Risk of active tuberculosis among COPD patients treated with fixed combinations of long-acting beta2 agonists and inhaled corticosteroids

Abstract Objectives To investigate the incidence of active tuberculosis (TB) among COPD patients using fluticasone/salmeterol or budesonide/formoterol, and to identify any differences between these two groups of patients. Methods The study enrolled COPD patients from Taiwan NHIRD who received treatment with fluticasone/salmeterol or budesonide/formoterol for > 90 days between 2004 and 2011. The incidence of active TB was the primary outcome. Results Among the intention-to-treat population prior to matching, the incidence rates of active TB were 0.94 and 0.61% in the fluticasone/salmeterol and budesonide/formoterol groups, respectively. After matching, the fluticasone/salmeterol group had significantly higher rates of active TB (adjusted HR, 1.41, 95% CI, 1.17–1.70) compared with the budesonide/formoterol group. The significant difference between these two groups remained after a competing risk analysis (HR, 1.45, 95% CI, 1.21–1.74). Following propensity score matching, the fluticasone/salmeterol group had significantly higher rates of active TB compared with the budesonide/formoterol group (adjusted HR, 1.45, 95% CI, 1.14–1.85). A similar trend was observed after a competing risk analysis (HR, 1.44, 95% CI, 1.19–1.75). A higher risk of active TB was observed in the fluticasone/salmeterol group compared with the budesonide/formoterol group across all subgroups, but some differences did not reach statistical significance. Conclusion Fluticasone/salmeterol carried a higher risk of active TB compared with budesonide/formoterol among COPD patients.

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The effect of trajectory of serum uric acid on patients and renal outcomes in patients with stage-3 chronic kidney disease

10.21203/rs.2.15346/v2 ◽

2020 ◽

Author(s):

Shangfeng Tsai(Former Corresponding Author) ◽

Cheng-Hsu Chen ◽

Ming-Ju Wu ◽

Chia-Lin Lee(New Corresponding Author)

Keyword(s):

Chronic Kidney Disease ◽

Uric Acid ◽

Kidney Disease ◽

Risk Analysis ◽

Statistical Significance ◽

Competing Risk ◽

Competing Risk Analysis ◽

Coronary Arterial Disease ◽

Bonferroni Adjustment

Abstract Background Uric acid (UA) is associated with renal and patient survivals but the causal association in nature remains unclear. Also, no finding is yet available regarding longitudinal UA control (trajectory). Methods We enrolled 808 subjects diagnosed with stage 3 chronic kidney disease from 2007 to 2017. We plotted the mean UA over a period of 6 months with a minimum of three samples of UA was required. From the sampled points, we generated for each patient an interpolated line by joining mean values of the UA levels over time. And from the lines from all patients, we classified them into three groups of trajectories (low, medium and high) through group-based trajectory modeling, and then we further separated into either a treatment or no-treatment subgroups. Due to multiple comparisons, we performed post hoc analysis by Bonferroni adjustment. Using the univariate competing-risks regression, we calculated the competing risk analysis with subdistribution hazard ratio of possible confounders. Results All of the 6 trajectories appeared as gradually falling functions with time without any of the curves crossed over one another. For all-cause mortality risk, none of the variables (including age, gender, coronary arterial disease, cerebrovascular disease, diabetes mellitus, renin-angiotensin-aldosterone system inhibitors, trajectories of UA, and treatment of UA) was statistically significant. All 6 trajectories appeared as steady curve without crossovers among them over the entire period of follow-up. Patients with DM were statistically more likely to undergo dialysis. There was only a trend that the on-treatment trajectories, compared to their no-treatment trajectories, had lower risks for dialysis. There was no effect of UA control on patients’ survival. Conclusions Initial treatment of UA is utterly important for UA control. However, the long-term effects on patients and renal survivals maybe minor without statistical significance. Keyword: uric acid, patient survival, renal survival, long-term effect, trajectory, competing risk analysis

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The acquisition of Multi-drug resistant bacteria in patients admitted to COVID-19 intensive care units: a monocentric retrospective case control study

10.21203/rs.3.rs-67837/v1 ◽

2020 ◽

Author(s):

Elisa Gouvêa Bogossian ◽

Fabio Silvio Taccone ◽

Antonio Izzi ◽

Nicolas Yin ◽

Alessandra Garufi ◽

...

Keyword(s):

Intensive Care ◽

Risk Analysis ◽

Case Control Study ◽

Statistical Significance ◽

Case Control ◽

Competing Risk ◽

Resistant Bacteria ◽

Competing Risk Analysis ◽

Icu Stay ◽

Control Study

Abstract Background: Whether the risk of multidrug resistant bacteria (MDRB) acquisition in the intensive care unit (ICU) is increased during the COVID-19 crisis is unknown. Our aim was to measure the rate of MDRB acquisition in patients admitted in COVID-19 ICU and to compare it with pre-COVID-19 controls.Methods: This single center case control study included adult patients admitted to COVID-19 ICUs for more than 48h. Patients were screen twice a week for MDRB carriage during ICU stay. We compared the rate of MDRB acquisition of COVID-19 patients with a cohort of patients admitted for subarachnoid hemorrhage (SAH) and matched on length of ICU stay using a competing risk analysis.Results: Among 72 patients admitted to the COVID-19 ICUs, 24 (33%) patients acquired 31 MDRB during ICU stay. The rate of MDRB acquisition was 30/1000 patient-days. Patients that acquired MDRB had received more antimicrobial therapy [22 (92%) vs 34 (78%, p=0.05] and had a longer exposure time [12 days (8-18) vs 5 days (2-18), p=0.02]. The rate of MDRB acquisition in matched SAH patients was 18/1000 patient-days. When compared to SAH retrospective cohort, being admitted to a COVID-19 ICU was associated with a numerically higher proportion of MDRB acquisition. This association did not reach statistical significance in the multivariable competing risk analysis (sHR 1.71 (CI 95% 0.93-3.21).Conclusion: Acquisition of MDRB was frequent during the COVID-19 first wave in ICU patients. Despite physical isolation, it was similar to patients admitted to the same ICU in previous years.

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Identification of an Upper Limit of Tumor Burden for Downstaging in Candidates with Hepatocellular Cancer Waiting for Liver Transplantation: A West–East Collaborative Effort

Cancers ◽

10.3390/cancers12020452 ◽

2020 ◽

Vol 12 (2) ◽

pp. 452 ◽

Cited By ~ 4

Author(s):

Quirino Lai ◽

Alessandro Vitale ◽

Karim Halazun ◽

Samuele Iesari ◽

André Viveiros ◽

...

Keyword(s):

New York ◽

Liver Transplantation ◽

Risk Analysis ◽

External Validation ◽

Hepatocellular Cancer ◽

Tumor Burden ◽

Competing Risk ◽

Competing Risk Analysis ◽

Intention To Treat ◽

Upper Limit

Since the introduction of Milan Criteria, all scoring models describing the prognosis of hepatocellular cancer (HCC) after liver transplantation (LT) have been exclusively based on characteristics available at surgery, therefore neglecting the intention-to-treat principles. This study aimed at developing an intention-to-treat model through a competing-risk analysis. Using data available at first referral, an upper limit of tumor burden for downstaging was identified beyond which successful LT becomes an unrealistic goal. Twelve centers in Europe, United States, and Asia (Brussels, Sapienza Rome, Padua, Columbia University New York, Innsbruck, Medanta-The Medicity Dehli, Hong Kong, Kyoto, Kaohsiung Taiwan, Mainz, Fukuoka, Shulan Hospital Hangzhou) created a Derivation (n = 2318) and a Validation Set (n = 773) of HCC patients listed for LT between January 2000–March 2017. In the Derivation Set, the competing-risk analysis identified two independent covariables predicting post-transplant HCC-related death: combined HCC number and diameter (SHR = 1.15; p < 0.001) and alpha-fetoprotein (AFP) (SHR = 1.80; p < 0.001). WE-DS Model showed good diagnostic performances at internal and external validation. The identified upper limit of tumor burden for downstaging was AFP ≤ 20 ng/mL and up-to-twelve as sum of HCC number and diameter; AFP = 21–200 and up-to-ten; AFP = 201–500 and up-to-seven; AFP = 501–1000 and up-to-five. The WE-DS Model proposed here, based on morphologic and biologic data obtained at first referral in a large international cohort of HCC patients listed for LT, allowed identifying an upper limit of tumor burden for downstaging beyond which successful LT, following downstaging, results in a futile transplantation.

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Bayesian competing risk analysis: An application to nasopharyngeal carcinoma patients data

Computational and Systems Oncology ◽

10.1002/cso2.1006 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Rakesh Kumar Saroj ◽

K. Narasimha Murthy ◽

Mukesh Kumar ◽

Atanu Bhattacharjee ◽

Kamalesh Kumar Patel

Keyword(s):

Nasopharyngeal Carcinoma ◽

Risk Analysis ◽

Competing Risk ◽

Competing Risk Analysis

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Self-employment duration during the COVID-19 pandemic: A competing risk analysis

Journal of Business Venturing Insights ◽

10.1016/j.jbvi.2021.e00241 ◽

2021 ◽

pp. e00241

Author(s):

Jasper Grashuis

Keyword(s):

Risk Analysis ◽

Competing Risk ◽

Competing Risk Analysis ◽

Self Employment ◽

Employment Duration

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Standard and competing risk analysis of the effect of albuminuria on cardiovascular and cancer mortality in patients with type 2 diabetes mellitus

Diagnostic and Prognostic Research ◽

10.1186/s41512-018-0035-4 ◽

2018 ◽

Vol 2 (1) ◽

Cited By ~ 7

Author(s):

Benjamin G. Feakins ◽

Emily C. McFadden ◽

Andrew J. Farmer ◽

Richard J. Stevens

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Risk Analysis ◽

Cancer Mortality ◽

Competing Risk ◽

Competing Risk Analysis

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A Scoring System For Predicting Hepatocellular Carcinoma Risk In Alcoholic Cirrhosis: A Competing Risk Analysis

10.21203/rs.3.rs-970975/v1 ◽

2021 ◽

Author(s):

Kyunghan Lee ◽

Gwang Hyeon Choi ◽

Eun Sun Jang ◽

Sook-Hyang Jeong ◽

Jin–Wook Kim

Keyword(s):

Hepatocellular Carcinoma ◽

Risk Analysis ◽

Viral Hepatitis ◽

Validation Cohort ◽

Alcoholic Cirrhosis ◽

Competing Risk ◽

Competing Risk Analysis ◽

Hazards Model ◽

B Virus

Abstract Background & Aims: The role of hepatocellular carcinoma (HCC) surveillance is being questioned in alcoholic cirrhosis because of the relative low HCC risk. Comorbid viral hepatitis may synergistically increase the HCC risk in alcoholic cirrhosis. This study aimed to assess the risk and predictors of HCC in patients with alcoholic cirrhosis by using competing risk analysis in an area with intermediate prevalence for hepatitis B virus.Methods: A total of 965 patients with alcoholic cirrhosis were recruited at a university-affiliated hospital in Korea and randomly assigned to either the derivation (n=643) and validation (n=322) cohort. Subdistribution hazards model of Fine and Gray was used with deaths and liver transplantation treated as competing risks. Death records were confirmed from Korean government databases. A nomogram was developed to calculate the Alcohol-associated Liver Cancer Estimation (ALICE) score.Results: Markers for viral hepatitis were positive in 21.0 % and 25.8 % of patients in derivation and validation cohort, respectively. The cumulative incidence of HCC was 13.5 and 14.9 % at 10 years for derivation and validation cohort, respectively. Age, positivity for viral hepatitis markers, alpha-fetoprotein level, and platelet count were identified as independent predictors of HCC and incorporated in the ALICE score, which discriminated low, intermediate, and high risk for HCC in alcoholic cirrhosis at the cut-off of 120 and 180. Conclusions: HCC risk can be stratified by using clinical parameters including viral markers in alcoholic cirrhosis in an area where the prevalence of viral hepatitis is substantial.

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