Platelet transfusion and mortality in patients with sepsis-induced thrombocytopenia: a propensity score-matching analysis

Abstract Thrombocytopenia is common among sepsis patients. Platelet transfusion is frequently administered to increase platelet counts but its clinical impacts remain unclear in sepsis-induced thrombocytopenia. The goal of this study was to explore the association between platelet transfusion and mortality in patients with sepsis-induced thrombocytopenia based on the Medical Information Mart for Intensive Care (MIMIC) III database. In this study, we included 1733 patients with sepsis-induced thrombocytopenia, and these patients were divided into two groups: platelet transfusion group (PT group) and no platelet transfusion group (NPT group). Propensity-score matching was used to reduce the imbalance. We found that patients in the PT group had a higher in-hospital mortality as compared with the NPT group. Furthermore, in the subgroup of age (>60 years), gender (female), sequential organ failure assessment score (≤8), simplified acute physiology score (≤47), platelet count (>27/nL), congestive heart failure, platelet transfusion was associated with increased in-hospital mortality. However, there was no significant difference in the 90-day mortality and the length of ICU stays (LOS-ICU) between these two groups. All these results remain stable after adjustment for confounders and in the comparisons after propensity score matching. In conclusion, platelet transfusion was associated with increased in-hospital mortality in patients with sepsis-induced thrombocytopenia.

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Platelet Transfusion is Not Associated with the Better Outcomes of Patients with Sepsis-Induced Thrombocytopenia: A Propensity Score-Matching Analysis.

10.21203/rs.3.rs-313903/v1 ◽

2021 ◽

Author(s):

Aiming Zhou ◽

Shanshan Wu ◽

Qin Chen ◽

Lili Chen ◽

Jingye Pan

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Platelet Transfusion ◽

Medical Information ◽

Propensity Score Matching Analysis ◽

Kaplan Meier ◽

All Cause Mortality ◽

Short Term Mortality ◽

Mimic Iii ◽

Mortality Hazard Ratio

Abstract Background: The association of platelet transfusion and short-term mortality in patients with sepsis-induced thrombocytopenia remains unclear. Therefore, we intended to explore whether platelet transfusion could make a difference for patients with sepsis-induced thrombocytopenia.Methods: The study was based on the Medical Information Mart for Intensive Care (MIMIC) III database. Sepsis patients were divided into those with or without platelet transfusion (Platelet Transfusion group [PT group] and No Platelet Transfusion group [NPT group], respectively) during hospital stay. The primary outcome was 28-day all-cause mortality, and secondary outcomes were length of ICU stay (LOS-ICU) and survival days of 28. Propensity-score matching was used to reduce the imbalance. Results: We included 1733 patients: 296 patients in the PT group and 1437 patients in the NPT group. Overall, 655 patients died by day 28. After propensity score matching, 294 paired patients constituted each group. 28-day mortality did not decreased in PT patients comparing to NPT patients (120 [40.54%] vs. 535 [37.23%] deaths; P=0.29). LOS-ICU was similar between PT group and NPT group (5.84[2.68-11.78] vs. 4.94[2.18-12.72]; P=0.44). After confounders were adjusted for, it showed no difference between PT group and NPT group in 28-day mortality (hazard ratio [HR], 1.28;95% confidence interval [CI], [0.96, 1.17]; P=0.09) or lOS-ICU (odd ratio [OR], 0.09; 95%CI, [-1.45, 1.62]; P=0.91). Survival at 28 days showed no difference between the groups according to Kaplan-Meier survival estimates. After propensity score matching, platelet transfusion was also not associated with 28-mortality or LOS-ICU.Conclusions: In the propensity score-matched analysis, there is no evidence that platelet transfusion is beneficial for patients with sepsis-induced thrombocytopenia, neither 28-mortality nor LOS-ICU.

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Abstract 13351: Association of Atrial Fibrillation With In-hospital Mortality Among Patients With Takotsubo Cardiomyopathy

Circulation ◽

10.1161/circ.142.suppl_3.13351 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Qiying Dai ◽

Abhishek Bose ◽

Pengyang Li ◽

PENG CAI ◽

Douglas Laidlaw

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Mortality Rate ◽

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Mortality Rates ◽

Primary Diagnosis ◽

Propensity Score Matching Analysis ◽

Significant Difference

Introduction: Takotsubo cardiomyopathy (TC), characterized by transient left ventricular dysfunction, is known to be precipitated by sudden physical or emotional stress. Atrial fibrillation (AF) is a common arrhythmia and its presence increases mortality in patients with chronic underlying diseases. Furthermore, multiple studies have suggested that in TC patients, underlying AF correlates with a higher in-hospital mortality. However, these studies were constrained by either a disproportionate percentage of AF patients or lack of risk factor matching. To systematically explore the association between TC and AF, we decided to perform a propensity score matching analysis. Methods: We performed a retrospective cohort analysis using the ICD-10 codes for a primary diagnosis of TC from the 2016 National Inpatient Sample. To adjust for underlying risk factors a multivariable logistic regression model was employed followed by a propensity score matching analysis for the AF group and the non-AF group. A similar analysis method was followed for the subset of patients with paroxysmal AF. In-hospital mortality rates were compared between the two groups. Results: Out of the total 3139 patients with a primary diagnosis of TC, 433 (13.7%) had AF and 243 (7.7%) had paroxysmal AF. In the unmatched group, patients with AF appeared to be older (74.7 vs. 65.3 years, P<0.001) and more likely to have comorbidities like diabetes mellitus (24.0% vs 19.2%, P=0.024), chronic kidney disease (15.7% vs 7.6%, P<0.001) and obstructive sleep apnea (8.8% vs 4.9%, P=0.002). On multivariable logistic regression, in-hospital mortality was higher in the AF group (3.9% vs 1.3%, P< 0.001). However, after propensity score matching, there was no significant difference in the mortality rate between the two groups (3.7% vs 1.9%, P=0.082). Similarly, on logistic regression followed by propensity matching for patients with paroxysmal AF, no significant difference was noted for in-hospital mortality rates (3.3% vs 1.3%, P=0.112). Conclusions: In patients with TC, the presence of underlying AF had no effect on the in-hospital mortality rate.

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Cold snare polypectomy reduced delayed postpolypectomy bleeding compared with conventional hot polypectomy: a propensity score-matching analysis

Endoscopy International Open ◽

10.1055/s-0043-105578 ◽

2017 ◽

Vol 05 (07) ◽

pp. E587-E594 ◽

Cited By ~ 23

Author(s):

Takeshi Yamashina ◽

Manabu Fukuhara ◽

Takanori Maruo ◽

Gensho Tanke ◽

Saiko Marui ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Secondary Analysis ◽

Colorectal Polyps ◽

Propensity Score Model ◽

Propensity Score Matching Analysis ◽

Significant Difference ◽

Cold Snare Polypectomy ◽

Few Data ◽

Snare Polypectomy

Abstract Background and study aims Cold snare polypectomy (CSP) for small colorectal polyps has lower incidence of adverse events, especially delayed postpolypectomy bleeding (DPPB). However, few data are available on comparisons of the incidence of DPPB of CSP and hot polypectomy (HP). The aim of this study was to evaluate the incidence of DPPB after CSP and compare it with that of HP. A propensity score model was used as a secondary analysis. Patients and methods This was a retrospective cohort study conducted in a single municipal hospital. We identified 539 patients with colorectal polyps from 2 mm to 11 mm in size who underwent CSP (804 polyps in 330 patients) or HP (530 polyps in 209 patients) between July 2013 and June 2015. Results There were no cases of DPPB in the CSP group. Conversely, DPPB occurred in 4 patients (1.9 %) after HP, resulting in a significant difference between the CSP and HP groups (0.008 % vs 0 %, P = 0.02). Propensity score-matching analysis created 402 matched pairs, yielding a significantly higher DPPB rate in the HP group than CSP group (0.02 % vs 0 %, P = 0.04). However, significantly more patients in the CSP group had unclear horizontal margins that precluded assessment (83 vs 38 cases, P < 0.001). The retrieval failure rate was significantly higher in the CSP group than in the HP group (3 % vs 0.7 %, P = 0.01). Conclusions DPPB was less frequent with CSP than HP, as selected by the propensity score-matching model. Our findings indicate that CSP is recommended polypectomy in daily clinical setting. However, special care should be taken during polyp retrieval and horizontal margin assessment, and these issues could be taken into account in follow-up after CSP.

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Ceftriaxone versus ampicillin/sulbactam for the treatment of aspiration-associated pneumonia in adults

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2019-0041 ◽

2019 ◽

Vol 8 (15) ◽

pp. 1275-1284 ◽

Cited By ~ 1

Author(s):

Shinya Hasegawa ◽

Atsushi Shiraishi ◽

Makito Yaegashi ◽

Naoto Hosokawa ◽

Konosuke Morimoto ◽

...

Keyword(s):

Risk Factor ◽

Propensity Score ◽

Observational Study ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Risk Difference ◽

Study Cohort ◽

Propensity Score Matching Analysis ◽

Related Risk ◽

Baseline Characteristics

Aim: To compare hospital mortality in patients with aspiration-associated pneumonia treated with ceftriaxone (CTRX) and in those treated with ampicillin/sulbactam (ABPC/SBT). Methods: From a Japanese multicentre observational study cohort of patients with pneumonia, those diagnosed with pneumonia and having at least one aspiration-related risk factor were selected. Propensity score-matching analysis was used to balance baseline characteristics of the participants and compare hospital mortality of patients treated with CTRX and those treated with ABPC/SBT. Results: Hospital mortality did not significantly differ between patients treated with CTRX and those treated with ABPC/SBT (6.6 vs 10.7%, risk difference -4.0, 95% CI [-9.4, 1.3]; p = 0.143). Conclusion: Further studies are needed to compare CTRX and ABPC/SBT treatments in patients with aspiration-associated pneumonia.

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Clinical Effect of the Acrylonitrile-Co-Methallyl Sulfonate Surface-Treated Membrane as a Cytokine Adsorption Therapy for Sepsis due to Acute Panperitonitis: A Retrospective Cohort Study

Blood Purification ◽

10.1159/000504560 ◽

2020 ◽

Vol 49 (3) ◽

pp. 364-371

Author(s):

Kentarou Hayashi ◽

Yusuke Sasabuchi ◽

Hiroki Matsui ◽

Mikio Nakajima ◽

Hiroyuki Ohbe ◽

...

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Primary Outcome ◽

Clinical Effect ◽

Primary Outcome Measure ◽

Gastrointestinal Perforation ◽

Disease Mechanism ◽

Diagnosis Procedure Combination ◽

Significant Difference

Introduction: Sepsis is a systemic inflammatory response syndrome caused by infectious diseases, with cytokines possibly having an important role in the disease mechanism. Acrylonitrile-co-methallyl sulfonate surface-treated (AN69ST) membrane is expected to improve the outcomes of patients with sepsis through cytokine adsorption. Objective: This study aimed to investigate the clinical effect of the AN69ST membrane in comparison to standard continuous renal replacement therapy (CRRT) membranes for panperitonitis due to lower gastrointestinal perforation. Methods: Using the Diagnosis Procedure Combination database, we identified adult patients with sepsis due to panperitonitis receiving any CRRT. Propensity score matching was used to compare patients who received CRRT with the AN69ST membrane (AN69ST group) and those who received CRRT with other membranes (non-AN69ST group). The primary outcome measure was in-hospital mortality. Results: A total of 528 and 1,445 patients were included in the AN69ST group and in the non-AN69ST group, respectively. Propensity score matching resulted in 521 pairs. There was no significant difference in in-hospital mortality (32.1 vs. 35.5%; p = 0.265) and 30-day mortality (41.3 vs. 42.8%, p = 0.074) between the AN69ST group and the non-AN69ST group. Conclusion: There is no significant difference in-hospital mortality between CRRT with the AN69ST membrane and CRRT with standard CRRT membranes for panperitonitis due to lower gastrointestinal perforation. These results indicate that the AN69ST membrane is not superior to the standard CRRT membrane.

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Association of Menopausal Status with COVID-19 Outcomes: A Propensity Score-Matching Analysis

10.21203/rs.3.rs-111926/v1 ◽

2020 ◽

Author(s):

Xing-Wang Wang ◽

Hao Hu ◽

Zhi-Yong Xu ◽

Gong-Kai Zhang ◽

Qing-Hua Yu ◽

...

Keyword(s):

Propensity Score ◽

Postmenopausal Women ◽

Propensity Score Matching ◽

Severe Disease ◽

Menopausal Status ◽

Premenopausal Women ◽

Disease Type ◽

Propensity Score Matching Analysis ◽

Significant Difference ◽

Bilateral Lung

Abstract Background: Despite the growing number of studies on the Coronavirus Disease-19 (COVID-19), little is known about the association of menopausal status with COVID-19 outcomes.Materials and methods: In this retrospective study, we included 336 COVID-19 in-patients between February 15, 2020 and April 30, 2020 at the Taikang Tongji Hospital (Wuhan), China. Electronic medical records, including patient demographics, laboratory results, and chest computed tomography (CT) images were reviewed. Results: In total, 300 patients with complete clinical outcomes were included for analysis. The mean age was 65.3 years and most patients were women (n=167, 55.7%). Over 50% of patients presented with comorbidities, with hypertension (63.5%) being the most common comorbidity. After propensity-score matching, results showed that men had significantly higher odds than premenopausal women for developing severe disease type (23.7% vs. 0%, OR 17.12, 95% CI 1.00–293.60; p=0.003) and bilateral lung infiltration (86.1% vs. 64.7%, OR 3.39, 95% CI 1.08–10.64; p= 0.04), but not for mortality (2.0% vs. 0%, OR 0.88, 95% CI 0.04–19.12, p=1.00). However, non-significant difference was observed among men and post-menopause women in the percentage of severe disease type (32.7% vs. 41.7%, OR 0.68, 95% CI 0.37–1.24, p=0.21) and bilateral lung infiltration (86.1% vs. 91.7%, OR 0.56, 95% CI 0.22–1.47, p=0.24), mortality (2.0% vs. 6.0%, OR 0.32, 95% CI 0.06–1.69, p=0.25).Conclusions: Men had higher disease severity than premenopausal women, while the differences disappeared between postmenopausal women and men. These findings support aggressive treatment for the poor-prognosis of postmenopausal women in clinical practice.

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Primary or secondary Bentall-De Bono procedure: are the outcomes worse?

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319832775 ◽

2019 ◽

Vol 27 (4) ◽

pp. 271-277

Author(s):

Ameya Kaskar ◽

Deepak V Bohra ◽

Rahul Rao K ◽

Varun Shetty ◽

Devi Shetty

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Survival Rates ◽

Median Sternotomy ◽

Postoperative Mortality ◽

Mortality And Morbidity ◽

Significant Difference ◽

Group 2 ◽

Group 1

Background The aim of this study was to compare the outcomes of a primary and secondary Bentall-De Bono procedure. Methods From 2008 to 2015 (8-year period), 308 patients underwent a Bentall-De Bono procedure in our institute. The mean age was 43 ± 13 years and 80% were men. Twenty-eight patients had prior cardiac surgery through a median sternotomy (group 1) and 280 underwent a primary Bentall-De Bono procedure (group 2). Various preoperative and perioperative parameters were analyzed before and after propensity-score matching. Results Before propensity-score matching, patients undergoing a secondary Bentall-De Bono procedure had a worse preoperative profile, as indicated by a higher EuroSCORE II ( p < 0.0001), with hospital mortality in group 1 of 14% (4/28) and 5% (14/280) in group 2 ( p = 0.069). After propensity-score matching, there was no significant difference in EuroSCORE II ( p = 0.922) or hospital mortality ( p = 0.729). After adjusting for the different variables, repeat sternotomy could not be identified as an independent predictor of postoperative mortality or morbidity. Survival at the end of 1 and 5 years in both groups showed no significant differences before or after propensity-score matching ( p = 0.328 and p = 0.356, respectively). In Cox multivariable regression analysis, reoperation was not identified as an independent factor for survival before ( p = 0.559) or after propensity-score matching ( p = 0.365). Conclusion A secondary Bentall-De Bono procedure can be performed with acceptable mortality and morbidity, and with midterm survival rates comparable to those of a primary Bentall-De Bono procedure.

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Safety and effectiveness of mucosal traction using a snare combined with endoclips to assist the resection of esophageal intraepithelial neoplasia: a propensity score matching analysis

Diseases of the Esophagus ◽

10.1093/dote/doab018 ◽

2021 ◽

Author(s):

Qiang Zhang ◽

Zhou-yang Lian ◽

Jian-Qun Cai ◽

Yang Bai ◽

Zhen Wang

Keyword(s):

Postoperative Complications ◽

Propensity Score ◽

Propensity Score Matching ◽

Operation Time ◽

Intraepithelial Neoplasia ◽

R0 Resection ◽

En Bloc ◽

Propensity Score Matching Analysis ◽

Significant Difference ◽

Traction Group

Summary Currently, the reports on esophageal endoscopic submucosal dissection (ESD) assisted by traction with a snare are rare. Because a snare is a commonly used endoscopic accessory and is easily available, its application in mucosal traction is worth exploring. The present study aims to evaluate the safety and effectiveness of snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia. Cases of esophageal intraepithelial neoplasia resected using ESD in the Digestive Endoscopy Center of Guangzhou Nanfang Hospital, China from June 2013 to March 2019 were retrospectively analyzed. The procedure of snare-endoclip traction-assisted ESD was compared with nontraction-assisted ESD by using a propensity score matching analysis. Operation time, en bloc and R0 resection, intra- and postoperative complications, and surgery-related costs were mainly evaluated. Overall, 99 cases of esophageal intraepithelial neoplasia under tissue biopsy were included in the present study. Further, 22 exact matched pairs were obtained. There were no differences in en bloc and R0 resection rates, intra- and postoperative complications, and costs of disposable surgical accessories between the traction group and the nontraction group. However, median operation time showed a significant difference: traction group, 50.0 min (range, 20–100 min); nontraction group, 70.0 min (range, 35–133 min), P=0.012. In conclusion, snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia was safe and shortened operation time in the study, thereby improving the efficiency of ESD. Despite the additional use of a snare and endoclips for traction, the total costs of endoscopic accessories seemed not to be increased.

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Association of menopausal status with COVID-19 outcomes: a propensity score matching analysis

Biology of Sex Differences ◽

10.1186/s13293-021-00363-6 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Xing-Wang Wang ◽

Hao Hu ◽

Zhi-Yong Xu ◽

Gong-Kai Zhang ◽

Qing-Hua Yu ◽

...

Keyword(s):

Propensity Score ◽

Postmenopausal Women ◽

Propensity Score Matching ◽

Severe Disease ◽

Menopausal Status ◽

Premenopausal Women ◽

Disease Type ◽

Propensity Score Matching Analysis ◽

Significant Difference ◽

Bilateral Lung

Abstract Background Despite the growing number of studies on the coronavirus disease-19 (COVID-19), little is known about the association of menopausal status with COVID-19 outcomes. Materials and methods In this retrospective study, we included 336 COVID-19 inpatients between February 15, 2020 and April 30, 2020 at the Taikang Tongji Hospital (Wuhan), China. Electronic medical records including patient demographics, laboratory results, and chest computed tomography (CT) images were reviewed. Results In total, 300 patients with complete clinical outcomes were included for analysis. The mean age was 65.3 years, and most patients were women (n = 167, 55.7%). Over 50% of patients presented with comorbidities, with hypertension (63.5%) being the most common comorbidity. After propensity score matching, results showed that men had significantly higher odds than premenopausal women for developing severe disease type (23.7% vs. 0%, OR 17.12, 95% CI 1.00–293.60; p = 0.003) and bilateral lung infiltration (86.1% vs. 64.7%, OR 3.39, 95% CI 1.08–10.64; p = 0.04), but not for mortality (2.0% vs. 0%, OR 0.88, 95% CI 0.04–19.12, p = 1.00). However, non-significant difference was observed among men and postmenopausal women in the percentage of severe disease type (32.7% vs. 41.7%, OR 0.68, 95% CI 0.37–1.24, p = 0.21), bilateral lung infiltration (86.1% vs. 91.7%, OR 0.56, 95% CI 0.22–1.47, p = 0.24), and mortality (2.0% vs. 6.0%, OR 0.32, 95% CI 0.06–1.69, p = 0.25). Conclusions Men had higher disease severity than premenopausal women, while the differences disappeared between postmenopausal women and men. These findings support aggressive treatment for the poor prognosis of postmenopausal women in clinical practice.

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Implications of anesthetic approach, spinal versus general, for the treatment of spinal disc herniation

Journal of Neurosurgery Spine ◽

10.3171/2018.7.spine18460 ◽

2019 ◽

Vol 30 (1) ◽

pp. 78-82

Author(s):

Nikhil Sharma ◽

Matthew Piazza ◽

Paul J. Marcotte ◽

William Welch ◽

Ali K. Ozturk ◽

...

Keyword(s):

Lumbar Spine ◽

Propensity Score ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Disc Herniation ◽

Direct Costs ◽

Perioperative Outcomes ◽

Lumbar Spine Surgery ◽

Propensity Score Matching Analysis ◽

Significant Difference

OBJECTIVEHealthcare costs continue to escalate. Approaches to care that have comparable outcomes and complications are increasingly assessed for quality improvement and, when possible, cost containment. Efforts to identify components of care to reduce length of stay (LOS) have been ongoing. Spinal anesthesia (SA), for select lumbar spine procedures, has garnered interest as an alternative to general anesthesia (GA) that might reduce cost and in-hospital LOS and accelerate recovery. While clinical outcomes with SA or GA have been studied extensively, few authors have looked at the cost-analysis in relation to clinical outcomes. The authors’ objectives were to compare the clinical perioperative outcomes of patients who received SA and GA, as well as the direct costs associated with each modality of care, and to determine which, in a retrospective analysis, can serve as a dominant procedural approach.METHODSThe authors retrospectively analyzed a homogeneous surgical population of 550 patients who underwent hemilaminotomy for disc herniation and who received either SA (n = 91) or GA (n = 459). All clinical and billing data were obtained via each patient’s chart and the hospital’s billing database, respectively. Additionally, the authors prospectively assessed patient-reported outcome measures for a subgroup of consecutively treated patients (n = 75) and compared quality-adjusted life year (QALY) gains between the two cohorts. Furthermore, the authors performed a propensity score–matching analysis to compare the two cohorts (n = 180).RESULTSDirect hospital costs for patients receiving SA were 40% higher, in the hundreds of dollars, than for patients who received GA (p < 0.0001). Furthermore, there was a significant difference with regard to LOS (p < 0.0001), where patients receiving SA had a considerably longer hospital LOS (27.6% increase in hours). Patients undergoing SA had more comorbidities (p = 0.0053), specifically diabetes and hypertension. However, metrics of complications, including readmission (p = 0.3038) and emergency department (ED) visits at 30 days (p = 1.0), were no different. Furthermore, in a small pilot group, QALY gains were statistically no different (n = 75, p = 0.6708). Propensity score–matching analysis demonstrated similar results as the univariate analysis: there was no difference between the cohorts regarding 30-day readmission (p = 1.0000); ED within 30 days could not be analyzed as there were no patients in the SA group; and total direct costs and LOS were significantly different between the two cohorts (p < 0.0001 and p = 0.0126, respectively).CONCLUSIONSBoth SA and GA exhibit the qualities of a good anesthetic, and the utilization of these modalities for lumbar spine surgery is safe and effective. However, this work suggests that SA is associated with increased LOS and higher direct costs, although these differences may not be clinically or fiscally meaningful.

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