1
|
Xia J, Hu C, Wang L, Zhang Y. Association between statin use on delirium and 30-day mortality in patients with chronic obstructive pulmonary disease in the intensive care unit. Eur J Med Res 2023; 28:572. [PMID: 38062497 PMCID: PMC10704755 DOI: 10.1186/s40001-023-01551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Delirium occurs frequently in patients with chronic obstructive pulmonary disease in the intensive care unit. Effective prevention and treatment strategies for delirium remain limited. We aimed to assess delirium and 30-day mortality in patients with chronic obstructive pulmonary disease who were statin and non-statin users. METHODS In this retrospective study, patients with chronic obstructive pulmonary disease were identified from the Medical Information Mart for Intensive Care database (MIMIC-IV). The primary exposure variable was the use of statins 3 days after entering the intensive care unit and the primary outcome measure was the presence of delirium. The secondary outcome measure was 30-day mortality. Since the cohort study was retrospective, we used an inverse probability weighting derived from the propensity score matching to balance different variables. RESULTS Among a cohort of 2725 patients, 1484 (54.5%) were statin users. Before propensity score matching, the prevalence of delirium was 16% and the 30-day mortality was 18% in patients with chronic obstructive pulmonary disease. Statin use was significantly negatively correlated with delirium, with an odds ratio of 0.69 (95% CI 0.56-0.85, p < 0.001) in the inverse probability weighted cohort and 30-day mortality of 0.7 (95% CI 0.57-0.85, p < 0.001). CONCLUSIONS Statin use is associated with a lower incidence of delirium and 30-day mortality in patients with chronic obstructive pulmonary disease in the intensive care unit.
Collapse
Affiliation(s)
- Jiangling Xia
- Department of Anesthesiology, Zibo Central Hospital, No. 54 Gongqingtuan Road, Zibo, Shandong, China
| | - Chunhuan Hu
- Department of Anesthesiology, The Second Affiliated Hospital of Mudanjiang Medical College, Mudanjiang, Heilongjiang, China
| | - Leilei Wang
- School of Architecture and Engineering, Zibo Vocational Institute, Zibo, Shandong, China
| | - Yuzhu Zhang
- Department of Anesthesiology, Zibo Central Hospital, No. 54 Gongqingtuan Road, Zibo, Shandong, China.
| |
Collapse
|
2
|
Gomeni R, Bressolle-Gomeni F, Fava M. A new method for analyzing clinical trials in depression based on individual propensity to respond to placebo estimated using artificial intelligence. Psychiatry Res 2023; 327:115367. [PMID: 37544088 DOI: 10.1016/j.psychres.2023.115367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 06/28/2023] [Accepted: 07/23/2023] [Indexed: 08/08/2023]
Abstract
One of the major reasons for trial failures in major depressive disorders (MDD) is the presence of unpredictable levels of placebo response as the individual baseline propensity to respond to placebo is not adequately controlled by the current randomization and statistical methodologies. The individual propensity to respond to any treatment or intervention assessed at baseline was considered as a major non-specific prognostic and confounding effect. The objective of this paper was to apply the propensity score methodology to control for potential imbalance at baseline in the propensity to respond to placebo in clinical trials in MDD. Individual propensity was estimated using artificial intelligence (AI) applied to observations collected in two pre-randomization occasions. Cases study are presented using data from two randomized, placebo-controlled trials to evaluate the efficacy of paroxetine in MDD. AI models were used to estimate the individual propensity probability to show a treatment non-specific placebo effect. The inverse of the estimated probability was used as weight in the mixed-effects analysis to assess treatment effect. The comparison of the results obtained with and without propensity weight indicated that the weighted analysis provided an estimate of treatment effect and effect size significantly larger than the conventional analysis.
Collapse
Affiliation(s)
| | | | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Huette P, Moussa MD, Beyls C, Guinot PG, Guilbart M, Besserve P, Bouhlal M, Mounjid S, Dupont H, Mahjoub Y, Michaud A, Abou-Arab O. Association between acute kidney injury and norepinephrine use following cardiac surgery: a retrospective propensity score-weighted analysis. Ann Intensive Care 2022; 12:61. [PMID: 35781575 PMCID: PMC9250911 DOI: 10.1186/s13613-022-01037-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Excess exposure to norepinephrine can compromise microcirculation and organ function. We aimed to assess the association between norepinephrine exposure and acute kidney injury (AKI) and intensive care unit (ICU) mortality after cardiac surgery. Methods This retrospective observational study included adult patients who underwent cardiac surgery under cardiopulmonary bypass from January 1, 2008, to December 31, 2017, at the Amiens University Hospital in France. The primary exposure variable was postoperative norepinephrine during the ICU stay and the primary endpoint was the presence of AKI. The secondary endpoint was in-ICU mortality. As the cohort was nonrandom, inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalances in the pre- and intra-operative characteristics. Results Among a population of 5053 patients, 1605 (32%) were exposed to norepinephrine following cardiac surgery. Before weighting, the prevalence of AKI was 25% and ICU mortality 10% for patients exposed to norepinephrine. Exposure to norepinephrine was estimated to be significantly associated with AKI by a factor of 1.95 (95% confidence interval, 1.63–2.34%; P < 0.001) in the IPW cohort and with in-ICU mortality by a factor of 1.54 (95% confidence interval, 1.19–1.99%; P < 0.001). Conclusion Norepinephrine was associated with AKI and in-ICU mortality following cardiac surgery. While these results discourage norepinephrine use for vasoplegic syndrome in cardiac surgery, prospective investigations are needed to substantiate findings and to suggest alternative strategies for organ protection. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01037-1.
Collapse
Affiliation(s)
- Pierre Huette
- Department of Anesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, 80054, Amiens, France
| | - Mouhamed Djahoum Moussa
- Anesthesia and Critical Care Department, Institut Coeur-Poumon, Lille Hospital University, 59000, Lille, France
| | - Christophe Beyls
- Department of Anesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, 80054, Amiens, France
| | - Pierre-Grégoire Guinot
- Department of Anesthesiology and Critical Care Medicine, Dijon University Hospital, 21000, Dijon, France
| | - Mathieu Guilbart
- Department of Anesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, 80054, Amiens, France
| | - Patricia Besserve
- Department of Anesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, 80054, Amiens, France
| | - Mehdi Bouhlal
- Department of Anesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, 80054, Amiens, France
| | - Sarah Mounjid
- Department of Anesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, 80054, Amiens, France
| | - Hervé Dupont
- Department of Anesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, 80054, Amiens, France
| | - Yazine Mahjoub
- Department of Anesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, 80054, Amiens, France
| | - Audrey Michaud
- Department of Biostatistics, Amiens Picardy University Hospital, 80054, Amiens, France
| | - Osama Abou-Arab
- Department of Anesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, 80054, Amiens, France.
| |
Collapse
|
4
|
Pazdernik M, Iung B, Mutlu B, Alla F, Riezebos R, Kong W, Nunes MCP, Pierard L, Srdanovic I, Yamada H, De Martino A, Miglioranza MH, Magne J, Piper C, Laroche C, Maggioni AP, Lancellotti P, Habib G, Selton-Suty C. Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry. Infection 2022; 50:1191-1202. [PMID: 35290614 DOI: 10.1007/s15010-022-01792-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/24/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. METHODS Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. RESULTS As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43-3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). CONCLUSION Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.
Collapse
Affiliation(s)
- Michal Pazdernik
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.,Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, APHP, Université de Paris, Paris, France
| | - Bulent Mutlu
- Department of Cardiology, Marmara University Hospital, Pendik, Istanbul, Turkey
| | | | | | - William Kong
- National University Heart Centre Singapore, Singapore, Singapore
| | | | - Luc Pierard
- University Hospital Sart Tilman, University of Liege, Liege, Belgium
| | | | - Hirotsugu Yamada
- Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | | | | | - Julien Magne
- Cardiology Dept, CHU Limoges, INSERM 1094, University Hospital Dupuytren, 87042, Limoges, France
| | - Cornelia Piper
- Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Biot, France
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, Biot, France.,Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | | | - Gilbert Habib
- Cardiology Dept, APHM, La Timone Hospital, Marseille, France.,Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Christine Selton-Suty
- Cardiology Dept, CIC-ECCHU Nancy-Brabois, 54000, Nancy, France. .,Association pour l'Etude et la Prevention de l'Endocardite Infectieuse (AEPEI), Paris, France.
| | | |
Collapse
|
5
|
Yang HY, Shi SF, Wang SX, Lyu JC, Zhang H. [The effect of endocapillary hypercellularity lesions on the renal prognosis and response to immunosuppressive therapy in IgA nephropathy]. Zhonghua Nei Ke Za Zhi 2021; 59:894-897. [PMID: 33120494 DOI: 10.3760/cma.j.cn112138-20200103-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this retrospective cohort study, we aim to evaluate the effect of endocapillary hypercellularity (E) lesions on the renal prognosis and response to immunosuppressive therapy, especially diffuse endocapillary hypercellularity lesion in IgA nephropathy (IgAN). A total of 365 patients with IgAN and E lesions and 31 patients with diffuse E lesions and over 12-month follow-up period were included in this study. We performed an 1∶1 propensity score to identify controls with matched clinical and pathological features from 769 IgAN patients without E lesions. The end-point was defined as a 30% decrease in estimated glomerular filtration rate (eGFR) or end-stage kidney disease. The kidney survival of the two groups was compared by Kaplan-Meier analysis. During median follow-up period of 41 months, kidney survival rates in patients with E lesions were 96.0% at 1 year, 83.6% at 3 years, 67.7% at 5 years; while they were 96.9% at 1 year, 83.6% at 3 years, and 68.7% at 5 years in patients without E lesions (P=0.265).The HR of immunosuppressive therapy was 1.038 (95%CI 0.749-1.440) and 1.113 (95%CI 0.770-1.609) in patients not receiving immunosuppressive therapy (P=0.781). (2) During median follow-up period of 52.5 months, the kidney survival rates in patients with diffuse E-lesion were 100.0% at 1 year, 96.2% at 3 years, 74.5% at 5 years; while they were 96.2% at 1 year, 82.3% at 3 years, and 63.7% at 5 years in patients without E-lesion (P=0.158). The HR of immunosuppressive therapy was 0.625 (95%CI 0.213-1.839) and 0.447 (95%CI 0.028-7.191) in patients not receiving immunosuppressive therapy (P=0.825). E lesion or diffuse E lesion may not be associated with prognosis or response to immunosuppressive therapy.
Collapse
Affiliation(s)
- H Y Yang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University),Ministry of Education, Beijing 100034, China
| | - S F Shi
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University),Ministry of Education, Beijing 100034, China
| | - S X Wang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University),Ministry of Education, Beijing 100034, China; Laboratory of Electron Microscopy, Peking University First Hospital, Beijing 100034, China
| | - J C Lyu
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University),Ministry of Education, Beijing 100034, China
| | - H Zhang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University),Ministry of Education, Beijing 100034, China
| |
Collapse
|
6
|
Zhang H, Liu Y, Meng X, Yang D, Shi S, Liu J, Yuan Z, Gu T, Han L, Lu F, Xu Z, Liu Y, Yu M. Effects of inhaled nitric oxide for postoperative hypoxemia in acute type A aortic dissection: a retrospective observational study. J Cardiothorac Surg 2020; 15:25. [PMID: 31969173 PMCID: PMC6977331 DOI: 10.1186/s13019-020-1069-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 01/07/2020] [Indexed: 01/18/2023] Open
Abstract
Background Postoperative hypoxemia in acute type A aortic dissection (AADA) is a common complication and is associated with negative outcomes. This study aimed to analyze the efficacy of low-dose (5–10 ppm) inhaled nitric oxide (iNO) in the management of hypoxemia after AADA surgery. Methods In this retrospective observational study, Medical records of patients who underwent AADA surgery at two institutions between January 2015 and January 2018 were collected. Patients with postoperative hypoxemia were classified as iNO and control groups. Clinical characteristics and outcomes were compared using a propensity score-matched (PSM) analysis. Results Among 436 patients who underwent surgical repair, 187 (42.9%) had hypoxemia and 43 were treated with low-dose iNO. After PSM, patients were included in the iNO treatment (n = 40) and PSM control (n = 94) groups in a 1:3 ratio. iNO ameliorated hypoxemia at 6, 24, 48, and 72 h after initiation, and shortened the durations of ventilator support (39.0 h (31.3–47.8) vs. 69.0 h (47.8–110.3), p < 0.001) and ICU stay (122.0 h (80.8–155.0) vs 179.5 h (114.0–258.0), p < 0.001). There were no significant between-group differences in mortality, complications, or length of hospital stay. Conclusions In this study, we found that low-dose iNO improved oxygenation in patients with hypoxemia after AADA surgery and shortened the durations of mechanical ventilation and ICU stay. No significant side effects or increase in postoperative mortality or morbidities were observed with iNO treatment. These findings warrant a randomized multicenter controlled trial to assess the exact efficiency of iNO for hypoxemia after AADA.
Collapse
Affiliation(s)
- Hang Zhang
- Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Department of Cardiovascular Surgery, Shanghai General Hospital, Nanjing Medical University, Shanghai, 200080, China
| | - Yaoyang Liu
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200000, China
| | - Xiangdong Meng
- Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
| | - Dicheng Yang
- Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
| | - Sheng Shi
- Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
| | - Jian Liu
- Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
| | - Zhongxiang Yuan
- Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China
| | - Tongtong Gu
- Department of Central laboratory, Nanjing First People's Hospital, Nanjing Medical University, NO.68 Changle Road, Nanjing, 210006, China
| | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Fanglin Lu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China. .,Department of Critical Care Medicine, Naval medical Center of PLA, Shanghai, 200433, China.
| | - Min Yu
- Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.
| |
Collapse
|
7
|
Ye ZJ, Zhang Z, Zhang XY, Tang Y, Liang J, Sun Z, Liang MZ, Yu YL. Effectiveness of adjuvant supportive-expressive group therapy for breast cancer. Breast Cancer Res Treat 2020; 180:121-134. [PMID: 31950384 DOI: 10.1007/s10549-020-05526-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/09/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Randomized control trials exploring adjuvant supportive-expressive group therapy (SEGT) for breast cancer have yielded conflicting survival results. This retrospective cohort study was designed to explore the association of adjuvant SEGT performed at diagnosis with survival in real-world patients. METHODS 3327 patients with breast cancer were divided between those who received oncologic treatment combined with SEGT-based intervention (referred to as BRBC [n = 354]) and those who only received oncologic treatment (referred to as OT [n = 2973]). Primary outcome was overall survival (OS) at 1-year, 3-year, 5-year. Propensity score-matched analysis (at a ratio of 1:3) and instrumental variable analysis (IVA) were performed. RESULTS The median overall survival was 7.3 years (95% CI 7.0-7.7 years) in BRBC and 7.1 years (95% CI 6.9-7.4 years) in OT. BRBC was not significantly associated with improved 1-year (HR 0.74, 95% CI 0.49-1.10, P = 0.1748; NNT = 44.8, 95% CI - 118.5 to 22.6), 3-year (HR 0.98, 95% CI 0.75-1.27, P = 0.8640; NNT = 273.7, 95% CI - 21.0 to 21.3), or 5-year survival (HR 0.79, 95% CI 0.61-1.02, P = 0.0908; NNT = 36.0, 95% CI - 384.5 to 19.1) compared with OT. IVA indicated that BRBC had a survival benefit over OT in the 1-year, 3-year, and 5-year of 1.5% (95% CI 1.2-1.9%), 0.7% (95% CI 0.6-0.8%), and 2.6% (95% CI 2.0-3.4%), respectively. CONCLUSION Adjuvant SEGT cannot significantly prolong 5-year survival in breast cancer, though a longer observation period is warranted according to the marginal survival benefit identified at the end of the follow-up.
Collapse
Affiliation(s)
- Zeng Jie Ye
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong Province, China.
| | - Zhang Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, China
| | - Xiao Ying Zhang
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 510275, Guangdong Province, China
| | - Ying Tang
- Institute of Tumor, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong Province, China
| | - Jian Liang
- Guangdong Provincial Key Laboratory of New Drug Development and Research of Chinese Medicine, Mathematical Engineering Academy of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong Province, China
| | - Zhe Sun
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong Province, China
| | - Mu Zi Liang
- Guangdong Academy of Population Development, Guangzhou, 510600, Guangdong Province, China
| | - Yuan Liang Yu
- South China University of Technology, Guangzhou, 510641, Guangdong Province, China
| |
Collapse
|
8
|
Affiliation(s)
- Ankur Kalra
- Department of Medicine, Division of Cardiovascular Medicine, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
9
|
Barili F, Freemantle N, Folliguet T, Parolari A. Reply to Kalra et al. Eur J Cardiothorac Surg 2018; 53:486-487. [PMID: 28958007 DOI: 10.1093/ejcts/ezx323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/12/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | - Thierry Folliguet
- Department of Cardiac Surgery, Centre Hospitalo-Universitaire Brabois ILCV, Nancy, France
| | | |
Collapse
|
10
|
Iba T, Hagiwara A, Saitoh D, Anan H, Ueki Y, Sato K, Gando S. Effects of combination therapy using antithrombin and thrombomodulin for sepsis-associated disseminated intravascular coagulation. Ann Intensive Care 2017; 7:110. [PMID: 29098447 PMCID: PMC5668219 DOI: 10.1186/s13613-017-0332-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 10/25/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND No single anticoagulant has been proven effective for sepsis-associated disseminated intravascular coagulation (DIC). Thus, the concomitant use of antithrombin concentrate and recombinant thrombomodulin has been conceived. This observational study was conducted to investigate the efficacy and safety of this combination therapy. METHODS A total of 510 septic DIC patients who received antithrombin substitution were retrospectively analyzed. Among them, 228 were treated with antithrombin and recombinant thrombomodulin (combination therapy) and the rest were treated with antithrombin alone (monotherapy). Propensity score matching created 129 matched pairs, and 28-day all-cause mortality, DIC scores, the sequential organ failure assessment (SOFA) scores, and the incidence of bleeding were compared. RESULTS A log-rank test revealed a significant association between combination therapy and a lower 28-day mortality rate (hazard ratio 0.49, 95% confidence interval 0.29-0.82, P = 0.006) in the matched pairs. The DIC scores and the SOFA scores in the combination therapy group were significantly lower than those in the monotherapy group on Day 4 and Day 7. The incidence of bleeding did not differ between the groups (2.11 vs. 2.31%, P = 1.000). CONCLUSIONS The current study demonstrated the potential benefit of adding recombinant thrombomodulin to antithrombin. The co-administration of these two anticoagulants was associated with reduced mortality among patients with sepsis-induced DIC without increasing the risk of bleeding.
Collapse
Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Akiyoshi Hagiwara
- National Center for Global Health and Medicine, Emergency Medicine and Critical Care, Tokyo, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokyo, Japan
| | - Hideaki Anan
- Emergency Medical Center, Fujisawa City Hospital, Fujisawa, Japan
| | - Yutaka Ueki
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichi Sato
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University Graduate School of Medicine, Izunokuni-shi, Japan
| | - Satoshi Gando
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
11
|
Chen Q, Jia Z, Yang Z, Fan W, Shi H. Transarterial Chemoembolization Monotherapy Versus Combined Transarterial Chemoembolization–Microwave Ablation Therapy for Hepatocellular Carcinoma Tumors ≤5 cm: A Propensity Analysis at a Single Center. Cardiovasc Intervent Radiol 2017; 40:1748-55. [DOI: 10.1007/s00270-017-1736-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/27/2017] [Indexed: 01/04/2023]
|
12
|
Iba T, Thachil J. Present and future of anticoagulant therapy using antithrombin and thrombomodulin for sepsis-associated disseminated intravascular coagulation: a perspective from Japan. Int J Hematol 2015; 103:253-61. [PMID: 26588929 DOI: 10.1007/s12185-015-1904-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/04/2015] [Accepted: 11/08/2015] [Indexed: 02/07/2023]
Abstract
In sepsis, the coagulation system is often systemically activated in combination with the simultaneous impairment of fibrinolysis and anticoagulant systems. Since this hypercoagulable state often leads to disseminated intravascular coagulation (DIC), an independent predictor of mortality in critically ill patients, the appropriate management of DIC itself is a crucial part of treatment strategies for severe sepsis. In this context, the Japanese Association of Acute Medicine (JAAM) scoring system for DIC has been proposed as a valid test for diagnosing DIC; this system is also expected to aid in devising specifically tailored management strategies. Anticoagulant therapy is commonly given to septic patients with DIC as part of the standard care in Japan. More recently, antithrombin concentrate and recombinant thrombomodulin have become the two major anticoagulant agents of choice. In relation to the use of antithrombin, recent studies have indicated that the recovery of antithrombin activity to within the normal range (>70%) is necessary if supplementation therapy is to provide a favorable outcome. Recombinant thrombomodulin is slightly more controversial, with favorable results being greater among severe cases of DIC. In the present review, we summarize recent clinical advances in anticoagulant therapy for sepsis-associated DIC.
Collapse
Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK.
| |
Collapse
|
13
|
Speicher PJ, Goldsmith ZG, Nussbaum DP, Turley RS, Peterson AC, Mantyh CR. Ureteral stenting in laparoscopic colorectal surgery. J Surg Res 2014; 190:98-103. [PMID: 24656474 DOI: 10.1016/j.jss.2014.02.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 02/17/2014] [Accepted: 02/19/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few studies have examined the current status of ureteral stent use or the indications for stenting, particularly in laparoscopic colorectal surgery. This study examines current national trends and predictors of ureteral stenting in patients undergoing major colorectal operations and the subsequent effects on perioperative outcomes. METHODS The 2005-2011 National Surgical Quality Improvement participant user files were used to identify patients undergoing laparoscopic segmental colectomy, low anterior resection, or proctectomy. Trends in stent use were assessed across procedure types. To estimate the predictors of stent utilization, a forward-stepwise logistic regression model was used. A 3:1 nearest neighbor propensity match with subsequent multivariable adjustment was then used to estimate the impact of stents. RESULTS A total of 42,311 cases were identified, of which 1795 (4.2%) underwent ureteral stent placement. Predictors of stent utilization included diverticular disease, need for radical resection (versus segmental colectomy), recent radiotherapy, and more recent calendar year. After adjustment, ureteral stenting appeared to be associated with a small increase in median operative time (44 min) and a trivial increase in length of stay (5.4%, P<0.001). However, there were no significant differences in morbidity or mortality. CONCLUSIONS We describe the clinical predictors of ureteral stent usage in this patient population and report that while stenting adds to operative time, it is not associated with significantly increased morbidity or mortality after adjusting for diagnosis and comorbidities. Focused institutional studies are necessary in the future to address the utility of ureteral stents in the identification and possible prevention of iatrogenic injury.
Collapse
|
14
|
Hayakawa M, Gando S, Mizuno H, Asai Y, Shichinohe Y, Takahashi I, Makise H. Effects of epinephrine administration in out-of-hospital cardiac arrest based on a propensity analysis. J Intensive Care 2013; 1:12. [PMID: 25908979 PMCID: PMC4407348 DOI: 10.1186/2052-0492-1-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 11/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epinephrine administration has been advocated for cardiopulmonary resuscitation (CPR) for decades. Despite the fact that epinephrine administration during CPR is internationally accepted, the effects of the prehospital epinephrine administration still remain controversial. We investigated the effects of epinephrine administration on patients with out-of-hospital cardiac arrest based on a propensity analysis with regard to the 'CPR time'. METHODS From April 1, 2007, to December 31, 2009, 633 out-of-hospital cardiac arrest patients with bystander witnesses were included in the present study. To rule out any survival bias, we used the propensity scores, which included CPR time. CPR time was defined as the time span from when the emergency medical technicians started CPR until either the return of spontaneous circulation or arrival at the hospital. After performing propensity score matching, the epinephrine and no-drug groups each included 141 patients. The primary study endpoint was a favorable neurological outcome at 30 days after cardiac arrest. RESULTS After propensity score matching, the frequency of the return of spontaneous circulation before arrival at the hospital in the matched epinephrine group was higher than that in the matched no-drug group (27% vs. 13%, P = 0.002). However, the frequency of a favorable neurological state did not differ between the two groups. With regard to the frequency of a favorable neurological state in the patients, the adjusted odds ratio of the time span from cardiac arrest to the first epinephrine administration was 0.917 (95% confidence interval 0.850-0.988, P = 0.023) per minute. CONCLUSIONS In patients with witnessed out-of-hospital cardiac arrest, prehospital epinephrine administration was associated with increase of the return of spontaneous circulation before arrival at the hospital. Moreover, the early administration of epinephrine might improve the overall neurological outcome.
Collapse
Affiliation(s)
- Mineji Hayakawa
- Emergency and Critical Care Center, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8648 Japan
| | - Satoshi Gando
- Emergency and Critical Care Center, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8648 Japan
| | - Hirotoshi Mizuno
- Department of Traumatology and Critical Care Medicine, Sapporo Medical University Hospital, Sapporo, Japan
| | - Yasufumi Asai
- Department of Traumatology and Critical Care Medicine, Sapporo Medical University Hospital, Sapporo, Japan
| | - Yasuo Shichinohe
- Department of Emergency and Critical Care Medicine, National hospital organization Hokkaido Medical Center, Sapporo, Japan
| | - Isao Takahashi
- Emergency Department, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hiroshi Makise
- Emergency and Critical Care Center, Sapporo City General Hospital, Sapporo, Japan
| |
Collapse
|
15
|
Kim CO, Joung WO. Effect of the Crisis Assistance Program on poverty transition for seriously ill people in South Korea: a quasi-experimental study. Soc Sci Med 2013; 101:28-35. [PMID: 24560221 DOI: 10.1016/j.socscimed.2013.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 11/07/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022]
Abstract
The Crisis Assistance Program (CAP) is a newly developed social protection scheme in South Korea. It was implemented in 2006 in order to assist individuals experiencing a sudden or temporary financial emergency. CAP provides temporary assistance to cover the direct user fees associated with inpatient care up to three or six million KRW (US $2673-5346). In this study, we aimed to compare the poverty dynamics in recipients versus non-recipients and to determine whether there is an association between participation in CAP and poverty transition. For the purpose, we analyzed longitudinal data from 2009 to 2011 from 55,710 people who requested CAP during a serious illness at local governmental offices throughout South Korea. During the 1.6 years of follow-up, 8712 (15.6%) of those who requested CAP fell into absolute poverty. Results showed that there was a 16% reducing effect of CAP on poverty transition (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.79-0.90, p < 0.001) and there was a 33% delay in the time to falling into poverty (time ratio [TR] 1.33, 95% CI 1.20-1.47, p < 0.001) after adjusting for covariates. In this analysis model, the risk of poverty transition induced by experiencing a serious illness decreased rapidly with time (ancillary parameter [AP] 0.61, 95% CI 0.59-0.62). The results were essentially unchanged even after performing a rigorous propensity analysis, which limited the analyses to 12,944 propensity-matched subjects (HR 0.84, 95% CI 0.77-0.91, p < 0.001; TR 1.38, 95% CI 1.18-1.61, p < 0.001; AP 0.54, 95% CI 0.52-0.57). Our findings provide additional evidence for recommending the use of a payment strategy that relieves out-of-pocket payments so as to reduce medical impoverishment. A temporary assistance scheme for people experiencing a serious illness may be an alternative healthcare financing strategy to confront the issue of health inequality among the medically and socioeconomically vulnerable.
Collapse
Affiliation(s)
- Chang-O Kim
- Department of Social Welfare, Seoul National University, Gwanak Street 1, Gwanak-gu, 151-746, Seoul, Republic of Korea.
| | - Won Oh Joung
- Department of Social Welfare, Sung-Kong-Hoe University, Hang-dong 1-1, Guro-gu, 152-716, Seoul, Republic of Korea.
| |
Collapse
|