Midazolam Increases The Risk of Delirium In Critically Ill Patients: A Propensity Score Analysis.

Abstract BACKGROUND: Midazolam is commonly administered in the intensive care unit (ICU) because of its limited effect on hemodynamics and stable calming and sleep-induction effects. Recent concerns about an increased risk of delirium associated with midazolam have resulted in decreased midazolam usage in the ICU. However, whether midazolam administration within 24 hours prior is related to the occurrence of delirium is still unknown.METHODS: We used real-world data from MIMIC III v1.4, MIMIC-IV v0.4 and eICU Collaborative Research to perform comparisons and assess the associated outcome effectiveness. We performed a systematic study with two cohorts to estimate the relative risks of outcomes among patients administered midazolam within 24 hours prior to delirium assessment. Propensity score matching was performed to generate a balanced 1:1 matched cohort and to identify potential prognostic factors. The outcomes included mortality, length of ICU stay, length of hospitalization, and odds of being discharged home.RESULTS: Propensity matching successfully balanced covariates for 9,348 patients (4,674 per group). There was no significant difference in hospitalization duration, (P = 0.03). However, compared to no administration of midazolam, midazolam administration was associated with a significantly higher risk for delirium (P<0.001). When compared with no midazolam administration, the use of midazolam, was associated with higher mortality and a longer ICU stay (P<0.001). Patients treated with midazolam were relatively less likely to be discharged home (P<0.001). CONCLUSIONS: Compared with no administration of midazolam, midazolam administration was associated with a difference in the incidence of delirium, mortality, ICU stay and likelihood of being discharged home but was not associated with hospitalization duration. These data suggest that midazolam may not be the preferred sedative drug for patients at risk for delirium.

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Procedural times in early non-intubated VATS program - a propensity score analysis

BMC Anesthesiology ◽

10.1186/s12871-021-01270-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Isabella Metelmann ◽

Johannes Broschewitz ◽

Uta-Carolin Pietsch ◽

Gerald Huschak ◽

Uwe Eichfeld ◽

...

Keyword(s):

Propensity Score ◽

Surgical Procedure ◽

Recovery Time ◽

Propensity Score Analysis ◽

Wedge Resection ◽

University Hospital ◽

Implementation Phase ◽

Score Analysis ◽

Significant Difference ◽

Procedural Time

Abstract Background Non-intubated video-assisted thoracic surgery (NiVATS) has been introduced to surgical medicine in order to reduce the invasiveness of anesthetic procedures and avoid adverse effects of intubation and one-lung ventilation (OLV). The aim of this study is to determine the time effectiveness of a NiVATS program compared to conventional OLV. Methods This retrospective analysis included all patients in Leipzig University Hospital that needed minor VATS surgery between November 2016 and October 2019 constituting a NiVATS (n = 67) and an OLV (n = 36) group. Perioperative data was matched via propensity score analysis, identifying two comparable groups with 23 patients. Matched pairs were compared via t-Test. Results Patients in NiVATS and OLV group show no significant differences other than the type of surgical procedure performed. Wedge resection was performed significantly more often under NiVATS conditions than with OLV (p = 0,043). Recovery time was significantly reduced by 7 min (p = 0,000) in the NiVATS group. There was no significant difference in the time for induction of anesthesia, duration of surgical procedure or overall procedural time. Conclusions Recovery time was significantly shorter in NiVATS, but this effect disappeared when extrapolated to total procedural time. Even during the implementation phase of NiVATS programs, no extension of procedural times occurs.

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Neutrophil-to-lymphocyte ratio is a prognostic factor for colon cancer: a propensity score analysis

10.21203/rs.3.rs-22564/v1 ◽

2020 ◽

Author(s):

Junichi Mazaki ◽

Kenji katsumata ◽

Kenta Kasahara ◽

Tomoya Tago ◽

Takahiro Wada ◽

...

Keyword(s):

Colon Cancer ◽

Prognostic Factor ◽

Propensity Score ◽

Propensity Score Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Oncologic Outcomes ◽

Lymphocyte Ratio ◽

Score Analysis ◽

Significant Difference

Abstract Background: A large number of patients suffer recurrence after curative resection, and mortality from colon cancer remains high. The role of cancer-associated malnutrition such as the neutrophil-to-lymphocyte ratio (NLR) in cancer recurrence and death has been increasingly recognized. This study aimed to analyze long-term oncologic outcomes of Stage II-III colon cancer to examine the prognostic value of NLR using a propensity score analysis.Methods: A total of 442 patients with colon cancer underwent radical surgery between 2000 and 2014 at Tokyo Medical University Hospital. Long-term oncologic outcomes of these patients were evaluated according to NLR values. A cut-off NLR of 3.0 was used based on receiver operating characteristic curve analysis. A propensity score analysis according to tumor sidedness was also performed. Primary outcomes were overall survival (OS) and relapse-free survival (RFS). Results: Patients with lower NLR values (“lower NLR group”) were more likely to have lymph node metastasis compared to those with higher NLR values (“higher NLR group”) before case matching. After case matching, clinical outcomes were similar between the two groups. There were no significant difference in 5-year OS and 5-year RFS rates between the two groups before case matching based on propensity scores. After case matching, 5-year OS rates were 94.5% in the lower NLR group (n = 135) and 87.0% in the higher NLR group (n = 135), showing a significant difference (p = 0.042). Five-year RFS rates were 87.8% in the lower NLR group and 77.9% in the higher NLR group, also showing a significant difference (p = 0.032). Among patients with left-sided colon cancer, 5-year OS and 5-year RFS rates were 95.2% and 87.3% in the lower NLR group (n = 88), respectively, and 86.4% and 79.2% in the higher NLR group (n = 71), respectively, showing significant differences (p = 0.014 and p = 0.047, respectively).Conclusions: The NLR is an important prognostic factor for advanced colon cancer, especially for left-sided colon cancer.

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Endovascular therapy versus microsurgical clipping of unruptured wide-neck aneurysms: a prospective multicenter study with propensity score analysis

Journal of Neurosurgery ◽

10.3171/2021.10.jns211942 ◽

2021 ◽

pp. 1-8

Keyword(s):

Propensity Score ◽

Clinical Outcome ◽

Endovascular Therapy ◽

Multicenter Study ◽

Propensity Score Analysis ◽

Prospective Multicenter Study ◽

Neck Width ◽

Score Analysis ◽

Increased Risk ◽

Wide Neck

OBJECTIVE Numerous techniques have been developed to treat wide-neck aneurysms (WNAs), each with different safety and efficacy profiles. Few studies have compared endovascular therapy (EVT) with microsurgery (MS). The authors’ objective was to perform a prospective multicenter study of a WNA registry using rigorous outcome assessments and to compare EVT and MS using propensity score analysis (PSA). METHODS Unruptured, saccular, not previously treated WNAs were included. WNA was defined as an aneurysm with a neck width ≥ 4 mm or a dome-to-neck ratio (DTNR) < 2. The primary outcome was modified Rankin Scale (mRS) score at 1 year after treatment (good outcome was defined as mRS score 0–2), as assessed by blinded research nurses and compared with PSA. Angiographic outcome was assessed using the Raymond scale with core laboratory review (adequate occlusion was defined as Raymond scale score 1–2). RESULTS The analysis included 224 unruptured aneurysms in the EVT cohort (n = 140) and MS cohort (n = 84). There were no differences in baseline demographic characteristics, such as proportion of patients with good baseline mRS score (94.3% of the EVT cohort vs 94.0% of the MS cohort, p = 0.941). WNA inclusion criteria were similar between cohorts, with the most common being both neck width ≥ 4 mm and DTNR < 2 (50.7% of the EVT cohort vs 50.0% of the MS cohort, p = 0.228). More paraclinoid (32.1% vs 9.5%) and basilar tip (7.1% vs 3.6%) aneurysms were treated with EVT, whereas more middle cerebral artery (13.6% vs 42.9%) and pericallosal (1.4% vs 4.8%) aneurysms were treated with MS (p < 0.001). EVT aneurysms were slightly larger (p = 0.040), and MS aneurysms had a slightly lower mean DTNR (1.4 for the EVT cohort vs 1.3 for the MS cohort, p = 0.010). Within the EVT cohort, 9.3% of patients underwent stand-alone coiling, 17.1% balloon-assisted coiling, 34.3% stent-assisted coiling, 37.1% flow diversion, and 2.1% PulseRider-assisted coiling. Neurological morbidity secondary to a procedural complication was more common in the MS cohort (10.3% vs 1.4%, p = 0.003). One-year mRS scores were assessed for 218 patients (97.3%), and no significantly increased risk of poor clinical outcome was found for the MS cohort (OR 2.17, 95% CI 0.84–5.60, p = 0.110). In an unadjusted direct comparison, more patients in the EVT cohort achieved a good clinical outcome at 1 year (93.4% vs 84.1%, p = 0.048). Final adequate angiographic outcome was superior in the MS cohort (97.6% of the MS cohort vs 86.5% of the EVT cohort, p = 0.007). CONCLUSIONS Although the treatments for unruptured WNA had similar clinical outcomes according to PSA, there were fewer complications and superior clinical outcome in the EVT cohort and superior angiographic outcomes in the MS cohort according to the unadjusted analysis. These results may be considered when selecting treatment modalities for patients with unruptured WNAs.

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Nephrectomy Is Not Associated with Increased Risk of Mortality or Acute Kidney Injury After High-Grade Renal Trauma: A Propensity Score Analysis of the Trauma Quality Improvement Program (TQIP)

The Journal of Urology ◽

10.1097/ju.0000000000002253 ◽

2021 ◽

Author(s):

Benjamin J. McCormick ◽

Joshua J. Horns ◽

Rupam Das ◽

Niraj Paudel ◽

Heidi A. Hanson ◽

...

Keyword(s):

Acute Kidney Injury ◽

Quality Improvement ◽

Propensity Score ◽

Propensity Score Analysis ◽

Kidney Injury ◽

High Grade ◽

Improvement Program ◽

Risk Of Mortality ◽

Score Analysis ◽

Increased Risk

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Increased Neonatal Respiratory Morbidity Associated with Gestational and Pregestational Diabetes: A Retrospective Study

American Journal of Perinatology ◽

10.1055/s-0037-1604414 ◽

2017 ◽

Vol 34 (11) ◽

pp. 1160-1168 ◽

Cited By ~ 6

Author(s):

T. Kawakita ◽

K. Bowers ◽

S. Hazrati ◽

C. Zhang ◽

J. Grewal ◽

...

Keyword(s):

Retrospective Study ◽

Propensity Score ◽

Gestational Diabetes ◽

Distress Syndrome ◽

Propensity Score Analysis ◽

Respiratory Morbidity ◽

Pregestational Diabetes ◽

Score Analysis ◽

Increased Risk ◽

Singleton Pregnancies

Objective To examine the risk of neonatal respiratory morbidity associated with gestational and pregestational diabetes, accounting for the prematurity-associated risk using a propensity score analysis. Study design In a retrospective study including 222,978 singleton pregnancies, delivering at 240/7 to 416/7 weeks (2002–2008), we calculated a probability to deliver at term (≥37 weeks of gestation). Outcomes were stratified by the probability to deliver at term (>0.8 and ≤0.8). Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated. Results Gestational and pregestational diabetes complicated 5.1 and 1.5% of pregnancies, respectively, and were associated with increased risks of neonatal respiratory morbidity compared with women without diabetes regardless of probability to deliver at term. However, these risks tended to be higher with a higher probability to deliver at term: respiratory distress syndrome (aOR: 1.5; 95% CI: 1.3–1.7 and aOR: 3.1; 95% CI: 2.6–3.7); transient tachypnea of newborn (aOR: 1.5; 95% CI: 1.3–1.6 and aOR: 2.2; 95% CI: 1.9–2.6); and apnea (aOR: 1.5; 95% CI: 1.2–1.7 and aOR: 3.2; 95% CI: 2.6–3.9, for gestational and pregestational at term, respectively). Conclusion Diabetes was associated with increased risk of neonatal respiratory morbidity beyond what can be attributed to prematurity. Neonatal respiratory morbidities were increased with pregestational diabetes compared with gestational diabetes.

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Neutrophil-to-lymphocyte ratio is a prognostic factor for colon cancer: a propensity score analysis

10.21203/rs.3.rs-22564/v3 ◽

2020 ◽

Author(s):

Junichi Mazaki ◽

Kenji katsumata ◽

Kenta Kasahara ◽

Tomoya Tago ◽

Takahiro Wada ◽

...

Keyword(s):

Colon Cancer ◽

Prognostic Factor ◽

Propensity Score ◽

Propensity Score Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Oncologic Outcomes ◽

Lymphocyte Ratio ◽

Score Analysis ◽

Significant Difference

Abstract Background: A large number of patients suffer recurrence after curative resection, and mortality from colon cancer remains high. The role of systemic inflammatory response, as reflected by neutrophil-to-lymphocyte ratio (NLR), in cancer recurrence and death has been increasingly recognized. This study aimed to analyze long-term oncologic outcomes of Stage II-III colon cancer to examine the prognostic value of NLR using a propensity score analysis.Methods: A total of 375 patients with colon cancer underwent radical surgery between 2000 and 2014 at Tokyo Medical University Hospital. Long-term oncologic outcomes of these patients were evaluated according to NLR values. A cut-off NLR of 3.0 was used based on receiver operating characteristic curve analysis. Primary outcomes were overall survival (OS) and relapse-free survival (RFS). An analysis of outcomes according to tumor sidedness was also performed.Results: Patients with lower NLR values (“lower NLR group”) were more likely to have lymph node metastasis compared to those with higher NLR values (“higher NLR group”) before case matching. After case matching, clinical outcomes were similar between the two groups. There were no significant differences in 5-year OS and 5-year RFS rates between the two groups before case matching based on propensity scores. After case matching, 5-year OS rates were 94.5% in the lower NLR group (n = 135) and 87.0% in the higher NLR group (n = 135), showing a significant difference (p = 0.042). Five-year RFS rates were 87.8% in the lower NLR group and 77.9% in the higher NLR group, also showing a significant difference (p = 0.032). Among patients with left-sided colon cancer in the matched cohort, 5-year OS and 5-year RFS rates were 95.2% and 87.3% in the lower NLR group (n = 88), respectively, and 86.4% and 79.2% in the higher NLR group (n = 71), respectively, showing significant differences (p = 0.014 and p = 0.047, respectively).Conclusions: The NLR is an important prognostic factor for advanced colon cancer, especially for left-sided colon cancer.

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Neutrophil-to-lymphocyte ratio is a prognostic factor for colon cancer: a propensity score analysis

10.21203/rs.3.rs-22564/v2 ◽

2020 ◽

Author(s):

Junichi Mazaki ◽

Kenji katsumata ◽

Kenta Kasahara ◽

Tomoya Tago ◽

Takahiro Wada ◽

...

Keyword(s):

Colon Cancer ◽

Prognostic Factor ◽

Propensity Score ◽

Propensity Score Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Oncologic Outcomes ◽

Lymphocyte Ratio ◽

Score Analysis ◽

Significant Difference

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Neutrophil-to-lymphocyte ratio is a prognostic factor for colon cancer: a propensity score analysis

BMC Cancer ◽

10.1186/s12885-020-07429-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Junichi Mazaki ◽

Kenji Katsumata ◽

Kenta Kasahara ◽

Tomoya Tago ◽

Takahiro Wada ◽

...

Keyword(s):

Colon Cancer ◽

Prognostic Factor ◽

Propensity Score ◽

Propensity Score Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Oncologic Outcomes ◽

Lymphocyte Ratio ◽

Score Analysis ◽

Significant Difference

Abstract Background A large number of patients suffer recurrence after curative resection, and mortality from colon cancer remains high. The role of systemic inflammatory response, as reflected by neutrophil-to-lymphocyte ratio (NLR), in cancer recurrence and death has been increasingly recognized. This study aimed to analyze long-term oncologic outcomes of Stage II-III colon cancer to examine the prognostic value of NLR using a propensity score analysis. Methods A total of 375 patients with colon cancer underwent radical surgery between 2000 and 2014 at Tokyo Medical University Hospital. Long-term oncologic outcomes of these patients were evaluated according to NLR values. A cut-off NLR of 3.0 was used based on receiver operating characteristic curve analysis. Primary outcomes were overall survival (OS) and relapse-free survival (RFS). An analysis of outcomes according to tumor sidedness was also performed. Results Patients with lower NLR values (“lower NLR group”) were more likely to have lymph node metastasis compared to those with higher NLR values (“higher NLR group”) before case matching. After case matching, clinical outcomes were similar between the two groups. There were no significant differences in 5-year OS and 5-year RFS rates between the two groups before case matching based on propensity scores. After case matching, 5-year OS rates were 94.5% in the lower NLR group (n = 135) and 87.0% in the higher NLR group (n = 135), showing a significant difference (p = 0.042). Five-year RFS rates were 87.8% in the lower NLR group and 77.9% in the higher NLR group, also showing a significant difference (p = 0.032). Among patients with left-sided colon cancer in the matched cohort, 5-year OS and 5-year RFS rates were 95.2 and 87.3% in the lower NLR group (n = 88), respectively, and 86.4 and 79.2% in the higher NLR group (n = 71), respectively, showing significant differences (p = 0.014 and p = 0.047, respectively). Conclusions The NLR is an important prognostic factor for advanced colon cancer, especially for left-sided colon cancer.

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