Efficacy of treatment with corticosteroids for fibrotic hypersensitivity pneumonitis: a propensity score-matched cohort analysis

Abstract Background Fibrotic hypersensitivity pneumonitis (HP) is a chronic interstitial lung disease caused by allergic responses to repeated exposures to a causative antigen. Therapeutic evidence of the use of corticosteroids to treat fibrotic HP remains lacking, although corticosteroids are recognized as a major treatment option. The purpose of this study was to evaluate the efficacy of corticosteroid treatment in patients with fibrotic HP in a propensity score-matched cohort. Methods A retrospective review of the medical records from 2005 to 2019 in a single center was conducted, and 144 patients with fibrotic HP were identified. Semiquantitative scores for lung abnormalities on HRCT were evaluated. Patients who received (PDN group) and did not receive (non-PDN group) corticosteroid treatment were matched using a propensity score method. Survival rates, serial changes in pulmonary function and annual changes in HRCT scores were compared in the matched cohort. Results In the matched analysis, 30 individuals in the PDN group were matched with 30 individuals in the non-PDN group, the majority of whom had ILD without extensive fibrosis. The survival rate was significantly better in the PDN group (P = 0.032 for the stratified Cox proportional hazards model; HR, 0.250). The absolute changes in FVC at 6, 12, and 24 months from baseline were significantly better in the PDN group. Fewer patients in the PDN group experienced annual deterioration, as reflected in the HRCT score, due to ground-glass attenuation, consolidation, reticulation, traction bronchiectasis and honeycombing. Conclusion We demonstrated that corticosteroids improved survival and slowed fibrotic progression in a matched cohort, the majority of whom had ILD without extensive fibrosis. Fibrotic HP with less severe fibrosis may benefit from corticosteroid treatment. We propose that the early initiation of corticosteroids should be considered for fibrotic HP when worsening fibrosis is observed.

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The Efficacy of Corticosteroid Therapy in Fibrotic Hypersensitivity Pneumonitis: A Propensity Score-matched Cohort Analysis

10.21203/rs.3.rs-99702/v1 ◽

2020 ◽

Author(s):

Masaru Ejima ◽

Tsukasa Okamoto ◽

Takafumi Suzuki ◽

Tatsuhiko Anzai ◽

Kunihiko Takahashi ◽

...

Keyword(s):

Survival Rate ◽

Propensity Score ◽

Pulmonary Function ◽

Hypersensitivity Pneumonitis ◽

Proportional Hazards Model ◽

Cohort Analysis ◽

Corticosteroid Treatment ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Propensity Score Method

Abstract Background: Fibrotic hypersensitivity pneumonitis (HP) is a chronic interstitial lung disease caused by allergic responses to repeated exposures to a causative antigen. Therapeutic evidence of corticosteroid for fibrotic HP remains lacking, although corticosteroid is recognized as a major treatment option. The purpose of this study was to evaluate the efficacy of corticosteroid for patients with fibrotic HP in a propensity score-matched cohort.Methods: Retrospective medical record review from 2005 to 2019 in a single center was conducted to identify 144 patients with fibrotic HP. Semiquantitative scores of lung abnormalities on HRCT were evaluated. Patients with corticosteroid treatment (PDN group) and without the treatment (non-PDN group) were matched using a propensity score method. Survival rates and serial changes in pulmonary function, and annual changes in HRCT scores werecompared between pair-matched patients. Results: In the matched analysis, 30 of the PDN group were matched with 30 of the non-PDN group, the majority of which comprised ILD without extensive fibrosis. The survival rate was significantly better in the PDN group (P = 0.032for the stratified Cox proportional hazards model; HR, 0.250). Absolute changes in %FVC at 6, 12, and 24 months from baseline were significantly better in the PDN group. Fewer cases experienced annual deterioration in HRCT scores in the non-PDN group for ground-glass attenuation, consolidation, reticulation, traction bronchiectasis and honeycombing. Conclusions: Fibrotic HP without extensive fibrosis may receive benefits from corticosteroid treatment in terms of improvements in survival rate and pulmonary function decline and inhibition of fibrotic progression. We propose that early initiation of corticosteroid be considered for fibrotic HP when worsening fibrosis is observed.

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Corticosteroid Use Following the Onset of Invasive Aspergillosis is Associated with Increased Mortality: A Propensity Score-Matched Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.125 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S55-S55

Author(s):

Michael Abers ◽

Jatin Vyas

Keyword(s):

Propensity Score ◽

Invasive Aspergillosis ◽

Nearest Neighbor ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Corticosteroid Dose ◽

Group Assignment ◽

Daily Prednisone

Abstract Background The safety of corticosteroid use (CSU) during active infection is controversial. In the invasive aspergillosis (IA) literature, CSU is typically defined using the time period prior to IA onset. Clinicians caring for patients with IA are unable to control prior CSU. The more clinically relevant question is whether CSU after IA onset is harmful. Methods Patients hospitalized at our institution from 2004 to 2014 with IA were retrospectively identified. CSU, defined as the average daily prednisone equivalent dose during the 7-day period following IA onset, was calculated for each patient. A CSU cut-off of 7.5mg was used to assign patients to treatment (>7.5mg) or control (<7.5mg, including no CSU) groups. A propensity score (PS) was generated to predict group assignment. Nearest neighbor matching was performed with a caliper width of 0.2. A Cox proportional hazards model was used to assess survival 6 weeks after IA onset. Results PS matching generated 61 matched pairs (122 patients). Baseline characteristics did not differ significantly between groups (Table). CSU was associated with increased mortality (PS adjusted hazard ratio [HR] 2.91, 95% CI 1.32–6.40). In the CSU group, a trend towards lower mortality was noted if corticosteroid dose was tapered to 7.5mg/day (HR 0.68, 95% CI 0.46–1.02). Conclusion CSU after IA onset is associated with increased mortality. In IA patients with CSU, efforts to reduce corticosteroid dose may be beneficial. Disclosures All authors: No reported disclosures.

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Corticosteroid therapy in critically ill patients with COVID-19: a multicenter, retrospective study

Critical Care ◽

10.1186/s13054-020-03429-w ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Yiming Li ◽

Qinghe Meng ◽

Xin Rao ◽

Binbin Wang ◽

Xingguo Zhang ◽

...

Keyword(s):

Logistic Regression ◽

Critically Ill ◽

Critically Ill Patients ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Corticosteroid Treatment ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Initiation Time ◽

Icu Admission

Abstract Background Corticoid therapy has been recommended in the treatment of critically ill patients with COVID-19, yet its efficacy is currently still under evaluation. We investigated the effect of corticosteroid treatment on 90-day mortality and SARS-CoV-2 RNA clearance in severe patients with COVID-19. Methods 294 critically ill patients with COVID-19 were recruited between December 30, 2019 and February 19, 2020. Logistic regression, Cox proportional-hazards model and marginal structural modeling (MSM) were applied to evaluate the associations between corticosteroid use and corresponding outcome variables. Results Out of the 294 critically ill patients affected by COVID-19, 183 (62.2%) received corticosteroids, with methylprednisolone as the most frequently administered corticosteroid (175 accounting for 96%). Of those treated with corticosteroids, 69.4% received corticosteroid prior to ICU admission. When adjustments and subgroup analysis were not performed, no significant associations between corticosteroids use and 90-day mortality or SARS-CoV-2 RNA clearance were found. However, when stratified analysis based on corticosteroid initiation time was performed, there was a significant correlation between corticosteroid use (≤ 3 day after ICU admission) and 90-day mortality (logistic regression adjusted for baseline: OR 4.49, 95% CI 1.17–17.25, p = 0.025; Cox adjusted for baseline and time varying variables: HR 3.89, 95% CI 1.94–7.82, p < 0.001; MSM adjusted for baseline and time-dependent variants: OR 2.32, 95% CI 1.16–4.65, p = 0.017). No association was found between corticosteroid use and SARS-CoV-2 RNA clearance even after stratification by initiation time of corticosteroids and adjustments for confounding factors (corticosteroids use ≤ 3 days initiation vs no corticosteroids use) using MSM were performed. Conclusions Early initiation of corticosteroid use (≤ 3 days after ICU admission) was associated with an increased 90-day mortality. Early use of methylprednisolone in the ICU is therefore not recommended in patients with severe COVID-19.

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Association between Sleep Duration and Incident Chronic Kidney Disease: A Population-Based Cohort Analysis of the NAGALA Study

Kidney & Blood Pressure Research ◽

10.1159/000504545 ◽

2020 ◽

Vol 45 (2) ◽

pp. 339-349

Author(s):

Hanako Nakajima ◽

Yoshitaka Hashimoto ◽

Takuro Okamura ◽

Akihiro Obora ◽

Takao Kojima ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Sleep Duration ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cohort Analysis ◽

Population Based ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Incident Chronic Kidney Disease

Background: The duration of sleep might be a risk factor for chronic kidney disease (CKD). We investigated the relationship between sleep duration and incident CKD. Methods: In this retrospective cohort study of 7,752 men and 6,722 women, we divided the subjects into 4 groups according to sleep duration, i.e., those whose reported regular sleep duration was <6 h (the “<6 h group”), those whose sleep duration was >6 but <7 h (the “6 to <7 h group”), those with a sleep duration of 7 to <8 h (the “7 to <8 h group”), and those with ≥8 h sleep (the “≥8 h group”). CKD was defined as the presence of proteinuria and/or an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. The HR of the 4 groups for incident CKD were calculated with a Cox proportional hazards model, with the 7 to <8 h group set as the reference. Results: Incident CKD was detected in 1,513 (19.5%) men and 688 (10.2%) women over the median follow-up period of 7.0 (3.3–11.9) years in the men and 6.7 (3.1–10.8) years in the women. There was no association between sleep duration and incident CKD in the women. In the men, the HR of incident CKD was 0.54 (95% CI 0.45–0.64, p < 0.001) in the <6 h group, 0.73 (95% CI 0.66–0.82, p < 0.001) in the 6 to <7 h group, and 0.93 (95% CI 0.78–1.11, p = 0.433) in the ≥8 h group. Conclusion: The risk of incident CKD is lowest in those who sleep <6 h. We revealed that the risk of incident CKD is lowest in those who sleep <6 h among apparently healthy men.

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Recurrent Vascular Access Dysfunction as a Novel Marker of Cardiovascular Outcome and Mortality in Hemodialysis Patients

American Journal of Nephrology ◽

10.1159/000448058 ◽

2016 ◽

Vol 44 (1) ◽

pp. 71-80 ◽

Cited By ~ 2

Author(s):

Hyo Jin Kim ◽

Hajeong Lee ◽

Dong Ki Kim ◽

Kook-Hwan Oh ◽

Yon Su Kim ◽

...

Keyword(s):

Risk Factor ◽

Propensity Score ◽

Vascular Access ◽

Independent Risk Factor ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

De Novo ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Patients Âgés

Background: Vascular access (VA) is essential for hemodialysis (HD) patients, and its dysfunction is a major complication. However, little is known about outcomes in patients with recurrent VA dysfunction. We explored the influence of recurrent VA dysfunction on cardiovascular (CV) events, death and VA abandonment. Methods: This is a single-center, retrospective study conducted in patients who underwent VA surgery between 2009 and 2014. VA dysfunction was defined as VA stenosis or thrombosis requiring intervention after the first successful cannulation. Patients with ≥2 interventions within 180 days were categorized as having recurrent VA dysfunction. Outcomes were analyzed using Cox proportional hazards model before and after propensity score matching. Results: Of 766 patients (ages 59.6 ± 14.3 years, 59.7% male), 10.1% were in the recurrent VA dysfunction group. Most baseline parameters after matching were similar between the recurrent and non-recurrent groups. A total of 213 propensity score-matched patients were followed for 28.7 ± 15.8 months, during which 46 (21.6%), 30 (14.1%) and 14 (6.6%) patients had de novo CV outcomes, died and abandoned VA, respectively. Recurrent VA dysfunction after adjustment remained an independent risk factor for CV events (adjusted hazards ratio (aHR), 2.71; 95% CI 1.48-4.98; p = 0.001). Moreover, recurrent VA dysfunction predicted composite all-cause mortality (ACM)/CV events (aHR 1.99; 95% CI 1.21-3.28; p = 0.007). Conclusions: Recurrent VA dysfunction was a novel independent risk factor for CV and composite ACM/CV events in HD patients, but not for VA abandonment. Patients with recurrent vascular dysfunction should be carefully monitored not only for VA patency but also for CV events.

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In utero exposure to the Great Chinese Famine and risk of intracerebral hemorrhage in midlife

Neurology ◽

10.1212/wnl.0000000000009407 ◽

2020 ◽

Vol 94 (19) ◽

pp. e1996-e2004

Author(s):

Yun Li ◽

Yanping Li ◽

M. Edip Gurol ◽

Yesong Liu ◽

Peng Yang ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cohort Analysis ◽

In Utero ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

In Utero Exposure ◽

Hazards Model ◽

Record Review

ObjectiveTo investigate whether in utero exposure to the Great Chinese Famine in 1959 to 1961 was associated with risk of intracerebral hemorrhage (ICH) in adulthood.MethodsIn this cohort analysis, we included 97,399 participants of the Kailuan Study who were free of cardiovascular disease and cancer at baseline (2006). Cases of incident ICH were confirmed by medical record review. We used the Cox proportional hazards model to calculate the hazard ratio (HR) and 95% confidence interval (CI) for ICH according to in utero famine exposure status.ResultsAmong 97,399 participants in the current analyses, 6.3% (n = 6,160) had been prenatally exposed to the Great Chinese Famine. During a median 9.0 years of follow-up (2006–2015), we identified 724 cases of incident ICH. After adjustment for potential confounders, the HR of ICH was 1.99 (95% CI 1.39–2.85) for in utero famine-exposed individuals vs individuals who were not exposed to the famine. When exposure to famine and severity of famine were examined jointly, the adjusted HR was 2.99 (95% CI 1.21–7.39) for in utero exposure to severe famine and 1.94 (95% CI 1.32–2.84) for in utero exposure to less severe famine relative to those without exposure to famine.ConclusionsIndividuals with in utero exposure to famine, especially those exposed to severe famine, were more likely to have ICH in midlife, highlighting the role of nutritional factors in susceptibility to this severe cerebral condition.

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Urban–Rural Disparities in the Incidence of Diabetes-Related Complications in Taiwan: A Propensity Score Matching Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9093012 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3012

Author(s):

Shu-Yu Tai ◽

Jiun-Shiuan He ◽

Chun-Tung Kuo ◽

Ichiro Kawachi

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Rural Areas ◽

Urban Areas ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Propensity Score Matching Analysis ◽

Urban Rural

Although a disparity has been noted in the prevalence and outcome of chronic disease between rural and urban areas, studies about diabetes-related complications are lacking. The purpose of this study was to examine the association between urbanization and occurrence of diabetes-related complications using Taiwan’s nationwide diabetic mellitus database. In total, 380,474 patients with newly diagnosed type 2 diabetes between 2000 and 2008 were included and followed up until 2013 or death; after propensity score matching, 31,310 pairs were included for analysis. Occurrences of seven diabetes-related complications of interest were identified. Cox proportional hazards model was used to determine the time-to-event hazard ratio (HR) among urban, suburban and rural groups. We found that the HRs of all cardiovascular events during the five-year follow-up was 1.04 times (95% confidence interval (CI) 1.00–1.07) and 1.15 times (95% CI 1.12–1.19) higher in suburban and rural areas than in urban areas. Patients in suburban and rural areas had a greater likelihood of congestive heart failure, stroke, and end-stage renal disease than those in urban areas. Moreover, patients in rural areas had a higher likelihood of ischemic heart disease, blindness, and ulcer than those in urban areas. Our empirical findings provide evidence for potential urban–rural disparities in diabetes-related complications in Taiwan.

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Effect of Leptin Therapy on Survival in Generalized and Partial Lipodystrophy: A Matched Cohort Analysis

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab216 ◽

2021 ◽

Author(s):

Keziah Cook ◽

Omer Ali ◽

Baris Akinci ◽

Maria Cristina Foss de Freitas ◽

Renan Magalhães Montenegro ◽

...

Keyword(s):

Mortality Risk ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cohort Analysis ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Sensitivity Analyses ◽

Naive Patient ◽

Partial Lipodystrophy ◽

The Impact

Abstract Context Data quantifying the impact of metreleptin therapy on survival in nonHIVrelated generalized lipodystrophy (GL) and partial lipodystrophy (PL) are unavailable. Objective This study aimed to estimate the treatment effect of metreleptin on survival in patients with GL and PL. Design/Setting/Patients Demographic and clinical characteristics were used to match metreleptin-treated and metreleptin-naïve patients with GL and PL. Differences in mortality risk were estimated between matched cohorts of metreleptin-treated and metreleptin-naïve patient cohorts using Cox proportional hazard models. Sensitivity analyses assessed the impact of study assumptions and robustness of results. Outcome Measures This study assessed time to mortality and risk of mortality. Results The analysis evaluated 103 metreleptin-naïve patients with characteristics matched to 103 metreleptin-treated patients at treatment initiation. Even after matching, some metabolic and organ abnormalities were more prevalent in the metreleptin-treated cohort due to bias toward treating more severely affected patients. A Cox proportional hazards model associated metreleptin therapy with an estimated 65% decrease in mortality risk (HR 0.348, 95% CI: 0.134-0.900; P = 0.029) even though the actual number of events were relatively small. Results were robust across a broad range of alternate methodological assumptions. Kaplan-Meier estimates of time to mortality for the metreleptin-treated and the matched metreleptin-naïve cohorts were comparable. Conclusions Metreleptin therapy was associated with a reduction in mortality risk in patients with lipodystrophy syndromes despite greater disease severity in treated patients, supporting the view that metreleptin can have a positive disease-modifying impact. Confirmatory studies in additional real-world and clinical datasets are warranted.

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Early estimates of SARS-CoV-2 Omicron variant severity based on a matched cohort study, Ontario, Canada

10.1101/2021.12.24.21268382 ◽

2021 ◽

Author(s):

Ana Cecilia Ulloa ◽

Sarah A Buchan ◽

Nick Daneman ◽

Kevin Antoine Brown

Keyword(s):

Cohort Study ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Immune Escape ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Onset Date ◽

Matched Cohort ◽

Adjusted Risk ◽

Matched Cohort Study

While it is now evident that Omicron is rapidly replacing Delta, due to a combination of increased transmissibility and immune escape, it is less clear how the severity of Omicron compares to Delta. In Ontario, we sought to examine hospitalization and death associated with Omicron, as compared to matched cases infected with Delta. We conducted a matched cohort study, considering time to hospitalization or death as the outcome, and analyzed with a Cox proportional hazards model. Cases were matched on age, gender, and onset date, while vaccine doses received and time since vaccination were included as adjustment variables. We identified 6,314 Omicron cases that met eligibility criteria, of which 6,312 could be matched with at least one Delta case (N=8,875) based on age, gender, and onset date. There were 21 (0.3%) hospitalizations and 0 (0%) deaths among matched Omicron cases, compared to 116 (2.2%) hospitalizations and 7 (0.3%) deaths among matched Delta cases. The adjusted risk of hospitalization or death was 54% lower (HR=0.46, 95%CI: 0.27, 0.77) among Omicron cases compared to Delta cases. While severity may be reduced, the absolute number of hospitalizations and impact on the healthcare system could still be significant due to the increased transmissibility of Omicron.

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Effects on Postoperative Gastrointestinal Motility After Neuromuscular Blockade Reversal With Sugammadex Versus Neostigmine/Glycopyrrolate in Colorectal Surgery Patients

Annals of Pharmacotherapy ◽

10.1177/1060028020929061 ◽

2020 ◽

Vol 54 (12) ◽

pp. 1165-1174

Author(s):

Molly E. Hunt ◽

John R. Yates ◽

Hannah Vega ◽

Robert E. Heidel ◽

Jason M. Buehler

Keyword(s):

Colorectal Surgery ◽

Regression Model ◽

Gastrointestinal Motility ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cohort Analysis ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hospital Length Of Stay ◽

Reversal Agent

Background: Neuromuscular blockers (NMBs) used during surgery have historically been reversed with acetylcholinesterase inhibitors and anticholinergic agents, which can slow gastrointestinal motility. Sugammadex (SUG) provides NMB reversal with minimal effects on gastrointestinal motility. Objective: The purpose of this study was to determine if SUG for reversal of NMB is associated with decreased time to first bowel movement (BM) following laparoscopic colorectal surgery. Methods: A retrospective cohort analysis divided 224 patients undergoing laparoscopic colorectal surgeries based on whether they received SUG or a combination of neostigmine and glycopyrrolate (NG) for NMB reversal. The primary outcome was time (in hours) from NMB reversal until first recorded BM. Secondary end points were postoperative ileus, postoperative nausea and vomiting, prevalence of residual NMB, and hospital length of stay. The relationship between NMB reversal agent and outcomes were analyzed using multivariable linear regression and Cox proportional hazards model. Results: There were 128 patients who received NG and 96 who received SUG. Time to first BM was faster in the SUG group by 11.7 hours ( P = 0.004). SUG maintained the effect in a multiple regression model ( P = 0.012). A Cox Proportional Hazards regression model found 50% increased odds of a BM across time for the SUG group ( P = 0.003). No adverse effects were noted. Conclusion and Relevance: This represents the first report demonstrating faster return of BM following colorectal surgery with SUG when compared with NG. Application of these data may add another tool to enhance recovery after colorectal surgery.

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