scholarly journals Improved survival with continuation of statins in bacteremic patients

2018 ◽  
Vol 6 ◽  
pp. 205031211880170
Author(s):  
Ajinkya M Pawar ◽  
Kerry L LaPlante ◽  
Tristan T Timbrook ◽  
Aisling R Caffrey
Keyword(s):  
Statin Therapy ◽  
Proportional Hazards ◽  
Primary Diagnosis ◽  
Cox Proportional Hazards ◽  
Inpatient Mortality ◽  
Hospital Data ◽  
Continuous Therapy ◽  
Proportional Hazards Regression ◽  
The Impact ◽  
Statin Use

Objectives: Varying statin exposures in bacteremic patients have different impacts on mortality. Among patients with adherent statin use, we sought to evaluate the impact of statin continuation on inpatient mortality in bacteremic patients. Methods: A retrospective cohort study was conducted using Optum ClinformaticsTM with matched Premier Hospital data (October 2009–March 2013). Patients with a primary diagnosis of bacteremia and 6 months of continuous enrollment prior to the admission, receiving antibiotics at least 2 days of antibiotics during the first 3 days of admission, were selected for inclusion. Furthermore, patients demonstrating adherent statin use based on 90 days of continuous therapy prior to admission were included. We then compared those continuing statin therapy for at least the first 5 days after admission and those not continuing during the admission. Results: Simvastatin (53.2%) and atorvastatin (33.8%) were the most commonly used statins among the 633 patients who met our inclusion and exclusion criteria. Propensity score adjusted Cox proportional hazards regression models demonstrated significantly lower inpatient mortality among those continuing statin therapy compared with those not continuing (n = 232 vs 401, adjusted hazard ratio 0.25, 95% confidence interval 0.08–0.79). Conclusion: Among patients adherent to their statin therapy prior to a bacteremia hospitalization, continued statin use after admission increased survival by 75% compared with those not continuing.

scholarly journals Effect on Survival of Longer Intervals Between Confirmed Diagnosis and Treatment Initiation Among Low-Income Women With Breast Cancer

2012 ◽  
Vol 30 (36) ◽  
pp. 4493-4500 ◽  
Author(s):  
John M. McLaughlin ◽  
Roger T. Anderson ◽  
Amy K. Ferketich ◽  
Eric E. Seiber ◽  
Rajesh Balkrishnan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
North Carolina ◽  
Low Income ◽  
Late Stage ◽  
Proportional Hazards ◽  
Treatment Initiation ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
The Impact

Purpose To determine the impact of longer periods between biopsy-confirmed breast cancer diagnosis and the initiation of treatment (Dx2Tx) on survival. Patients and Methods This study was a noninterventional, retrospective analysis of adult female North Carolina Medicaid enrollees diagnosed with breast cancer from January 1, 2000, through December, 31, 2002, in the linked North Carolina Central Cancer Registry–Medicaid Claims database. Follow-up data were available through July 31, 2006. Cox proportional hazards regression models were constructed to evaluate the impact on survival of delaying treatment ≥ 60 days after a confirmed diagnosis of breast cancer. Results The study cohort consisted of 1,786 low-income, adult women with a mean age of 61.6 years. A large proportion of the patients (44.3%) were racial minorities. Median time from biopsy-confirmed diagnosis to treatment initiation was 22 days. Adjusted Cox proportional hazards regression showed that although Dx2Tx length did not affect survival among those diagnosed at early stage, among late-stage patients, intervals between diagnosis and first treatment ≥ 60 days were associated with significantly worse overall survival (hazard ratio [HR], 1.66; 95% CI, 1.00 to 2.77; P = .05) and breast cancer–specific survival (HR, 1.85; 95% CI, 1.04 to 3.27; P = .04). Conclusion One in 10 women waited ≥ 60 days to initiate treatment after a diagnosis of breast cancer. Waiting ≥ 60 days to initiate treatment was associated with a significant 66% and 85% increased risk of overall and breast cancer–related death, respectively, among late-stage patients. Interventions designed to increase the timeliness of receiving breast cancer treatments should target late-stage patients, and clinicians should strive to promptly triage and initiate treatment for patients diagnosed at late stage.

scholarly journals Risk factors for dementia onset in older adults with metastatic renal cell carcinoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 701-702
Author(s):  
Samuel Miller ◽  
Lauren Wilson ◽  
Melissa Greiner ◽  
Jessica Pritchard ◽  
Tian Zhang ◽  
...  
Keyword(s):  
Older Adults ◽  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
The Impact

Abstract Renal dysfunction is a driver of dementia. It is also associated with renal cell carcinoma, possibly the result of the tumor itself or from cancer treatment. This study evaluates metastatic renal cell carcinoma (mRCC) as a risk factor for developing mild cognitive impairment or dementia (MCI/D) as well as the impact of RCC-directed therapies on the development of MCI/D. We identified all patients diagnosed with mRCC in SEER-Medicare from 2007-2015. The main outcome was incident MCI/D within one year of mRCC diagnosis or cohort entry. Exclusion criteria included age <65 at mRCC diagnosis and diagnosis of MCI/D within preceding year of mRCC diagnosis. Patients with mRCC (n=2,533) were matched to non-cancer controls (n=7,027) on age, sex, race, comorbidities and year. Cox proportional hazards regression showed that having mRCC (HR 8.52, 95% MCI/D 6.49-11.18, p<0.001) and being older (HR 1.05 for 1-year age increase, 95% MCI/D 1.03-1.07, p<0.001) were predictive of developing MCI/D. A second Cox proportional hazards regression of only patients with mRCC revealed that neither those initiating treatment with oral anticancer agents (OAAs) nor those who underwent nephrectomy were more likely to develop MCI/D. Black patients had a higher risk of dementia compared to white patients (HR 1.92, 95% MCI/D 1.02-3.59, p=0.047). In conclusion, patients with mRCC were more likely to develop MCI/D than those without mRCC. The medical and surgical therapies evaluated were not associated with increased incidence of MCI/D. The increased incidence of MCI/D in older adults with mRCC may be the result of the pathology itself.

SimTube: A National Simulation Training and Research Project

2020 ◽  
Vol 163 (3) ◽  
pp. 522-530
Author(s):  
Gregory J. Wiet ◽  
Ellen S. Deutsch ◽  
Sonya Malekzadeh ◽  
Amanda J. Onwuka ◽  
Nathan W. Callender ◽  
...  
Keyword(s):  
Simulation Training ◽  
Proportional Hazards ◽  
Intervention Group ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Regression ◽  
P 16 ◽  
Training And Research ◽  
Live Surgery ◽  
And Control ◽  
The Impact

Objective To test the feasibility and impact of a simulation training program for myringotomy and tube (M&T) placement. Study Design Prospective randomized controlled. Setting Multi-institutional. Subjects and Methods An M&T simulator was used to assess the impact of simulation training vs no simulation training on the rate of achieving competency. Novice trainees were assessed using posttest simulator Objective Structured Assessment of Technical Skills (OSATS) scores, OSATS score for initial intraoperative tube insertion, and number of procedures to obtain competency. The effect of simulation training was analyzed using χ2 tests, Wilcoxon-Mann-Whitney tests, and Cox proportional hazards regression. Results A total of 101 residents and 105 raters from 65 institutions were enrolled; however, just 63 residents had sufficient data to be analyzed due to substantial breaches in protocol. There was no difference in simulator pretest scores between intervention and control groups; however, the intervention group had better OSATS global scores on the simulator (17.4 vs 13.7, P = .0003) and OSATS task scores on the simulator (4.5 vs 3.6, P = .02). No difference in OSATS scores was observed during initial live surgery rating ( P = .73 and P = .41). OSATS scores were predictive of the rate at which residents achieved competence in performing myringotomy; however, the intervention was not associated with subsequent OSATS scores during live surgeries ( P = .44 and P = .91) or the rate of achieving competence ( P = .16). Conclusions A multi-institutional simulation study is feasible. Novices trained using the M&T simulator achieved higher scores on simulator but not initial intraoperative OSATS, and they did not reach competency sooner than those not trained on the simulator.

scholarly journals 558 PREVALENCE AND IMPACT OF FRAILTY IN PATIENTS HOSPITALISED WITH COVID-19. THE SALFORD EXPERIENCE IN WAVES 1 AND 2

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
A Khan ◽  
F R Espinoza ◽  
T Kneen ◽  
A Dafnis ◽  
H Allafi ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Proportional Hazards ◽  
Hospital Admissions ◽  
Cox Proportional Hazards ◽  
Vulnerable Group ◽  
Clinical Frailty Scale ◽  
Patient Demographics ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
The Impact

Abstract Introduction The COVID-19 pandemic has had an extensive impact on the frail older population, with significant rates of COVID-related hospital admissions and deaths amongst this vulnerable group. There is little evidence of frailty prevalence amongst patients hospitalised with COVID-19, nor the impact of frailty on their survival. Methods Prospective observational study of all consecutive patients admitted to Salford Royal NHS Foundation (SRFT) Trust between 27th February and 28th April 2020 (wave 1), and 1st October to 10th November 2020 (wave 2) with a diagnosis of COVID-19. The primary endpoint was in-hospital mortality. Patient demographics, co-morbidities, admission level disease severity (estimated with CRP) and frailty (using the Clinical Frailty Scale, score 1–3 = not frail, score 4–9 = frail) were collected. A Cox proportional hazards regression model was used to assess the time to mortality. Results A total of 693 (N = 429, wave 1; N = 264, wave 2) patients were included, 279 (N = 180, 42%, wave 1; N = 104, 38%, wave 2) were female, and the median age was 72 in wave 1 and 73 in wave 2. 318 (N = 212, 49%, wave 1; N = 106, 39%, wave 2) patients presenting were frail. There was a reduction in mortality in wave 2, adjusted Hazard ratio (aHR) = 0.60 (95%CI 0.44–0.81; p = 0.001). There was an association between frailty and mortality aHR = 1.57 (95%CI 1.09–2.26; p = 0.015). Conclusion Frailty is highly prevalent amongst patients of all ages admitted to SRFT with COVID-19. Higher scores of frailty are associated with increased mortality.

scholarly journals Statins Are Associated With Reduced Mortality in Multiple Myeloma

2016 ◽  
Vol 34 (33) ◽  
pp. 4008-4014 ◽  
Author(s):  
Kristen Marie Sanfilippo ◽  
Jesse Keller ◽  
Brian F. Gage ◽  
Suhong Luo ◽  
Tzu-Fei Wang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Statin Therapy ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Sensitivity Analyses ◽  
Reductase Inhibitors ◽  
Specific Mortality ◽  
Statin Use

Purpose The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) have activity in one of the pathways influenced by nitrogen-containing bisphosphonates, which are associated with improved survival in multiple myeloma (MM). To understand the benefit of statins in MM, we evaluated the association between statin use and mortality in a large cohort of patients with MM. Patients and Methods From the Veterans Administration Central Cancer Registry, we identified patients diagnosed with MM between 1999 and 2013. We defined statin use as the presence of any prescription for a statin within 3 months before or any time after MM diagnosis. Cox proportional hazards regression assessed the association of statin use with mortality, while controlling for known MM prognostic factors. Results We identified a cohort of 4,957 patients, of whom 2,294 received statin therapy. Statin use was associated with a 21% decrease in all-cause mortality (adjusted hazard ratio, 0.79; 95% CI, 0.73 to 0.86; P < .001) as well as a 24% decrease in MM-specific mortality (adjusted hazard ratio, 0.76; 95% CI, 0.67 to 0.86; P < .001). This association remained significant across all sensitivity analyses. In addition to reductions in mortality, statin use was associated with a 31% decreased risk of developing a skeletal-related event. Conclusion In this cohort study of US veterans with MM, statin therapy was associated with a reduced risk of both all-cause and MM-specific mortality. Our findings suggest a potential role for statin therapy in patients with MM. The putative benefit of statin therapy in MM should be corroborated in prospective studies.

scholarly journals Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species

Antibiotics ◽  
2020 ◽  
Vol 9 (5) ◽  
pp. 254 ◽  
Author(s):  
Caroline Derrick ◽  
P. Brandon Bookstaver ◽  
Zhiqiang K. Lu ◽  
Christopher M. Bland ◽  
S. Travis King ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Bloodstream Infections ◽  
Cox Proportional Hazards ◽  
Third Generation ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Definitive Therapy ◽  
The Impact

Objectives: There is debate on whether the use of third-generation cephalosporins (3GC) increases the risk of clinical failure in bloodstream infections (BSIs) caused by chromosomally-mediated AmpC-producing Enterobacterales (CAE). This study evaluates the impact of definitive 3GC therapy versus other antibiotics on clinical outcomes in BSIs due to Enterobacter, Serratia, or Citrobacter species. Methods: This multicenter, retrospective cohort study evaluated adult hospitalized patients with BSIs secondary to Enterobacter, Serratia, or Citrobacter species from 1 January 2006 to 1 September 2014. Definitive 3GC therapy was compared to definitive therapy with other non-3GC antibiotics. Multivariable Cox proportional hazards regression evaluated the impact of definitive 3GC on overall treatment failure (OTF) as a composite of in-hospital mortality, 30-day hospital readmission, or 90-day reinfection. Results: A total of 381 patients from 18 institutions in the southeastern United States were enrolled. Common sources of BSIs were the urinary tract and central venous catheters (78 (20.5%) patients each). Definitive 3GC therapy was utilized in 65 (17.1%) patients. OTF occurred in 22/65 patients (33.9%) in the definitive 3GC group vs. 94/316 (29.8%) in the non-3GC group (p = 0.51). Individual components of OTF were comparable between groups. Risk of OTF was comparable with definitive 3GC therapy vs. definitive non-3GC therapy (aHR 0.93, 95% CI 0.51–1.72) in multivariable Cox proportional hazards regression analysis. Conclusions: These outcomes suggest definitive 3GC therapy does not significantly alter the risk of poor clinical outcomes in the treatment of BSIs secondary to Enterobacter, Serratia, or Citrobacter species compared to other antimicrobial agents.

Influence of pre-diagnosis statin use on survival among patients with pancreatic cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 427-427 ◽  
Author(s):  
Brian Z Huang ◽  
Jonathan I Chang ◽  
Bechien U Wu
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Ductal Adenocarcinoma ◽  
Risk Of Death ◽  
Cholesterol Control ◽  
The Individual ◽  
The Impact ◽  
Statin Use

427 Background: Recent studies have suggested associations between statin use and enhanced survival among patients with pancreatic ductal adenocarcinoma (PDAC). We aimed to explore the impact of pre-diagnosis statin treatment on survival across different agents and exposure levels. Methods: We conducted a retrospective cohort study on 2,142 pancreatic cancer patients diagnosed from 2006-2014 in an integrated healthcare system. Patients were identified from an internal cancer registry and followed until censored at death, date of last contact, or end of study. We used electronic pharmacy records to abstract information on the type, length and dosage of all statin exposures in the year prior to diagnosis. The overall influence of statins as well as the individual effects of simvastatin, lovastatin, atorvastatin, pravastatin and rosuvastatin were assessed using Cox proportional hazards regression. All analyses were adjusted for age, race, stage, receipt of surgery, receipt of chemotherapy and Charlson comorbidity index. We further adjusted for cholesterol control to determine whether statins acted through a lipid-mediated pathway. Results: Overall statin use was associated with a 13% decrease in the risk of mortality (HR 0.87, CI 0.79-0.97). Specifically, those who had used statins for 9-12 months (HR 0.85, CI 0.75-0.95), received higher doses (40+ mg/day) (HR 0.86, CI 0.76-0.98) or were active users at diagnosis (HR 0.86, CI 0.78-0.96) all had better survival compared to non-statin users. When assessing the individual statins, we found similar improvements in survival only among simvastatin users. Further stratified analyses revealed that simvastatin decreased the risk of death by 26% in stage IV patients (HR 0.74, CI 0.64-0.85), but had no effect for stage I-III patients (pinteraction= 0.03). Cholesterol control did not impact any of the associations between statin use and survival. Conclusions: We found that pre-diagnosis statin use, specifically simvastatin, was associated with improved survival in pancreatic cancer patients.

scholarly journals Optimal duration for continuation of statin therapy in bacteremic patients

2018 ◽  
Vol 5 (5) ◽  
pp. 83-90
Author(s):  
Ajinkya M. Pawar ◽  
Kerry L. LaPlante ◽  
Tristan T. Timbrook ◽  
Aisling R. Caffrey
Keyword(s):  
Statin Therapy ◽  
Disease Risk ◽  
Classification And Regression Tree ◽  
Risk Scores ◽  
Optimal Timing ◽  
Inpatient Mortality ◽  
Hospital Data ◽  
Cart Analysis ◽  
Optimal Duration ◽  
Statin Use

Background: Evidence suggests statins may improve survival in patients with bloodstream infections. However, there is no consensus on optimal timing and duration of exposure. Objectives: To quantify statin therapy duration associated with decreased mortality in bacteremic statin users. Methods: We conducted a case-control study using OptumClinformatics™ with matched Premier hospital data (1 October 2009–31 March 2013). Cases who died during the hospitalization were matched 1:1 to survivors on disease risk scores (DRSs). Post-admission statin therapy duration was evaluated in patients with at least 90 days of pre-admission continuous statin use. Classification and regression tree (CART) analysis was conducted to identify the optimal duration of statin continuation which provided the lowest inpatient mortality. Logistic regression was used to calculate the odds of mortality. Results: We included 58 DRS matched pairs of cases and controls: 47 patients (41%) continued statin therapy during the hospital admission, 15 (32%) cases and 32 (68%) controls. The CART analysis partitioned the continuation of statin therapy at ⩾2 days, representing lower mortality for patients who continued statins for 2 days or more and higher mortality for patients who did not continue or remained on statins for only 1 day. Inpatient mortality was 76% lower among those with at least 2 days of continued statin use (odds ratio 0.24, 95% confidence interval 0.11–0.55). Conclusion: Among matched cases and controls with at least 90 days of baseline statin use prior to the admission, the continuation of statins for at least 2 days after admission demonstrated a survival benefit among bacteremic patients.

scholarly journals A Quasi-Experiment To Study the Impact of Vancomycin Area under the Concentration-Time Curve-Guided Dosing on Vancomycin-Associated Nephrotoxicity

2017 ◽  
Vol 61 (12) ◽  
Author(s):  
Natalie A. Finch ◽  
Evan J. Zasowski ◽  
Kyle P. Murray ◽  
Ryan P. Mynatt ◽  
Jing J. Zhao ◽  
...  
Keyword(s):  
Trough Concentration ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Time Curve ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Concentration Time ◽  
Trough Concentrations ◽  
The Impact ◽  
Quasi Experiment

ABSTRACT Evidence suggests that maintenance of vancomycin trough concentrations at between 15 and 20 mg/liter, as currently recommended, is frequently unnecessary to achieve the daily area under the concentration-time curve (AUC24) target of ≥400 mg · h/liter. Many patients with trough concentrations in this range have AUC24 values in excess of the therapeutic threshold and within the exposure range associated with nephrotoxicity. On the basis of this, the Detroit Medical Center switched from trough concentration-guided dosing to AUC-guided dosing to minimize potentially unnecessary vancomycin exposure. The primary objective of this analysis was to assess the impact of this intervention on vancomycin-associated nephrotoxicity in a single-center, retrospective quasi-experiment of hospitalized adult patients receiving intravenous vancomycin from 2014 to 2015. The primary analysis compared the incidence of nephrotoxicity between patients monitored by assessment of the AUC24 and those monitored by assessment of the trough concentration. Multivariable logistic and Cox proportional hazards regression examined the independent association between the monitoring strategy and nephrotoxicity. Secondary analysis compared vancomycin exposures (total daily dose, AUC, and trough concentrations) between monitoring strategies. Overall, 1,280 patients were included in the analysis. After adjusting for severity of illness, comorbidity, duration of vancomycin therapy, and concomitant receipt of nephrotoxins, AUC-guided dosing was independently associated with lower nephrotoxicity by both logistic regression (odds ratio, 0.52; 95% confidence interval [CI], 0.34 to 0.80; P = 0.003) and Cox proportional hazards regression (hazard ratio, 0.53; 95% CI, 0.35 to 0.78; P = 0.002). AUC-guided dosing was associated with lower total daily vancomycin doses, AUC values, and trough concentrations. Vancomycin AUC-guided dosing was associated with reduced nephrotoxicity, which appeared to be a result of reduced vancomycin exposure.

scholarly journals Underweight increases the risk of early death in tuberculosis patients

2017 ◽  
Vol 118 (12) ◽  
pp. 1052-1060 ◽  
Author(s):  
Yung-Feng Yen ◽  
Fu-I Tung ◽  
Bo-Lung Ho ◽  
Yun-Ju Lai
Keyword(s):  
Proportional Hazards ◽  
Early Death ◽  
Cox Proportional Hazards ◽  
Tuberculosis Patients ◽  
Proportional Hazards Regression ◽  
Increased Risk ◽  
Specific Mortality ◽  
Joint Consideration ◽  
The Impact ◽  
Timing Of Death

AbstractEvidence regarding the association between BMI and mortality in tuberculosis (TB) patients is limited and inconsistent. We investigated the impact of BMI on TB-specific and non-TB-specific mortality with respect to different timing of death. All Taiwanese adults with TB in Taipei were included in a retrospective cohort study in 2012–2014. Multinomial Cox proportional hazards regression was used to evaluate the associations between BMI, cause-specific mortality and timing of death. Of 2410 eligible patients, 86·0 % (2061) were successfully treated, and TB-specific and non-TB-specific mortality occurred for 2·2 % (54) and 13·9 % (335), respectively. After controlling for potential confounders, underweight was significantly associated with a higher risk of all-cause mortality (adjusted hazard ratio (AHR) 1·57; 95 % CI 1·26, 1·95), whereas overweight was not. When cause-specific death was considered, underweight was associated with an increased risk of either TB-specific (AHR 1·85; 95 % CI 1·03, 3·33) or non-TB-specific death (AHR 1·52; 95 % CI 1·19, 1·95) during treatment. With joint consideration of cause-specific and timing of death, underweight only significantly increased the risk of TB-specific (AHR 2·23; 95 % CI 1·09, 4·59) and non-TB-specific mortality (AHR 1·81; 95 % CI 1·29, 2·55) within the first 8 weeks of treatment. This study suggests that underweight increases the risk of early death in TB patients during treatment.

Sign in / Sign up

Export Citation Format

Share Document