Principles for modeling propensity scores in medical research: a systematic literature review

Weitzen, Sherry; Lapane, Kate L.; Toledano, Alicia Y.; Hume, Anne L.; Mor, Vincent

doi:10.1002/pds.969

Cited by 305 publications

(257 citation statements)

References 86 publications

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“…The propensity score method combines all measured confounders of interest in a single score used for matching. Examining the differences in distributions of confounders between matched groups is performed to verify the appropriate balance (23). Although neither this nor any other method can account for unmeasured variables, it is the best currently available for this type of analysis.…”

Section: Discussionmentioning

confidence: 99%

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Have We Changed the Outcome in Membranous Nephropathy? A Propensity Study on the Role of Immunosuppressive Therapy

Cattran

Reich

Kim

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The long-term effect of immunosuppressive therapy (IS) on kidney survival in idiopathic membranous nephropathy (MGN) is debated. The introduction of renin angiotensin blockade, rigorous BP control, and the increasing age at presentation of patients with MGN adds further uncertainty. Given these important changes, we sought to determine whether implementation of IS has altered outcome. Design, setting, participants, & methodsWe prospectively evaluated 280 incident MGN patients from three distinct 10-year periods starting from 1975. ResultsWe found expected changes in treatment regimens but also variations in age, renal function, severity of proteinuria, and BP at presentation over this time. Outcomes did not differ over time if these significant variations in clinical characteristics were not accounted for across the eras. The effect of IS in the 57 patients treated with currently recommended regimens was assessed using propensity adjustment to address selection bias and the effect of newer, conservative therapies. A propensity score estimating the probability of receiving IS permitted the pairing of 39 treated patients with controls with similar high risk of progression of clinical features. Using this approach, IS was associated not only with remissions in proteinuria but also with substantially improved renal survival. ConclusionsThe study confirms that patient presenting characteristics and management regimens have changed significantly over time and the natural history of MGN has been altered. A study of propensitymatched patients confirms that current recommendations for IS have improved outcomes in MGN patients at high risk of progression.

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Section: Discussionmentioning

confidence: 99%

“…Using logistic regression modeling, we derived predicted probabilities (propensity scores) for receiving immunosuppression (22,23). Given the number of patients treated, only five variables could be included in the model.…”

Section: Statistical Analysesmentioning

confidence: 99%

Have We Changed the Outcome in Membranous Nephropathy? A Propensity Study on the Role of Immunosuppressive Therapy

Cattran

Reich

Kim

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…To be able to compare outcomes in patients with CS therapy with controls of similar risk, we used the propensity score. 31 Multiple methodologic choices were made in performing this analysis (Figure 1). They are as follows:…”

Section: Statistical Analysesmentioning

confidence: 99%

“…31 Matched treated and untreated groups were compared. The benefits of therapy were studied in subgroups defined by the initial eGFR, proteinuria findings, and pathology findings.…”

Section: Pathology Findingsmentioning

confidence: 99%

Corticosteroids in IgA Nephropathy

Tesař

Troyanov

Bellur

et al. 2015

Journal of the American Society of Nephrology

199

161

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Current guidelines suggest treatment with corticosteroids (CS) in IgA nephropathy (IgAN) when proteinuria is persistently $1 g/d despite 3-6 months of supportive care and when eGFR is .50 ml/min per 1.73 m 2 . Whether the benefits of this treatment extend to patients with an eGFR#50 ml/min per 1.73 m 2 , other levels of proteinuria, or different renal pathologic lesions remains unknown. We retrospectively studied 1147 patients with IgAN from the European Validation Study of the Oxford Classification of IgAN (VALIGA) cohort classified according to the Oxford-MEST classification and medication used, with details of duration but not dosing. Overall, 46% of patients received immunosuppression, of which 98% received CS. Treated individuals presented with greater clinical and pathologic risk factors of progression. They also received more antihypertensive medication, and a greater proportion received renin angiotensin system blockade (RASB) compared with individuals without immunosuppressive therapy. Immunosuppression was associated with a significant reduction in proteinuria, a slower rate of renal function decline, and greater renal survival. Using a propensity score, we matched 184 subjects who received CS and RASB to 184 patients with a similar risk profile of progression who received only RASB. Within this group, CS reduced proteinuria and the rate of renal function decline and increased renal survival. These benefits extended to those with an eGFR#50 ml/min per 1.73 m 2 , and the benefits increased proportionally with the level of proteinuria. Thus, CS reduced the risk of progression regardless of initial eGFR and in direct proportion to the extent of proteinuria in this cohort.

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“…The authors used a sophisticated method to match new users and nonusers by propensity score [17], and succeeded in identifying two subgroups of COPD patients with similar distribution of measured confounders. Nonetheless, it has been reported that omission of important confounders in propensity score calculations not only leads to biased estimates of the treatment effect but also cannot be detected with model fit or discrimination analyses [18,19]. Indeed, no method can be of help when the relevant potential confounders are missing because they are not available in the original dataset.…”

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confidence: 99%

Should we exercise caution with benzodiazepine use in patients with COPD?

Rodríguez-Roisín

Garcia‐Aymerich

2014

Eur Respir J

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Principles for modeling propensity scores in medical research: a systematic literature review

Abstract: Reporting of aspects related to propensity score model development is limited and raises questions about the value of these principles in developing propensity scores from which unbiased treatment effects are estimated.

Cited by 305 publications

References 86 publications

Have We Changed the Outcome in Membranous Nephropathy? A Propensity Study on the Role of Immunosuppressive Therapy

Have We Changed the Outcome in Membranous Nephropathy? A Propensity Study on the Role of Immunosuppressive Therapy

Corticosteroids in IgA Nephropathy

Should we exercise caution with benzodiazepine use in patients with COPD?

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