scholarly journals Risk factors for progression of juvenile-onset non-radiographic axial spondyloarthritis to juvenile-onset ankylosing spondylitis: a nested case–control study

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e001867
Author(s):  
Hao-Guang Li ◽  
Dan-Min Wang ◽  
Feng-Cai Shen ◽  
Shu-Xin Huang ◽  
Zhi-Duo Hou ◽  
...  

ObjectiveTo evaluate the clinical characteristics of juvenile-onset non-radiographic axial spondyloarthritis (nr-axSpA) and to investigate risk factors associated with progression to juvenile-onset ankylosing spondylitis (JoAS).MethodsA nested case–control study was conducted using the retrospectively collected data of 106 patients with juvenile-onset nr-axSpA (age at disease onset, <16 years) in the Clinical characteristic and Outcome in Chinese Axial Spondyloarthritis study cohort. Baseline demographic and clinical characteristics and prognosis were reviewed. Logistic regression analyses were performed to investigate risk factors associated with progression to JoAS.ResultsOverall, 58.5% of patients with juvenile-onset nr-axSpA presented with peripheral symptoms at disease onset. In 82.1% of these patients, axial with peripheral involvement occurred during the disease course. The rate of disease onset at >12 years and disease duration of ≤10 years were significantly higher in those with progression to JoAS than in those without progression to JoAS (83.0% vs 52.8%, p=0.001; 92.5% vs 56.6%, p<0.001, respectively). Multivariable logistic regression analysis revealed that inflammatory back pain (IBP) (OR 13.359 (95% CI 2.549 to 70.013)), buttock pain (OR 10.171 (95% CI 2.197 to 47.085)), enthesitis (OR 7.113 (95% CI 1.670 to 30.305)), elevated baseline C reactive protein (CRP) levels (OR 7.295 (95% CI 1.984 to 26.820)) and sacroiliac joint-MRI (SIJ-MRI) positivity (OR 53.821 (95% CI 9.705 to 298.475)) were significantly associated with progression to JoAS.ConclusionPeripheral involvement was prevalent in juvenile-onset nr-axSpA. IBP, buttock pain, enthesitis, elevated baseline CRP levels and SIJ-MRI positivity in patients with the disease are associated with higher risk of progression to JoAS.

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052841
Author(s):  
Gabriella Wojewodka ◽  
Martin C Gulliford ◽  
Mark Ashworth ◽  
Mark P Richardson ◽  
Leone Ridsdale

ObjectivesPeople with epilepsy (PWE) have a higher mortality rate than the general population. Epilepsy-related deaths have increased despite all-cause mortality decreasing in the general population pre-COVID-19. We hypothesised that clinical and lifestyle factors may identify people more at risk.DesignWe used a retrospective cohort study to explore cause of death and a nested case–control study to identify risk factors.SettingWe explored factors associated with mortality using primary care population data from 1 April 2004 to 31 March 2014. Data were obtained from the Clinical Practice Research Datalink which compiles anonymised patient data from primary care in the UK. Cause of death data was supplemented from the Office of National Statistics when available.ParticipantsThe analysis included 70 431 PWE, with 11 241 registered deaths.ResultsThe number of deaths within the database increased by 69% between the first and last year of the study. Epilepsy was considered as a contributing cause in approximately 45% of deaths of PWE under 35. Factors associated with increased risk of death included attendance at emergency departments and/or emergency admissions (OR 3.48, 95% CI 3.19 to 3.80), antiepileptic drug (AED) polytherapy (2 AEDs: OR 1.60, 95% CI 1.51 to 1.71; 3 AEDs: OR 2.06, 95% CI 1.86 to 2.29; 4+AEDs: OR 2.62, 95% CI 2.23 to 3.08), status epilepticus (OR 2.78, 95% CI 1.64 to 4.71), depression (OR 1.67, 95% CI 1.57 to 1.76) and injuries (OR 1.54, 95% CI 1.43 to 1.67). No seizures in the prior year (OR 0.52, 95% CI 0.41 to 0.65).ConclusionOur results add to existing evidence that deaths in epilepsy are increasing. Future studies could focus on identifying PWE at high risk and addressing them with clinical interventions or better self-management. Identifying specific risk factors for younger people should be a priority as epilepsy may be a factor in close to half of deaths of PWE under 35 years of age.


2020 ◽  
Vol 49 (6) ◽  
pp. 677-684
Author(s):  
Javier Enrique Cely ◽  
Elkin José Mendoza ◽  
John Jaime Sprockel ◽  
Luis Carlos Perez ◽  
Janeth Marcela Mateus ◽  
...  

<b><i>Introduction:</i></b> Research about the risk factors associated with community-acquired acute kidney injury (CA-AKI) in acute medical diseases is scarce. Data extrapolation from surgical to medical illnesses is questionable. <b><i>Objectives:</i></b> To evaluate potential risk factors and hospital outcomes associated with a CA-AKI in medical illnesses. <b><i>Methods:</i></b> We performed an unmatched nested case-control study from a previous prospective cohort study. We included adult patients with acute illnesses treated with internal medicine. Cases were defined as patients with a CA-AKI diagnosis upon hospital admission, and controls included patients from the same cohort who did not develop AKI during the first 5 days of hospitalisation. A logistic regression model was used to assess the association between potential risk factors and ­CA-AKI. <b><i>Results:</i></b> A total of 868 patients were included in the study (223 cases and 645 controls). The median age was 65 years (interquartile range 50–78). In a logistic regression model, the risk factors associated with CA-AKI included chronic kidney disease (CKD; OR 6.27; 95% CI 2.95–13.3, <i>p</i> &#x3c; 0.001), ≥65 years old (OR 1.72; 95% CI 1.16–2.57, <i>p</i> = 0.007), acute bacterial infection (OR 1.95; 95% CI 1.36–2.80, <i>p</i> &#x3c; 0.001), hypovolaemia (OR 1.88; 95% CI 1.32–2.69, <i>p</i> &#x3c; 0.001), pre-hospital nephrotoxic drugs (OR 1.77; 95% CI 1.23–2.55, <i>p</i> = 0.002), anaemia (OR 1.49; 95% CI 1.03–2.14, <i>p</i> = 0.031) and systolic blood pressure (SBP) &#x3c;107 mm Hg (OR 2.25; 95% CI 1.38–3.67, <i>p</i> = 0.001). A significant interaction between CKD and age was found (<i>p</i> = 0.017) and included in the model (patients with CKD and ≥65 years old [OR 10.85; 95% CI 4.14–28.41, <i>p</i> &#x3c; 0.001]). The area under the receiver operating characteristic curve of the final model was 0.743. <b><i>Conclusions:</i></b> CKD is strongly associated with CA-AKI upon hospital admission in medical illnesses patients. Older age enhances the risk of CA-AKI in patients with CKD. Other risk factors include pre-hospital nephrotoxic drugs, acute bacterial infection, anaemia, low SBP and hypovolaemia.


2017 ◽  
Vol 4 (4) ◽  
pp. 1284
Author(s):  
Arunagirinathan V. ◽  
Stalin S. ◽  
Narayanan E.

Background: Empyema thoracis (ET) is serious complication of pneumonia in children, treatment outcome depends upon many risk factors. Empyema thoracis is a serious infection of the pleural space. Despite the availability of broad spectrum antibacterial, improved vaccination coverage and better diagnostic tools, ET remains associated with high morbidity worldwide. This study was undertaken to identify risk factors associated with poor outcome and to describe etiological agents.Methods: This nested case control study was conducted at Institute of Child Health and Hospital for Children, Egmore, and Chennai from January 2011 to October 2012 in age group from 1 month to 12 years attending with clinical/radiological evidence of empyema. Cases children with complications and controls without complications. Basic investigations, ultrasonogram chest, pleural fluid gram stain/ culture and blood culture done. Antibiotics started empirically and changed based on culture and sensitivity. Intercostal drainage (ICD) was inserted with an underwater seal.  Demographic data and other variables analysed were haemoglobin, persistent positive CRP, serum albumin level, pleural fluid gram stain, culture and sensitivity, imaging like ultra-sonogram, CECT, X-ray chest after ICD insertion.Results: Of 90 empyema cases, 26 recovered without complication, 56 recovered with complication, 8 died. Logistic regression uses to find association between variables and complications. Risk factors significantly associated with complications were persistent positive CRP, pleural fluid gram stain, imaging ultra-sonogram chest showing loculations, CECT scan showing pleural thickening and X-ray chest after ICD insertion.Conclusions: Independent risk factors associated with complications were X-ray chest after ICD insertion showing non-resolution, ultrasonogram revealing loculations and septations. Early diagnosis, appropriate antibiotics and timely intervention helps in reduction of empyema and complications.


2020 ◽  
Vol 148 ◽  
Author(s):  
Xinjie Li ◽  
Tuohutaerbieke Marmar ◽  
Qiang Xu ◽  
Jing Tu ◽  
Yue Yin ◽  
...  

Abstract To determine what exacerbate severity of the COVID-19 among patients without comorbidities and advanced age and investigate potential clinical indicators for early surveillance, we adopted a nested case−control study, design in which severe cases (case group, n = 67) and moderate cases (control group, n = 67) of patients diagnosed with COVID-19 without comorbidities, with ages ranging from 18 to 50 years who admitted to Wuhan Tongji Hospital were matched based on age, sex and BMI. Demographic and clinical characteristics, and risk factors associated with severe symptoms were analysed. Percutaneous oxygen saturation (SpO2), lymphocyte counts, C-reactive protein (CRP) and IL-10 were found closely associated with severe COVID-19. The adjusted multivariable logistic regression analyses revealed that the independent risk factors associated with severe COVID-19 were CRP (OR 2.037, 95% CI 1.078–3.847, P = 0.028), SpO2 (OR 1.639, 95% CI 0.943–2.850, P = 0.080) and lymphocyte (OR 1.530, 95% CI 0.850–2.723, P = 0.148), whereas the changes exhibited by indicators influenced incidence of disease severity. Males exhibited higher levels of indicators associated with inflammation, myocardial injury and kidney injury than the females. This study reveals that increased CRP levels and decreased SpO2 and lymphocyte counts could serve as potential indicators of severe COVID-19, independent of comorbidities, advanced age and sex. Males could at higher risk of developing severe symptoms of COVID-19 than females.


Author(s):  
Waraporn Thepampan ◽  
Nuchsara Eungapithum ◽  
Krittai Tanasombatkul ◽  
Phichayut Phinyo

Postpartum hemorrhage (PPH) is a common complication of pregnancy and a global public health concern. Even though PPH risk factors were extensively studied and reported in literature, almost all studies were conducted in non-Asian countries or tertiary care centers. Our study aimed to explore relevant risk factors for PPH among pregnant women who underwent transvaginal delivery at a Thai–Myanmar border community hospital in Northern Thailand. An exploratory nested case-control study was conducted to explore risk factors for PPH. Women who delivered transvaginal births at Maesai hospital from 2014 to 2018 were included. Two PPH definitions were used, which were ≥ 500 mL and 1000 mL of estimated blood loss within 24 h after delivery. Multivariable conditional logistic regression was used to identify significant risk factors for PPH and severe PPH. Of 4774 women with vaginal births, there were 265 (5.55%) PPH cases. Eight factors were identified as independent predictors for PPH and severe PPH: elderly pregnancy, minority groups, nulliparous, previous PPH history, BMI ≥ 35 kg/m2, requiring manual removal of placenta, labor augmentation, and fetal weight > 4000 gm. Apart from clinical factors, particular attention should be given to pregnant women who were minority groups as PPH risk significantly increased in this population.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bülent Çomçalı ◽  
Servet Kocaoz ◽  
Buket Altun Özdemir ◽  
Ömer Parlak ◽  
Birol Korukluoğlu

AbstractThe aim of this study is to compare patients with and without mastalgia and to analyze the factors affecting mastalgia and its severity. The patient’s age, height, weight, educational status, marital status, and occupation were recorded in all subjects. In addition, the women were asked about the presence of any risk factors for mastalgia, such as tea and coffee consumption, smoking, alcohol consumption, and weight gain. The sternal notch to nipple distance (SNND) was measured to determine whether there was breast sagging. Mastalgia was significantly more common in women with BMIs of > 30 kg/m2 (OR: 2.94, CI 1.65–5.24), those who were primary school graduates or illiterate (OR: 2.96, CI 1.6–5.46), and those with SNND values of 22–25 cm (OR: 2.94, CI 1.79–4.82). In these women, drinking more than 6 cups of tea a day (OR: 2.15, CI 1.32–3.5), smoking at least 10 cigarettes a day (OR: 2.94, CI 1.78–4.83), and drinking alcohol at least once a week (OR: 2.1, CI 1.12–3.91) were found to be important factors that increased the risk of mastalgia. As a result, it has been found that severe mastalgia complaints cause by obesity, sagging breasts, never giving birth, unemployment anxiety, regular smoking, alcohol use, and excessive tea consumption.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mintao Lin ◽  
Jiani Chen ◽  
Sisi Li ◽  
Yingjie Qin ◽  
Xuruan Wang ◽  
...  

AbstractPeople with epilepsy (PWE) have an increased suicide prevalence. This study aimed to identify the risk factors for suicidal tendency among PWE in West China. A nested case–control study was designed in a cohort of patients with epilepsy (n = 2087). In total, 28 variates were calculated. In the univariate analysis, unemployment, low income, seizure frequency, seizure-free time, infectious or structural etiology, levetiracetam or phenobarbital use, anxiety, depression, and stigma were associated with suicidal tendency. A multivariate analysis indicated that unemployment (odds ratio [OR] 5.74, 95% confidence interval [CI] 2.13–15.48), levetiracetam use (OR 2.80, 95%CI 1.11–7.05), depression (C-NDDI-E score ≥ 13; OR 3.21, 95%CI 1.26–8.21), and stigma (SSCI score ≥ 16; OR 6.67, 95%CI 1.80–24.69) were independently associated with suicidal tendency. Conditional inference tree analysis indicated that SSCI and C-NDDI-E scores could effectively identify patients with suicidal tendency. Thus, this study suggests that unemployment, levetiracetam use, depression, and stigma are independent risk factors for suicidal tendency in PWE in China.


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