scholarly journals Risk factors for severe infections in secondary immunodeficiency: a retrospective US administrative claims study in patients with hematological malignancies

2021 ◽  
pp. 1-10
Author(s):  
Stephen Jolles ◽  
B. Douglas Smith ◽  
Donald Cuong Vinh ◽  
Rajiv Mallick ◽  
Gabriela Espinoza ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hematological Malignancies ◽  
Administrative Claims ◽  
Secondary Immunodeficiency ◽  
Severe Infections

SAT0188 HIGH-DOSE STEROIDS ARE IMPORTANT CONTRIBUTORS TO THE INFECTION BURDEN OF PATIENTS WITH LUPUS NEPHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1036.1-1036
Author(s):  
A. Vornicu ◽  
B. Obrisca ◽  
R. Jurubita ◽  
B. Sorohan ◽  
A. Andronesi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Female Gender ◽  
Neurological Involvement ◽  
High Dose ◽  
Pulse Methylprednisolone ◽  
Sledai Score ◽  
Oral Corticosteroids ◽  
Dose Oral ◽  
Severe Infections

Background:Infection remains a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE) and lupus nephritis (LN) treated with systemic immunosuppression (IS).Objectives:We sought to describe the infection profile in patients with LN treated with aggressive immunosuppression (induction and maintenance therapy) and to identify the associated risk factors.Methods:Patients with LN followed in the Nephrology Department of Fundeni Clinical Institute, were retrospectively reviewed for any infection that occurred from initiation of induction therapy. Infections were graded (1-5) according to the Common Terminology Criteria for Adverse Events. Infection site and type of microorganism were also recorded. Univariate and multivariate Cox proportional hazard regression analysis were performed in order to identify independent risk factors for infection.Results:The study cohort comprised 101 patients (86.1% females) with a mean age of 34 ± 14 years. Forty-eight patients (47.5%) had at least one infection with a total 92 episodes of infection occurring during a median follow-up of 17 months (IQR:8.5-52.5 months). The majority of patients (31 of 48) had infections during the first 12 months since IS treatment initiation. The most common site was lung infection (in 24.8% of patients), followed by urinary tract (20.8% of patients) and cutaneous/mucosal infections (11% of patients). Thirty-eight percent of patients had bacterial infections. Nineteen percent of patients had severe infections (grade 3 or higher) with 3.3% of infection-related deaths (3 patients). The most common induction regimen was cyclophosphamide in addition to corticosteroids (48.5%), with 44.6% of patients receiving pulse methylprednisolone and 45.5% of patients receiving more than 30 mg/d of prednisone as the maximum oral dose. In univariate Cox regression analysis, female gender (HR 3.34; 95% CI, 1.03-10.8, p=0.04), pulse methylprednisolone (HR 2.9; 95% CI, 1.6-5.24, p=0.001), high-dose (≥30 mg/day) oral corticosteroids (HR 4.22; 95% CI, 2.21-8.02,p=0.001) and SLEDAI score (HR 1.047; 95% CI, 1.012-1.084, p=0.008) were risk factors for infection. In multivariate Cox regression analysis, female gender (HR 6.35; 95%CI, 1.86-21.64,p=0.003), high-dose oral corticosteroids (HR 4.7; 95% CI, 2.25-9.87, p=0.003) and SLEDAI score (HR 1.046; 95% CI, 1.003-1.09, p=0.034) remained independent predictors of infection risk. Of the risk factors associated with severe infections (grade 3 or higher), in univariate analysis we identified younger age (HR 0.96, 95%CI, 0.92-0.99, p=0.035), neurological involvement (HR 2.59; 95%, 0.86-7.83, p=0.09), pulse methylprednisolone (HR 5.42; 95% CI, 1.79-16.35, p=0.003) and high-dose oral corticosteroids (HR 8.32; 95% CI, 2.4-28.77, p=0.001) as risk factors for infection. After multivariate adjustment, neurological involvement (HR 4.33; 95%, 1.29-14.51, p=0.01) and high-dose oral corticosteroids (HR 7.6; 95% CI, 1.6-35.39, p=0.01) were identified as independent predictors of infection risk.Conclusion:A high-dose oral corticosteroid regimen increased the risk for any infection and for severe infections by 4.7-fold and 7.6-fold, respectively. In addition, female gender and a higher SLEDAI score were identified as risk factors for any infection, while neurological involvement was associated with an increased risk for severe infections.References:[1]Jung JY, Yoon D, Choi Y, Kim HA, Suh CH. Associated clinical factors for serious infections in patients with systemic lupus erythematosus. Sci Rep. 2019;9(1):9704.Disclosure of Interests: :None declared

Abstract WP179: Rate of Pulmonary Embolism After Cerebral Venous Thrombosis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ava L Liberman ◽  
Alexander E Merkler ◽  
Gino Gialdini ◽  
Michael P Lerario ◽  
Steven R Messe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Vascular Risk Factors ◽  
Emergency Department Visits ◽  
Administrative Claims ◽  
Cerebral Vein ◽  
Vascular Risk ◽  
Index Hospitalization ◽  
Increased Risk

Introduction: Cerebral vein thrombosis (CVT) is associated with an increased risk of subsequent venous thromboembolism. It is unknown whether the risk of pulmonary embolism (PE) after CVT is similar to that of PE after deep venous thrombosis (DVT). Methods: We performed a retrospective cohort study using administrative claims data from all emergency department visits and hospitalizations in California from 2005-2011, New York from 2006-2013, and Florida from 2005-2013. We identified patients with CVT or DVT as well as the primary outcome of PE using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM ) codes. In order to minimize misclassification error, patients with both CVT and DVT during the same index hospitalization were excluded and patients with CVT were censored at the time of development of DVT and vice versa. Kaplan-Meier survival statistics and Cox proportional hazards models were used to compare the risk of PE after CVT versus after DVT while adjusting for demographics, vascular risk factors, and the Elixhauser comorbidity index. Results: We identified 4,450 patients with CVT and 217,589 patients with DVT. During a mean follow-up of 2.0 (±1.7) years, 124 patients with DVT developed a PE and 18,698 patients with DVT developed a PE. Patients with CVT were younger (mean age 45 vs 63), more often female (71% vs 52%), more often pregnant, and had fewer vascular risk factors than patients with DVT. During the index hospitalization, the rate of PE was 1.5% (95% confidence interval [CI], 1.1-1.8%) in patients with CVT and 6.2% (95% CI, 6.1-6.3%, p<0.001) in patients with DVT. By 5 years, the cumulative rate of PE after CVT was 3.7% (95% CI, 3.0-4.4%) compared to 10.5% (95% CI, 10.3-10.6%, p<0.001) after DVT. After adjustment for demographics and comorbidities, CVT was associated with a significantly lower hazard of PE when compared to DVT (hazard ratio, 0.31; 95% CI, 0.26-0.38). Conclusion: In a large, heterogeneous population, we found that the risk of PE after CVT was significantly lower than that of PE after DVT. Among patients with CVT, the greatest risk for PE was apparent during the index hospitalization.

Abstract 56: Change in Midlife Fitness is an Independent Predictor of Heart Failure in Older Age

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Ambarish Pandey ◽  
Benjamin Willis ◽  
David Leonard ◽  
Laura DeFina ◽  
Ang Gao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Recurrent Events ◽  
Middle Age ◽  
Older Age ◽  
Administrative Claims ◽  
Metabolic Equivalents ◽  
Failure Risk ◽  
Increased Risk ◽  
Fitness Levels

Background: Low mid-life fitness is associated with increased risk for heart failure (HF) events decades later. However, the association between changes in mid-life fitness and heart failure risk has not been studied. Methods: We included 9050 subjects (15% Females, mean age 48 years) with no prior cardiovascular disease who underwent two cardiorespiratory fitness measurements approximately 8 years apart. Fitness was estimated in metabolic equivalents (METs) according to Balke treadmill time, with low fitness defined as the lowest quintile of fitness and high fitness defined as quintiles 2-5. Change in fitness was defined categorically according to fitness quintiles (see figure legend) and continuously as the change in METs between the two examinations. Baseline data from the CCLS were matched with Medicare administrative claims data from the Center for Medicare and Medicaid Services. Hospitalization for HF was determined from Medicare claims files. The association between change in fitness and HF hospitalization was assessed by applying a proportional hazard recurrent events model to the failure time data and adjusted for traditional risk factors. Results: After 60,635 person years of Medicare follow up, we observed 242 hospitalizations for HF. Compared to individuals with persistently low fitness levels in middle-age, individuals who increased their fitness levels had a lower rate of HF hospitalization (0.88 vs. 0.64%/year). After multivariable adjustment for baseline fitness level and other risk factors, each 1 MET increase in middle age fitness was associated with 5% less risk for HF hospitalization in later life [HR 0.95 (0.93-0.97) per MET]. Conclusion: Change in mid-life fitness is associated with HF risk in older age. These findings suggest that the heart failure risk related to low fitness may be modifiable with exercise training.

Ultrastructural Study of Leukemic Cell Phagocytosis Using the Myeloperoxidase Reaction

1979 ◽  
Vol 65 (5) ◽  
pp. 517-526 ◽  
Author(s):  
Ermanno Pozzoli ◽  
Giorgio Lambertenghi-Deliliers ◽  
Davide Soligo ◽  
Maria Teresa Nava ◽  
Paola Zanon ◽  
...  
Keyword(s):  
Electron Microscope ◽  
Cell Differentiation ◽  
Hematological Malignancies ◽  
Leukemic Cell ◽  
Blast Cell ◽  
Morphological Alteration ◽  
Phagocytic Capacity ◽  
Serum Factors ◽  
Severe Infections ◽  
Peripheral Leukocytes

The phagocytosis (in the absence of serum factors) of zymosan particles by peripheral leukocytes isolated from ten patients with acute leukemia (AMbL, AMoL, AMML, AUL, ALL and CML-BC) was studied at the electron microscope. An evident phagocytic activity was observed only in the cells in which cytochemical and ultrastructural features suggested that the blast elements belonged to the monocytic series. However, no phagocytosis by unclassifiable leukemic blasts was observed, even though they had some submicroscopic characteristics of the monocytic series. These findings suggest that phagocytic capacity develops during the course of cell differentiation, becoming striking only when the blast cell acquires the ultrastructural features of the pro-monocytic stage. Using the myeloperoxidase reaction, this study also demonstrates a morphological alteration in the degranulation process after the ingestion of zymosan particles in both the blasts and the mature PMN cells of leukemic patients. This defect could be related to the susceptibility to severe infections usually found in subjects with hematological malignancies.

Increased Bone Marrow Iron Stores, Severe Mucositis and Large Area under the Curve (AUC) of Profound Neutropenia Predict Severe Infection in 382 Myeloma Patients Undergoing Melphalan - Autologous Stem Cell Transplantation (MEL-ASCT).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1158-1158
Author(s):  
Elias J. Anaissie ◽  
Marisa H. Miceli ◽  
Li Dong ◽  
Monica L. Grazziutti ◽  
Sabitha Rajan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Severe Infection ◽  
Severe Neutropenia ◽  
Large Area ◽  
Iron Stores ◽  
Severe Infections ◽  
Severe Mucositis

Abstract Background: MEL-ASCT is standard therapy for multiple myeloma (MM) but is associated with severe infections, at times life-threatening. Objective: To determine the risk factors for severe infection (bacteremia, septic shock, colitis, pneumonia) following MEL - ASCT for MM. Materials and Methods: 382 consecutive MM patients (pts) enrolled in our Total Therapy 2 protocol and who received their first MEL - ASCT between 10/1998 and 12/2002 were included. Variables evaluated included age, sex and MM remission status, severity of mucositis and others. Because of the known association between increased body iron stores and infection, pre-ASCT bone marrow (BM) iron stores were also evaluated. The AUC for severe neutropenia (<100 absolute neutrophils (ANC) / mL) was used as a single variable accounting for both the depth and duration of neutropenia. Results: Median age was 56 years (range: 30–76) and 235 pts (62 %) were males. Severe infections developed in 77 pts (20%) including pneumonia (42 pts). Pre-ASCT risk factors for infection by univariate analysis were increased BM iron stores (OR= 3.601; 95%CI 1.795–7.222; p<0.0007) and low platelets counts (OR for -1000 platelets/μL = 0.997; 95% CI 0.994 – 1; p=0.0381). Increased BM iron stores remained significant by multivariate analysis (OR= 3.601; 95% CI 1.795–7.222; p<0.0007). Post-ASCT risk factors that were significant by both univariate and multivariate analysis were severe mucositis (Grades 3–4 by NCI Common Toxicity Criteria) (OR=1.916; 95% 1.093–3.36; p=0.02) and AUC of severe neutropenia (OR= 1.001/unit; 95% 1–1.002; p=0.03). Neither the duration (days with ANC <1000 / mL) nor the depth of moderate neutropenia (AUC < 1000 neutrophils / mL) predicted infection. Conclusion: MM pts scheduled to undergo MEL - ASCT and who have increased BM iron stores, and those who develop severe mucositis and / or prolonged and profound neutropenia following ASCT should be considered at greater risk for developing severe infection. AUC of severe neutropenia is a useful single marker of both depth and duration of neutropenia and should be included in studies evaluating risk for infection in neutropenic pts.

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