group (31%). At treatment initiation, the mean (SD) clinical disease activcity index was 24.8 (12.1) in the TOFA group and 21.8 (12.0) in the TNFi group.Over a mean of 17.3 month follow-up, discontinuation was reported in 75 (36%) and 103 (29%) of all TOFA and TNFi patients, respectively. After adjusting for propensity score, patients treated with TNFi and MTX remained on treatment longer than those treated without MTX (Logrank p=0.002) while there was no significant difference in TOFA discontinuation in patients with and without MTX (Logrank p=0.31).Conclusion:In this real world data study, we found that TOFA retention is similar in patients with and without MTX, while patients treated with TNFi and MTX remained on treatment longer than those treated without MTX. Merging data with other RA registries in Canada is proposed to increase study power and to provide more robust results.Disclosure of Interests:Mohammad Movahedi Consultant of: Allergan, Angela Cesta: None declared, Xiuying Li: None declared, Edward Keystone Grant/research support from: AbbVie; Amgen; Gilead Sciences, Inc; Lilly Pharmaceuticals; Merck; Pfizer Pharmaceuticals; PuraPharm; Sanofi, Consultant of: AbbVie; Amgen; AstraZeneca Pharma; Bristol-Myers Squibb Company; Celltrion; F. Hoffman-La Roche Ltd.; Genentech, Inc; Gilead Sciences, Inc.; Janssen, Inc; Lilly Pharmaceuticals; Merck; Myriad Autoimmune; Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis., Speakers bureau: AbbVie; Amgen; Bristol-Myers Squibb; Celltrion; F. Hoffman-La Roche Ltd, Janssen, Inc; Merck; Pfizer Pharmaceuticals; Sanofi-Genzyme; UCB, Claire Bombardier Grant/research support from: Dr Bombardier reports sources of funding for Ontario Best Practice Research Initiative Research grants from Abbvie, Janssen, Amgen, Medexus, Merck, Pfizer, and Novartis outside of the submitted work. Consulting Agreements: Abbvie, Covance, Janssen, Merck, Pfizer, Sanofi and Novartis outside of the submitted work. Advisory Board Membership: Hospira, Sandoz, Merck, Pfizer and Novartis outside of the submitted work.

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

RADT-33. LONG-TERM OUTCOMES, TREATMENT UTILIZATION, AND PROGNOSTIC FACTORS FOR PEDIATRIC CHORDOMA: AN NCDB ANALYSIS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi48-vi48
Author(s):  
James Cantrell ◽  
Pawan Acharya ◽  
Sara Vesely ◽  
Michael Confer ◽  
Ozer Algan ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Radiation Dose ◽  
Proportional Hazards ◽  
Propensity Score Analysis ◽  
Descriptive Analysis ◽  
Patient Characteristics ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Total Resection ◽  
Kaplan Meier

Abstract BACKGROUND Chordomas are rare tumors arising from the embryonal notochord presenting at the base of skull, spine, or sacrum. Pediatric chordomas (PC) comprise less than 5% of all chordomas and are more likely to be atypical or dedifferentiated. Evidence for management is limited to single institution series with 5-year overall survival (OS) between 60-100%. METHODS Using the NCDB Participant User File, a retrospective observational cohort study was performed. The cohort was defined using the bone-soft-tissue, brain, and central nervous system databases selecting for cases with chordoma ICD-03 codes and age ≤ 25 years. Kaplan Meier method, log-rank test, and Cox proportional hazards regression were performed. RESULTS 297 patients from 2004-2017 met inclusion criteria for descriptive analysis with 269 cases included for survival analysis. Mean age was 16.9 years, with 10% less than age 5. The cohort was 55% female, 8% Black, and 79% White. Primary sites included bones of the skull (70%), spine (22%), and pelvis (6%). Regarding treatment, 7% had no resection, 49% sub-total resection (STR), 33% gross-total resection (GTR), and 11% unspecified resection. 51% received radiation therapy with 46% of those receiving proton therapy. 7% received chemotherapy. The 1, 3, 5, and 10-year OS was 95%, 86%, 77%, and 72%. Selected prognostic factors from univariable OS model for OS analysis included: age &gt; 5 (HR 0.30 (95% CI 0.16-0.57) p = 0.0002), surgical resection [GTR (HR 0.28 (95% CI 0.12-0.63) p = 0.0023) and STR (HR 0.27 (95% CI 0.12-0.59) p = 0.0011)], and radiation dose ≥ 7200cGy (HR 0.40 (95% CI 0.16-0.99) p = 0.047). CONCLUSION In the largest cohort reported for PC, 3 and 10-year OS was 86% and 72%. Age, surgery, and radiation dose are important prognostic factors. Propensity score analysis to gauge effect of treatment, tumor, and patient characteristics on OS is forthcoming.

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