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

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01608-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Masaru Ejima ◽

Tsukasa Okamoto ◽

Takafumi Suzuki ◽

Tatsuhiko Anzai ◽

Kunihiko Takahashi ◽

...

Keyword(s):

Propensity Score ◽

Hypersensitivity Pneumonitis ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cohort Analysis ◽

Corticosteroid Treatment ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Matched Cohort ◽

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 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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Effects of Corticosteroid Treatment and Antigen Avoidance in a Large Hypersensitivity Pneumonitis Cohort: A Single-Centre Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm8010014 ◽

2018 ◽

Vol 8 (1) ◽

pp. 14 ◽

Cited By ~ 20

Author(s):

Laurens De Sadeleer ◽

Frederik Hermans ◽

Els De Dycker ◽

Jonas Yserbyt ◽

Johny Verschakelen ◽

...

Keyword(s):

Therapeutic Effect ◽

Median Survival ◽

Hypersensitivity Pneumonitis ◽

Proportional Hazards Model ◽

Pulmonary Function Tests ◽

Corticosteroid Treatment ◽

Cox Proportional Hazards Model ◽

Therapeutic Interventions ◽

Mixed Effect ◽

Dismal Prognosis

Background: Although the third most frequent interstitial lung disease, hypersensitivity pneumonitis (HP) remains an enigmatic disease without clear diagnostic and therapeutic guidelines. We assessed the effect of the commonly used therapeutic interventions (i.e. exposure avoidance and corticosteroid treatment) in an HP cohort. Methods: We collected clinical data of all HP patients followed at our centre between January 1, 2005, and December 31, 2016. HP patients were stratified according to the presence of fibrosis on chest CT. Survival was analysed using the multivariate Cox proportional hazards model. Forced vital capacity (percent predicted, FVC%) and diffusing capacity of the lung for carbon monoxide (percent predicted, DLCO%) evolution were analysed using linear mixed-effect models. Results: Two hundred and two HP patients were identified: 93 non-fibrotic HP (nfHP) and 109 fibrotic HP (fHP), experiencing a monthly FVC% decline before treatment of 0.93% and 0.56%, respectively. While nfHP had an excellent survival, fHP patients experienced a median survival of 9.2 years. Corticosteroid treatment and exposure avoidance did not result in survival differences. Although nfHP patients showed FVC% and DLCO% increase after corticosteroid initiation, no therapeutic effect was seen in fHP patients. FVC% and DLCO% increased in nfHP patients after exposure avoidance, while a positive numerical trend was seen for FVC% after exposure avoidance in fHP patients (p = 0.15). Conclusions: nfHP patients experienced an excellent survival with good therapeutic effect on pulmonary function tests with both corticosteroid initiation as well as antigen avoidance. In contrast, fHP patients experienced a dismal prognosis (median survival of 9.2 years) without any therapeutic effect of corticosteroid treatment. Whether antigen avoidance is useful in fHP patients is still unclear.

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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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SAT-015 Incidence and Predictors of Hypertension in a Cohort of Australian Women with and Without Polycystic Ovary Syndrome

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.233 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Nadira Sultana Kakoly ◽

Arul Earnest ◽

Deborah Loxton ◽

Helena Jane Teede ◽

Anju Elizabeth Joham

Keyword(s):

Polycystic Ovary Syndrome ◽

Proportional Hazards Model ◽

Polycystic Ovary ◽

Cohort Analysis ◽

Early Adulthood ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Adult Women ◽

Ovary Syndrome

Abstract Background: There is a lack of longitudinal studies exploring the relationships between polycystic ovary syndrome (PCOS) and hypertension, in population-based settings. Objectives: To identify predictors of hypertension in women with and without PCOS and the relationship to body mass of index (BMI). Methods: We undertook a community-based cohort analysis of the Australian Longitudinal Study (ALSWH) data conducted on 9,688 young adult women, aged 21–42 years from 2000–2015. We conducted survival analysis using the Cox Proportional Hazards Model to identify predictors and person-time analysis to calculate incidence rates of hypertension. Results: Overall, 9,508 women were followed for 145,159 PY (person-years) and 1,556 (16.37%) women developed hypertension during the follow-up. The incidence of hypertension was significantly higher (p = 0.001) among women with PCOS (17/1000 PY) compared to women without (11/1000 PY). There were significant differences in time to hypertension development between women +/- PCOS. Hypertension was observed among women with PCOS from early adulthood and across BMI categories. The difference in the actual number of incident hypertension cases (incidence rate difference (IRD)) between women with and without PCOS, was fourfold higher (15.8 vs. 4.3 respectively) among women who were obese at baseline, compared to age-matched lean women. PCOS was independently associated with hypertension with a 36% greater risk, adjusting for BMI and other confounders. Conclusion: Our results suggest women with PCOS as more likely to develop hypertension from early adulthood, independent of BMI and with risk exacerbated by obesity.

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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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Survival rate of patients with bladder cancer and its related factors in Kurdistan Province (2013–2018): a population-based study

BMC Urology ◽

10.1186/s12894-020-00769-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mozhdeh Amiri ◽

Sofimajidpour Heshmatollah ◽

Nader Esmaeilnasab ◽

Jamshid Khoubi ◽

Ebrahim Ghaderi ◽

...

Keyword(s):

Bladder Cancer ◽

Survival Rate ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Population Based ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Disease Stage ◽

Related Factors ◽

Hazards Model

Abstract Background Bladder cancer is one of the most common urinary tract cancers. This study aims to estimate the survival rate of patients with bladder cancer according to the Cox proportional hazards model based on some key relevant variables. Methods In this retrospective population-based cohort study that explores the survival of patients with bladder cancer and its related factors, we first collected demographic information and medical records of 321 patients with bladder cancer through in-person and telephone interviews. Then, in the analysis phase, Kaplan–Meier method and log-rank test were used to draw the survival curve, compare the groups, and explore the effect of risk factors on the patient survival rate using Cox proportional hazards model. Results The median survival rate of patients was 63.2 (54.7–72) months and one, three and five-year survival rates were 87%, 68% and 54%, respectively. The results of multiple analyses using Cox's proportional hazards model revealed that variables of sex (male gender) (HR = 11.8, 95% CI: 0.4–100.7), more than 65 year of age (HR = 4.1, 95% CI: 0.4–11), occupation, income level, (HR = 0.4, 95% CI: 0.2–0.8), well differentiated tumor grade (HR = 3.2, 95% CI: 1.7–6) and disease stage influenced the survival rate of patients (p < 0.05). Conclusion The survival rate of patients with bladder cancer in Kurdistan province is relatively low. Given the impact of the disease stage on the survival rate, adequate access to appropriate diagnostic and treatment services as well as planning for screening and early diagnosis, especially in men, can increase the survival rate of patients.

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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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