scholarly journals Association of Diabetes and Outcomes in Patients with COVID-19: A Propensity Score Matched Analyses from a French Retrospective Cohort

2020 ◽  
Author(s):  
Willy Sutter ◽  
Baptiste Duceau ◽  
Aurélie Carlier ◽  
Antonin Trimaille ◽  
Thibaut Pommier ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Vital Signs ◽  
Patient Characteristics ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Patients With Diabetes

Abstract Background: To compare the clinical outcomes between patients with and without diabetes admitted to hospital with COVID-19.Methods: Retrospective multicentre cohort study from 24 academic tertiary medical centres in France including 2851 patients (675 with diabetes) hospitalised for COVID-19 between February 26 and April 20, 2020. A propensity score matching method (1:1 matching including patient characteristics, medical history, vital signs, and laboratory results) was used to compare patients with and without diabetes (n=603 in each group). The primary outcome was admission to intensive care unit (ICU) or in-hospital death. Results: Patients with diabetes were older (71 ± 13 vs. 65 ± 18 years; p<0.001), were less often female (38% vs. 44%; p<0.001) and more likely to have comorbidities: hypertension (79% vs 42%; p<0.001), coronary heart disease (23% vs 9%; p<0.001), stroke (13% vs 8%; p<0.001), heart failure (17% vs 9%; p<0.001), chronic kidney disease (26% vs 10%; p<0.001), and chronic obstructive pulmonary disease (7% vs 5%; p<0.05). The primary outcome occurred in 584 (36.4%) patients with diabetes compared to 246 (26.8%) in those without diabetes (p<0.001). After propensity score matching, the risk of primary outcome was similar in patients with and without diabetes (hazard ratio [HR] 1.16, 95%CI 0.95-1.41, p=0.14) and was 1.29 (95%CI 0.97 – 1.69) for in-hospital mortality, 1.26 (95%CI 0.93 – 1.72) for mortality without transfer in ICU, and 1.14 (95%CI 0.88 – 1.47) for transfer to ICU.Conclusions: In this retrospective cohort of patients hospitalised for COVID-19, diabetes was not significantly associated with a higher risk of COVID-19 severe outcomes after propensity score matching.Trial registration NCT04344327

scholarly journals Impact of chronic obstructive pulmonary disease on patients with aortic aneurysms: a nationwide retrospective cohort study in Taiwan

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e015806 ◽  
Author(s):  
Kuang-Ming Liao ◽  
Chung-Yu Chen
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cohort Study ◽  
Mortality Rate ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

ObjectivesAortic aneurysm (AA) is a leading cause of death worldwide. Chronic obstructive pulmonary disease (COPD) is a risk factor for AA, and the prognoses of COPD patients with AA who underwent/did not undergo an operation warrant investigation.DesignA nationwide retrospective cohort study.SettingWe included patients with AA older than 18 years who received their first AA diagnosis between 2005 and 2011 in Taiwan.ParticipantsThis study enrolled 3263 COPD patients with AA before propensity score matching and 2127 COPD patients with AA after propensity score matching.Outcome measuresThe main outcomes were all-cause mortality and rehospitalisation for AA or operation. The outcomes of COPD patients with AA and COPD patients without AA during an 8-year follow-up period were examined using Cox proportional hazards models.ResultsIn the AA population, patients with COPD showed higher rates of mortality and rehospitalisation than patients without COPD with adjusted HRs of 1.12 (95% CI 1.03 to 1.22) and 1.11 (95% CI 1.01 to 1.23), respectively, after propensity score matching. Analysis of the patients who underwent an operation revealed that the rates of mortality of COPD and non-COPD patients were not significantly different. In contrast, among the patients who did not receive an operation, patients with COPD showed a higher mortality rate than patients without COPD with an adjusted HR of 1.11 (95% CI 1.0 to 1.22).ConclusionsThe outcomes of COPD patients with AA undergoing an operation were improved, but the mortality rate of non-COPD patients with AA remained high. An effective treatment to reduce mortality in this group warrants further investigation.

Hospitalized with stroke at the weekend: Higher cost and risk of early death?

2021 ◽  
pp. 174749302199259
Author(s):  
Marco Ghiani ◽  
Sabrina Mueller ◽  
Ulf Maywald ◽  
Thomas Wilke
Keyword(s):  
Propensity Score ◽  
Cerebral Infarction ◽  
Propensity Score Matching ◽  
Disease Severity ◽  
Patient Characteristics ◽  
Weekend Effect ◽  
Health Claims ◽  
Hospital Death ◽  
Stroke Severity ◽  
Baseline Characteristics

Objectives Previous studies have shown that weekend hospitalizations are associated with poorer health outcomes and higher mortality (“weekend effect”). However, few of these studies have adjusted for disease severity and little is known about the effect on costs. This work investigates the weekend effect and its costs for patients with cerebral infarction in Germany, adjusting for patient characteristics and proxies of stroke severity. Methods Adult patients with a cerebral infarction hospitalization 10th revision of the International statistical classification of diseases and related health problems (ICD-10: I63) between 01 January 2014 and 30 June 2017 were included from German health claims (AOK PLUS dataset). Propensity score matching was used to match patients hospitalized on weekends or on public holidays (weekend group) with patients hospitalized during the working week (workday group), based on baseline characteristics and proxies for disease severity such as concomitant diagnoses of aphasia, ataxia, and coma, or peg tube at index hospitalization. Matched cohorts were compared in terms of in-hospital, 7-day, and 30-day mortality, as well as risk and costs of stroke and rehabilitation stays in the year after first stroke. Results Of 32,311 patients hospitalized with cerebral infarction between 01 January 2014 and 30 June 2017, 8409 were in the weekend group and 23,902 in the workday group. After propensity score matching, 16,730 patients were included in our study (8365 per group). Matched cohorts did not differ in baseline characteristics or stroke severity. In the weekend group, the risk of in-hospital death (11.2%) and the seven-day mortality rate (6.8%) were 13.1% and 17.2% higher than in the workday group, respectively (both p < 0.01). The hazard ratio for death in the weekend group was 1.1 ( p = 0.043). The risks of subsequent stroke hospitalization and rehabilitation stays for a stroke were 8.4% higher and 5.5% higher in the weekend group (both p = 0.02). As a result, the stroke-related hospitalization and rehabilitation costs per patient year were, respectively, 5.6% and 8.0% higher in the weekend group (both p = 0.01). Conclusions A significant weekend effect emerged after controlling for observable patient characteristics and proxies of stroke severity. This effect also resulted in higher costs for patients admitted on weekends.

scholarly journals Impact of Chronic Obstructive Pulmonary Disease on In-hospital Mortality in Patients with Aneurysmal Subarachnoid Hemorrhage: An Observational Cohort Study with Propensity Score Matching

2020 ◽  
Author(s):  
Yu Zhang ◽  
Linjie Li ◽  
Wei Yao ◽  
Xing Wang ◽  
Liyuan Peng ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cohort Study ◽  
Subarachnoid Hemorrhage ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Pulmonary Disease ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Objective: Chronic obstructive pulmonary disease (COPD) has been associated with several complications and mortality in acutely ill patients. For patients with aneurysmal subarachnoid hemorrhage (aSAH), the association between COPD and clinical outcomes remains unclear. Methods: In this retrospective cohort study, we analyzed consecutive aSAH patients admitted to the West China Hospital between 2009 and 2019. Propensity score matching was performed to obtain the adjusted odds ratios (ORs) with 95% CI. The primary outcome was in hospital mortality.Results: Using a ten-year clinical database from a large university medical center, 5643 patients with aSAH were identified, of whom 377 (7.9%) also had COPD. After matching, 289 patients were included in COPD group and 1156 in non-COPD groups. COPD was associated with increased in-hospital mortality (OR 1.63, 95% CI 1.02-2.62) and poor functional outcome at discharge (OR 1.37, 95% CI 1.04-1.80). Similarly, patients with COPD had significantly longer length of hospital stay, higher odds of seizure (OR 2.05, 95% CI 1.04-4.04), pneumonia (OR 3.10, 95% CI 2.38-4.04), intracranial infection (OR 1.62, 95% CI 1.14-2.29), urinary tract infection (OR 1.59, 95% CI 1.16-2.20) and bloodstream infection(OR 3.27, 95% CI 1.74-6.15). Conclusions: Among aSAH patients, COPD is associated with increased mortality. COPD represents a significant risk factor for pneumonia and seizure.

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 Hospitalized Prognosis of Ischemic Stroke with COPD: A Propensity Score Matching Study

2021 ◽  
Author(s):  
Siyan Zhang ◽  
Qiong Zeng ◽  
Liling Wei ◽  
Kun Lin
Keyword(s):  
Ischemic Stroke ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Pulmonary Infection ◽  
Chronic Obstructive ◽  
Stroke Patients ◽  
Obstructive Pulmonary Disease ◽  
Medical College ◽  
Propensity Score Matching Analysis ◽  
Inpatient Outcomes

Abstract Purpose: The relationship between chronic obstructive pulmonary disease (COPD) and hospitalized prognosis, in ischemic stroke patients, as well as complications is not well understood. This study aimed to investigate the influence of COPD on inpatient outcomes among ischemic stroke patients.Methods: A retrospective investigation was conducted in 9260 patients with confirmed ischemic stroke, in the First Affiliated Hospital of Shantou University Medical College, from 2013 to 2020. After excluding patients with missing data or hospital discharge within 24 hours, we divided the eligible 9021 patients into two groups based on whether or not they had been diagnosed with COPD. After a 1:3 ratio propensity score matching (PSM) (n=290, COPD group vs n=856, non-COPD group), we compared hospitalized prognosis and complications between two groups.Results: Stroke patients with COPD had a significantly higher rate of non-recovered and deceased patients at discharge (4.1% vs 2.1%, OR=1.972, P=0.023), and a higher risk of infection (66.2% vs 48.3%, OR=2.10, P<0.001), especially pulmonary infection (48.1% vs 32.3%, OR=1.944, P<0.001), compared to stroke patients without COPD. After propensity score matching analysis, the differences were still statistically significant concerning inpatient non-recovery and death (4.1% vs 1.9%; OR=2.266, P=0.031), infection (66.2% vs 52.9%, OR=1.743, P<0.001) and pulmonary infection (48.3% vs 36.6%, OR=1.619, P<0.001).Conclusion: Stroke patients with COPD have poorer hospitalized prognosis, with a higher rate of non-recovered and deceased patients, as well as higher incidence of infection, compared with those without COPD.

scholarly journals The association of blood urea nitrogen levels upon emergency admission with mortality in acute exacerbation of chronic obstructive pulmonary disease

2021 ◽  
Vol 18 ◽  
pp. 147997312110600
Author(s):  
Lan Chen ◽  
Lijun Chen ◽  
Han Zheng ◽  
Sunying Wu ◽  
Saibin Wang
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Blood Urea Nitrogen ◽  
Regression Models ◽  
Chronic Obstructive ◽  
Urea Nitrogen ◽  
Obstructive Pulmonary Disease ◽  
Logistic Regression Models ◽  
Survivor Group

Background and purpose High blood urea nitrogen (BUN) is associated with an elevated risk of mortality in various diseases, such as heart failure and pneumonia. Heart failure and pneumonia are common comorbidities of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, data on the relationship of BUN levels with mortality in patients with AECOPD are sparse. The purpose of this study was to evaluate the correlation between BUN level and in-hospital mortality in a cohort of patients with AECOPD who presented at the emergency department (ED). Methods A total of 842 patients with AECOPD were enrolled in the retrospective observational study from January 2018 to September 2020. The outcome was all-cause in-hospital mortality. Receiver operating characteristic (ROC) curve analysis and logistic regression models were performed to evaluate the association of BUN levels with in-hospital mortality in patients with AECOPD. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics, and logistic regression models were also performed in the propensity score matching cohort. Results During hospitalization, 26 patients (3.09%) died from all causes, 142 patients (16.86%) needed invasive ventilation, and 190 patients (22.57%) were admitted to the ICU. The mean level of blood urea nitrogen was 7.5 ± 4.5 mmol/L. Patients in the hospital non-survivor group had higher BUN levels (13.48 ± 9.62 mmol/L vs. 7.35 ± 4.14 mmol/L, p < 0.001) than those in the survivor group. The area under the curve (AUC) was 0.76 (95% CI 0.73–0.79, p < 0.001), and the optimal BUN level cutoff was 7.63 mmol/L for hospital mortality. As a continuous variable, BUN level was associated with hospital mortality after adjusting respiratory rate, level of consciousness, pH, PCO2, lactic acid, albumin, glucose, CRP, hemoglobin, platelet distribution width, D-dimer, and pro-B-type natriuretic peptide (OR 1.10, 95% CI 1.03–1.17, p=0.005). The OR of hospital mortality was significantly higher in the BUN level ≥7.63 mmol/L group than in the BUN level <7.63 mmol/L group in adjusted model (OR 3.29, 95% CI 1.05–10.29, p=0.041). Similar results were found after multiple imputation and in the propensity score matching cohort. Conclusions Increased BUN level at ED admission is associated with hospital mortality in patients with AECOPD who present at the ED. The level of 7.63 mmol/L can be used as a cutoff value for critical stratification.

Abstract 263: Evaluation of Survival Benefit of Statins in Patients with Pulmonary Hypertension and Chronic Obstructive Pulmonary Disease: A Propensity Score Matching Study

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Luise Holzhauser ◽  
Ninel Hovnanian ◽  
Parham Eshtehardi ◽  
Khalid Mojadidi ◽  
David Goodman-Meza ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Hypertension ◽  
Propensity Score ◽  
Statin Therapy ◽  
Propensity Score Matching ◽  
Survival Benefit ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Statin Group ◽  
All Cause Mortality

Background: Pulmonary hypertension (PH) is a multifactorial disease characterized by endothelial dysfunction and inflammation. In line with this, pleiotropic effects of statins have been found beneficial in PH resulting in hemodynamic improvement. However, the role of statins in subgroups of PH, especially inflammation triggered chronic obstructive pulmonary disease (COPD) is unknown and their effect on mortality has not yet been studied. Methods: Consecutive patients ≥18 years with severe PH (pulmonary artery systolic pressure ≥60 mmHg) and preserved left ventricular function (ejection fraction ≥50%) defined by transthoracic echocardiograms were included from January 2002 to August 2012. Patients were divided into two groups based on being on statin therapy for 12 consecutive months after diagnosis of PH. Propensity score matching was performed for all baseline demographics, comorbidities, labs, lipid profile, and medications with ratio matching of 1 (treated) to 5 (untreated controls). Subgroup analysis was done based on COPD status. Study endpoint was 1-year all-cause mortality. Results: 2,363 patients (age 71±16; 31% male) were included, 140 (6%) patients were on statin therapy. 1-year mortality for the entire population was 34%. Following propensity score matching, 137 patients on statin (statin group) and 625 patients not on statin (controls), all-cause mortality was significantly lower in statin group compared to controls (15.3% vs. 36.2%, HR 0.38 [95% CI 0.25, 0.60], p<0.001). After stratifying patients based on COPD status, while statins significantly reduced 1-year all-cause mortality in patients without COPD (HR 0.30 [95%CI 0.16, 0.56], p<0.001), patients with COPD did not show a survival benefit from statins (HR 0.54 [95%CI 0.28, 1.05], p=0.069). Conclusions: In this study, we identify statin therapy as an independent predictor of lower 1-year mortality in patients with severe PH but interestingly not in the subgroup of patients with COPD. This observation might be linked to the high severity of PH in our study population and less likely to the lack of anti-inflammatory effects. However the overall survival benefit in patients with severe PH is a novel and promising finding that needs to be confirmed in large randomized trials.

scholarly journals Inhaled corticosteroid withdrawal may improve outcomes in elderly patients with COPD exacerbation: a nationwide database study

2020 ◽  
Vol 6 (1) ◽  
pp. 00246-2019 ◽  
Author(s):  
Taisuke Jo ◽  
Hideo Yasunaga ◽  
Yasuhiro Yamauchi ◽  
Akihisa Mitani ◽  
Yoshihisa Hiraishi ◽  
...  
Keyword(s):  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Bronchial Asthma ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Obstructive Pulmonary Disease ◽  
Inverse Probability ◽  
Propensity Score Matching Analysis

BackgroundInhaled corticosteroids (ICSs) are used for advanced-stage chronic obstructive pulmonary disease (COPD). The application and safety of ICS withdrawal remain controversial.This study aimed to evaluate the association between ICS withdrawal and outcomes in elderly patients with COPD with or without comorbid bronchial asthma, who were hospitalised for exacerbation.Patients and methodsWe conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2016. We identified patients aged ≥65 years who were hospitalised for COPD exacerbation. Re-hospitalisation for COPD exacerbation or death, frequency of antimicrobial medicine prescriptions and frequency of oral corticosteroid prescriptions after discharge were compared between patients with withdrawal and continuation of ICSs using propensity score analyses, namely 1–2 propensity score matching and stabilised inverse probability of treatment weighting.ResultsAmong 3735 eligible patients, 971 and 2764 patients had ICS withdrawal and continuation, respectively. The hazard ratios (95% confidence intervals) of re-hospitalisation for COPD exacerbation or death for ICS withdrawal compared to continuation were 0.65 (0.52–0.80) in the propensity score matching and 0.71 (0.56–0.90) in the inverse probability of treatment weighting. The frequency of antimicrobial prescriptions but not corticosteroid prescriptions within 1 year was significantly less in the ICS withdrawal group. Among patients with comorbid bronchial asthma, ICS withdrawal was significantly associated with reduced re-hospitalisation for COPD exacerbation or death only in the propensity score matching analysis.ConclusionICS withdrawal after COPD exacerbation was significantly associated with reduced incidences of re-hospitalisation or death among elderly patients, including those with comorbid bronchial asthma.

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