scholarly journals Early Start Hemodialysis With A Catheter is Associated With Greater Mortality: A Propensity Score Analysis

2021 ◽  
Author(s):  
Gustavo Laham ◽  
Gervasio Soler Pujol ◽  
Jenny Guzman ◽  
Natalia Boccia ◽  
Anabel Abib ◽  
...  
Keyword(s):  
Propensity Score ◽  
Vascular Access ◽  
Propensity Scores ◽  
Propensity Score Analysis ◽  
Survival Rates ◽  
Rank Test ◽  
Dialysis Unit ◽  
Early Start ◽  
The Impact ◽  
Morbid Conditions

Abstract Introduction: Deciding when and how to initiate hemodialysis (HD) is still controversial. An early start (ES) seems to show a lack of benefit. “Lead time bias" and comorbidities have been associated with different outcomes in ES groups. On the other hand, it is well accepted the impact that the type of vascular access (VA) has on patient survival. Our aim was to evaluate survival with early start (ES) vs. late start (LS) on HD, taking into account the vascular access (VA) used.Methods: Between 01/95 and 06/18, 503 incidental patients initiated HD at our Dialysis Unit. eGFR was estimated by the CKD-EPI equation. Diabetes mellitus (DM), coronary disease (CD), and peripheral vascular disease (PVD) were considered co-morbid conditions. According to eGFR and VA, patients were divided into four groups: G1: ES (eGFR > 7 ml/min) with catheter (ES+C), G2: ES with fistula or graft (F/G) (ES+F/G), G3: LS (eGFR< 7 ml/min) with catheter (LS+C), and G4: LS with F/G (LS+F/G). The cut-off value to define ES or LS was based on median eGFR for these 503 patients. We compared patient’s survival rates by Kaplan-Meier and log-rank test. The four groups were compared before and after matching with propensity scores (PS). Cox analysis was performed to determine the impact of predictors of mortality. Results: Median eGFR was 7 (5.3-9.5) ml/min/1.73m2, median follow-up time was 30.9 (13-50) months, 52.1% had F/G access at entry, and 46.9 % died during the observation period. Among the four groups, the ES+C were significantly older, there were more diabetics and co-morbid conditions, while phosphatemia, iPTH, albumin, and hemoglobin were significantly higher in the LS groups. Before propensity score (PS) matching, the ES+C group had a poor survival rate (P<0.0001), while LS+F/G access had the best survival. After PS, a total of 180 patients were selected in the same four groups and ES+C kept showing a statistically significant poorer survival. Multivariate analysis revealed that ES+C was an independent predictor of mortality.Conclusion: In this retrospective study, ES+C on HD was associated with a higher mortality rate than LS. This association persisted after PS matching.

scholarly journals Burden of motorcyclists without helmets in a state without a universal helmet law: a propensity score analysis

2020 ◽  
Vol 5 (1) ◽  
pp. e000583
Author(s):  
Michael D Jones ◽  
Joel G Eastes ◽  
Damjan Veljanoski ◽  
Kristina M Chapple ◽  
James N Bogert ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Alcohol Intoxication ◽  
Civil Liberties ◽  
Hospital Charges ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Helmet Use ◽  
Score Analysis ◽  
The Impact

BackgroundAlthough helmets are associated with reduction in mortality from motorcycle collisions, many states have failed to adopt universal helmet laws for motorcyclists, in part on the grounds that prior research is limited by study design (historical controls) and confounding variables. The goal of this study was to evaluate the association of helmet use in motorcycle collisions with hospital charges and mortality in trauma patients with propensity score analysis in a state without a universal helmet law.MethodsMotorcycle collision data from the Arizona State Trauma Registry from 2014 to 2017 were propensity score matched by regressing helmet use on patient age, sex, race/ethnicity, alcohol intoxication, illicit drug use, and comorbidities. Linear and logistic regression models were used to evaluate the impact of helmet use.ResultsOur sample consisted of 6849 cases, of which 3699 (54.0%) were helmeted and 3150 (46.0%) without helmets. The cohort was 88.1% male with an average age of 40.9±16.0 years. Helmeted patients were less likely to be admitted to the intensive care unit (20.3% vs. 23.7%, OR 0.82 (0.72–0.93)) and ventilated (7.8% vs. 12.0%, OR 0.62 (0.52–0.75)). Propensity-matched analyses consisted of 2541 pairs and demonstrated helmet use to be associated with an 8% decrease in hospital charges (B −0.075 (0.034)) and a 56% decrease in mortality (OR 0.44 (0.31–0.58)).DiscussionIn a state without mandated helmet use for all motorcyclists, the burden of the unhelmeted rider is significant with respect to lives lost and healthcare charges incurred. Although the helmet law debate with respect to civil liberties is complex and unsettled, it appears clear that helmet use is strongly associated with both survival and less economic encumbrance on the state.Level of evidenceLevel III, prognostic and epidemiological.

Propensity score specification for optimal estimation of average treatment effect with binary response

2020 ◽  
Vol 29 (12) ◽  
pp. 3623-3640
Author(s):  
John A Craycroft ◽  
Jiapeng Huang ◽  
Maiying Kong
Keyword(s):  
Propensity Score ◽  
Treatment Effect ◽  
Propensity Scores ◽  
Optimal Estimation ◽  
Theoretical Explanation ◽  
Average Treatment Effect ◽  
Adaptive Lasso ◽  
Confounding Bias ◽  
Average Treatment ◽  
The Impact

Propensity score methods are commonly used in statistical analyses of observational data to reduce the impact of confounding bias in estimations of average treatment effect. While the propensity score is defined as the conditional probability of a subject being in the treatment group given that subject’s covariates, the most precise estimation of average treatment effect results from specifying the propensity score as a function of true confounders and predictors only. This property has been demonstrated via simulation in multiple prior research articles. However, we have seen no theoretical explanation as to why this should be so. This paper provides that theoretical proof. Furthermore, this paper presents a method for performing the necessary variable selection by means of elastic net regression, and then estimating the propensity scores so as to obtain optimal estimates of average treatment effect. The proposed method is compared against two other recently introduced methods, outcome-adaptive lasso and covariate balancing propensity score. Extensive simulation analyses are employed to determine the circumstances under which each method appears most effective. We applied the proposed methods to examine the effect of pre-cardiac surgery coagulation indicator on mortality based on a linked dataset from a retrospective review of 1390 patient medical records at Jewish Hospital (Louisville, KY) with the Society of Thoracic Surgeons database.

scholarly journals Propensity score analysis exploring the impact of smoking and drinking on the prognosis of patients with oral cancer

Head & Neck ◽  
2020 ◽  
Vol 42 (8) ◽  
pp. 1837-1847 ◽  
Author(s):  
Xiaodan Bao ◽  
Fengqiong Liu ◽  
Qing Chen ◽  
Lin Chen ◽  
Jing Lin ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Propensity Score ◽  
Propensity Score Analysis ◽  
Score Analysis ◽  
The Impact

scholarly journals Long-term outcomes of omentum-preserving versus resecting gastrectomy for locally advanced gastric cancer with propensity score analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yusuke Sakimura ◽  
Noriyuki Inaki ◽  
Toshikatsu Tsuji ◽  
Shinichi Kadoya ◽  
Hiroyuki Bando
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Missing Values ◽  
Propensity Score Analysis ◽  
Locally Advanced ◽  
R0 Resection ◽  
Significant Difference ◽  
First Recurrence ◽  
The Impact

Abstract Omentectomy is conducted for advanced gastric cancer (AGC) patients as radical surgery without an adequate discussion of the effect. This study was conducted to reveal the impact of omentum-preserving gastrectomy on postoperative outcomes. AGC patients with cT3 and 4 disease who underwent total or distal gastrectomy with R0 resection were identified retrospectively. They were divided into the omentum-preserved group (OPG) and the omentum-resected group (ORG) and matched with propensity score matching with multiple imputation for missing values. Three-year overall survival (OS) and 3-year relapse-free survival (RFS) were compared, and the first recurrence site and complications were analysed. The numbers of eligible patients were 94 in the OPG and 144 in the ORG, and after matching, the number was 73 in each group. No significant difference was found in the 3-year OS rate (OPG: 78.9 vs. ORG: 78.9, P = 0.54) or the 3-year RFS rate (OPG: 77.8 vs. ORG: 68.2, P = 0.24). The proportions of peritoneal carcinomatosis and peritoneal dissemination as the first recurrence site and the rate and severity of complications were similar in the two groups. Omentectomy is not required for radical gastrectomy for AGC.

Using Propensity Scores to Reduce Selection Bias in Mathematics Education Research

2010 ◽  
Vol 41 (2) ◽  
pp. 147-168 ◽  
Author(s):  
Suzanne E. Graham
Keyword(s):  
Education Research ◽  
Mathematics Education ◽  
Propensity Score ◽  
Selection Bias ◽  
Propensity Scores ◽  
Mathematics Education Research ◽  
Causal Inferences ◽  
Propensity Score Methods ◽  
Mathematics Classrooms ◽  
The Impact

Selection bias is a problem for mathematics education researchers interested in using observational rather than experimental data to make causal inferences about the effects of different instructional methods in mathematics on student outcomes. Propensity score methods represent 1 approach to dealing with such selection bias. This article describes general principles underlying propensity score methods and illustrates their application to mathematics education research using 2 examples investigating the impact of problem-solving emphasis in mathematics classrooms on students' subsequent mathematics achievement and course taking. Limitations of the method are discussed.

scholarly journals Association of vascular access flow with short-term and long-term mortality in chronic haemodialysis patients: a retrospective cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017035 ◽  
Author(s):  
Chung-Kuan Wu ◽  
Chia-Lin Wu ◽  
Chia-Hsun Lin ◽  
Jyh-Gang Leu ◽  
Chew-Teng Kor ◽  
...  
Keyword(s):  
Cohort Study ◽  
Vascular Access ◽  
Secondary Outcome ◽  
Rank Test ◽  
Chronic Haemodialysis ◽  
Short Term ◽  
All Cause Mortality ◽  
The Impact ◽  
Vascular Mortality

ObjectivesTo investigate the impact of vascular access flow (Qa) on vascular and all-cause mortality in chronic haemodialysis (HD) patients.DesignObservational cohort study.SettingSingle centre.ParticipantsAdult chronic HD patients at the HD unit of Shin Kong Wu Ho-Su Memorial Hospital between 1 January 2003 and 31 December 2003 were recruited. Patients were excluded if they had arteriovenous fistula or arteriovenous graft failure within 3 months before the date of Qa measurement, were aged <18 years and had Qa levels of ≥2000mL/min. A total of 378 adult chronic HD patients were eventually enrolled for the study.InterventionsThe selected patients were evaluated with Qa and cardiac index (CI). They were divided into four groups according to three Qa cut-off points (500, 1000 and 1500 mL/min).Primary and secondary outcome measuresShort-term and long-term vascular (cardiovascular or cerebrovascular) and all-cause mortality.ResultsQa was positively correlated with CI (r=0.48, p<0.001). A Qa level of <1000 mL/min was independently associated with 1-year all-cause mortality (adjusted OR, 6.04; 95% CI 1.64 to 22.16; p=0.007). Kaplan-Meier analysis revealed that the cumulative incidence rates of all-cause and vascular mortality were significantly higher in the patients with a Qa level of <1000 mL/min (log-rank test; all p<0.01). Furthermore, a Qa level of <1000 mL/min was independently associated with long-term all-cause mortality (adjusted HR, 1.62; 95% CI 1.11 to 2.37; p=0.013); however, the risk of vascular mortality did not significantly increase after adjustment for confounders.ConclusionsQa is moderately correlated with cardiac function, and a Qa level of <1000 mL/min is an independent risk factor for both short-term and long-term all-cause mortality in chronic HD patients.

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