Control of Confounding and Reporting of Results in Causal Inference Studies. Guidance for Authors from Editors of Respiratory, Sleep, and Critical Care Journals

Lederer, David J.; Bell, S. C.; Branson, Richard D.; Chalmers, James D.; Marshall, Rachel D.; Maslove, David; Ost, David; Punjabi, Naresh M.; Schatz, Michael; Smyth, Alan; Stewart, Paul W.; Suissa, Samy; Adjei, Alex A.; Akdiş, Cezmi A.; Azoulay, Élie; Bakker, Jan; Ballas, Zuhair K.; Bardin, Philip G.; Barreiro, Esther; Bellomo, Rinaldo; Bernstein, Jonathan A.; Brusasco, Vito; Buchman, Timothy G.; Chokroverty, Sudhansu; Collop, Nancy A.; Crapo, James D.; Fitzgerald, Dominic A.; Hale, Lauren; Hart, Nicholas; Herth, Felix J.F.; Iwashyna, Theodore J.; Jenkins, Gisli; Kolb, Martin; Marks, Guy B.; Mazzone, Peter J.; Moorman, J. Randall; Murphy, Thomas M.; Noah, Terry L.; Reynolds, Paul N.; Riemann, Dieter; Russell, Richard; Sheikh, Aziz; Sotgiu, Giovanni; Swenson, Erik R.; Szczesniak, Rhonda; Szymusiak, Ronald; Teboul, Jean Louis; Vincent, Jean‐Louis

doi:10.1513/annalsats.201808-564ps

Cited by 555 publications

(423 citation statements)

References 34 publications

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“…Additionally, using an absolute BD response vs a relative response may be controversial, however, we found using the absolute change did not significantly alter our overall conclusions. We recognize the limitations of stepwise logistic regression and the potential to impact the variable selection process . As our study is inherently exploratory, were are unable to use the preferred causal methods of prediction.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of the bronchodilator response in children with severe asthma

Coverstone

Bacharier

Wilson

et al. 2019

Pediatric Pulmonology

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Background Our objective was to determine those characteristics associated with reversibility of airflow obstruction and response to maximal bronchodilation in children with severe asthma through the Severe Asthma Research Program (SARP). Methods We performed a cross‐sectional analysis evaluating children ages 6 to 17 years with nonsevere asthma (NSA) and severe asthma (SA). Participants underwent spirometry before and after 180 µg of albuterol to determine reversibility (≥12% increase in FEV1). Participants were then given escalating doses up to 720 µg of albuterol to determine their maximum reversibility. Results We evaluated 230 children (n = 129 SA, n = 101 NSA) from five centers across the United States in the SARP I and II cohorts. SA (odds ratio [OR], 2.08, 95% confidence interval [CI], 1.05‐4.13), second‐hand smoke exposure (OR, 2.81, 95%CI, 1.23‐6.43), and fractional exhaled nitric oxide (FeNO; OR, 1.97, 95%CI, 1.35‐2.87) were associated with increased odds of airway reversibility after maximal bronchodilation, while higher prebronchodilator (BD) FEV1% predicted (OR, 0.91, 95%CI, 0.88‐0.94) was associated with decreased odds. In an analysis using the SARP III cohort (n = 186), blood neutrophils, immunoglobulin E (IgE), and FEV1% predicted were significantly associated with BD reversibility. In addition, children with BD response have greater healthcare utilization. BD reversibility was associated with reduced lung function at enrollment and 1‐year follow‐up though less decline in lung function over 1 year compared to those without reversibility. Conclusions Lung function, that is FEV1% predicted, is a predictor of BD response in children with asthma. Additionally, smoke exposure, higher FeNO or IgE level, and low peripheral blood neutrophils are associated with a greater likelihood of BD reversibility. BD response can identify a phenotype of pediatric asthma associated with low lung function and poor asthma control.

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Section: Discussionmentioning

confidence: 99%

Clinical significance of the bronchodilator response in children with severe asthma

Coverstone

Bacharier

Wilson

et al. 2019

Pediatric Pulmonology

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“…As a result, certain variables (for example, recipient age) were not included even if the P value was <.1 on univariate analysis . We included only one time‐dependent variable in each multivariable model to avoid overinflation of risk; as a result, we present three multivariable models .…”

Section: Methodsmentioning

confidence: 99%

Pseudomonas aeruginosa and acute rejection independently increase the risk of donor-specific antibodies after lung transplantation

Kulkarni

Tsui

Sunder

et al. 2020

American Journal of Transplantation

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Factors contributing to donor‐specific HLA antibody (DSA) development after lung transplantation have not been systematically evaluated. We hypothesized that the isolation of Pseudomonas aeruginosa in respiratory specimens would increase the risk of DSA development. Our objective was to determine the risk of DSA development associated with the isolation of Pseudomonas aeruginosa after lung transplantation. We conducted a single‐center retrospective cohort study of primary lung transplant recipients and examined risk factors for DSA development using Cox regression models. Of 460 recipients, 205 (45%) developed DSA; the majority developed Class II DSA (n = 175, 85%), and 145 of 205 (71%) developed DSA to HLA‐DQ alleles. Univariate time‐dependent analyses revealed that isolation of Pseudomonas from respiratory specimens, acute cellular rejection, and lymphocytic bronchiolitis are associated with an increased risk of DSA development. In multivariable analyses, Pseudomonas isolation, acute cellular rejection, and lymphocytic bronchiolitis remained independent risk factors for DSA development. Additionally, there was a direct association between the number of positive Pseudomonas cultures and the risk of DSA development. Our findings suggest that pro‐inflammatory events including acute cellular rejection, lymphocytic bronchiolitis, and Pseudomonas isolation after transplantation are associated with an increased risk of DSA development.

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“…For each treatment exposure (pulmonary toxic chemotherapy, chest radiation, and thoracic surgery), unadjusted and adjusted models were fitted. We used directed acyclic graphs (DAGs) implemented in DAGitty to select a minimal sufficient adjustment set of variables to allow estimation of an unconfounded effect of each treatment exposure on respiratory admissions From the DAG (available at http://dagitty.net/m6dZKD2) the minimal sufficient adjustment set included deprivation, diagnosis age, diagnosis year, diagnostic group and treatment exposures. Further models were examined including an interaction term between age group (children and AYA) and pulmonary toxic chemotherapy and chest radiation to determine whether the association between treatment and risk of admission differed by age.…”

Section: Methodsmentioning

confidence: 99%

Respiratory morbidity in young people surviving cancer: Population‐based study of hospital admissions, treatment‐related risk factors and subsequent mortality

Smith

Glaser

Peckham

et al. 2019

Intl Journal of Cancer

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Respiratory diseases are a major cause of late morbidity and mortality amongst childhood cancer survivors. This population‐based study investigates respiratory hospital admissions in long‐term survivors of cancers diagnosed in young people to identify specific respiratory morbidities, treatment‐related risks and their relationship to subsequent morbidity and mortality. Population‐based cancer registrations in Yorkshire, England, diagnosed between 1990 and 2011 aged 0–29 years, were linked to inpatient Hospital Episode Statistics (HES) for admissions up to 2017. All 5‐year survivors were included in analysis (n = 4235). Admission rates were compared to age‐ and sex‐ matched general population rates. Competing risk regression models were used to assess associations between treatment exposures and risk of admission. Risk of death after admission was calculated using Cox regression. By age 40, cumulative incidence for an admission for any type of respiratory condition was 49%. Respiratory admission rates were 1.86 times higher in cancer survivors than in the general population (95% Confidence Interval (CI) 1.73–2.01), and varied by respiratory condition and age at diagnosis. Treatment with chemotherapy with known lung toxicity increased the risk of admission for all respiratory conditions (subdistribution Hazard ratio (sHR) = 1.26, 95%CI 1.03–1.53) and pneumonia (sHR = 1.48, 95%CI 1.01–2.17). Subsequent mortality was highest in those admitted for pneumonia compared to other respiratory conditions (28% and 15% respectively). Survivors of childhood and young adult cancer remain at significantly increased risk of respiratory complications several decades after treatment, emphasising the importance for clinical initiatives for prevention, early detection and treatment.

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Control of Confounding and Reporting of Results in Causal Inference Studies. Guidance for Authors from Editors of Respiratory, Sleep, and Critical Care Journals

Cited by 555 publications

References 34 publications

Clinical significance of the bronchodilator response in children with severe asthma

Clinical significance of the bronchodilator response in children with severe asthma

Pseudomonas aeruginosa and acute rejection independently increase the risk of donor-specific antibodies after lung transplantation

Respiratory morbidity in young people surviving cancer: Population‐based study of hospital admissions, treatment‐related risk factors and subsequent mortality

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