Cutaneous lupus erythematosus and the risk of deep venous thrombosis and pulmonary embolism: A Danish nationwide cohort study

Lupus ◽  
2017 ◽  
Vol 26 (13) ◽  
pp. 1435-1439 ◽  
Author(s):  
O Ahlehoff ◽  
J J Wu ◽  
J Raunsø ◽  
S L Kristensen ◽  
U Khalid ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
General Population ◽  
Lupus Erythematosus ◽  
Cutaneous Lupus Erythematosus ◽  
Significant Risk ◽  
Reference Population ◽  
Incidence Rates ◽  
Health Concern ◽  
Increased Risk

Background Venous thromboembolism (VTE) is a major public health concern. Lupus erythematosus (LE) is a chronic autoimmune disease ranging from localized cutaneous disease (CLE) to systemic involvement (SLE). Patients with SLE have an increased risk of venous thromboembolism (VTE), but little is known about the CLE-related risk of VTE. Methods To evaluate the risk of VTE in patients with SLE and CLE as compared to the general population, a retrospective cohort study was conducted. Incidence rates and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox regression models were used to evaluate and compare the risk of VTE. Registries of hospitalizations, outpatient visits, and prescription drug use were studied to determine the risk of VTE in patients with CLE and SLE and the general population between 1997 and 2011. Results A total of 3234 patients with CLE and 3627 patients with SLE were identified and compared to 5,590,070 individuals in the reference population. The incidence rates per 1000 year of VTE were higher in patients with LE, i.e. 1.20, 3.06, and 5.24 for the reference population, CLE, and SLE, respectively. In adjusted models, both CLE (HR 1.39; 95% CI 1.10–1.78) and SLE (HR 3.32; 95% CI 2.73–4.03) were associated with a statistically significant increased risk of VTE, compared to the reference population. Conclusion In this nationwide study, both CLE and SLE were significant risk factors for VTE. The results add to our understanding of comorbidities in patients with LE, and call for further studies and increased awareness of thromboembolic complications in patients with CLE.

Risk of Stroke in Nasopharyngeal Cancer Survivors: A National Registry-Based Population Cohort Study

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013058
Author(s):  
Teng Hwee Tan ◽  
Huili Zheng ◽  
Timothy Cheo ◽  
Jeremy Tey ◽  
Yu Yang Soon
Keyword(s):  
Cohort Study ◽  
General Population ◽  
Nasopharyngeal Cancer ◽  
Reference Population ◽  
National Registry ◽  
Age Group ◽  
Post Stroke ◽  
Risk Of Death ◽  
Increased Risk ◽  
Stage 1

BackgroundWe aim to determine the risk of stroke and death within 30 days post stroke in nasopharyngeal cancer (NPC) survivors.MethodsWe conducted a population-based cohort study of patients diagnosed with NPC from Jan 1, 2005 to Dec 31, 2017. Using the cancer and stroke disease registries and the Singapore general population as the reference population, we report the age-standardized incidence rate differences (SIRDs) ratios (SIRs) and the cumulative incidence of stroke and the standardized mortality rate differences (SMRDs) and ratios (SMRs) for all causes of death within 30 days post stroke for NPC survivors.FindingsAt a median follow up of 48.4 months (IQR 19.8 – 92.9) for 3849 patients diagnosed with NPC, 96 patients developed stroke. The overall SIRD and SIR for stroke was 3.12 (95% CI 2.09 – 4.15) and 2.54 (95% CI 2.08 – 3.10) respectively. The SIRD was highest for the age group 70 – 79 years old (8.84 cases per 1000 person-years (PY); 0.46 – 17.21) while the SIR was highest for the age group 30 – 39 years old (16.41; 6.01 – 35.82). The SIRD and SIR for stage 1 disease was (6.96 cases per 1000 PY; 2.16 – 11.77) and (4.15; 2.46 – 7.00) respectively. The SMRD and SMR for all cause deaths within 30 days of stroke was (3.20 cases per 100 persons; -3.87 – 10.28) and (1.34; 0.76 – 2.37) respectively.InterpretationThe overall risk of stroke was markedly elevated in survivors of NPC, especially in Stage 1 disease when compared to the general population. The risk of death within 30 days of stroke was not significantly higher for NPC survivors.Classification of EvidenceThis study provides Class II evidence of the increased risk of stroke in survivors of nasopharyngeal cancer compared to general population.

Cutaneous lupus erythematosus and systemic lupus erythematosus are associated with clinically significant cardiovascular risk: a Danish nationwide cohort study

Lupus ◽  
2016 ◽  
Vol 26 (1) ◽  
pp. 48-53 ◽  
Author(s):  
J Halskou Hesselvig ◽  
O Ahlehoff ◽  
L Dreyer ◽  
G Gislason ◽  
K Kofoed
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Lupus Erythematosus ◽  
Cutaneous Lupus Erythematosus ◽  
Low Grade ◽  
Systemic Lupus ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Cutaneous Lupus

Systemic lupus erythematosus (SLE) is a well-known cardiovascular risk factor. Less is known about cutaneous lupus erythematosus (CLE) and the risk of developing cardiovascular disease (CVD). Therefore, we investigated the risk of mortality and adverse cardiovascular events in patients diagnosed with SLE and CLE. We conducted a cohort study of the entire Danish population aged ≥ 18 and ≤ 100 years, followed from 1997 to 2011 by individual-level linkage of nationwide registries. Multivariable adjusted Cox regression models were used to estimate the hazard ratios (HRs) for a composite cardiovascular endpoint and all-cause mortality, for patients with SLE and CLE. A total of 3282 patients with CLE and 3747 patients with SLE were identified and compared with 5,513,739 controls. The overall HR for the composite CVD endpoint was 1.31 (95% CI 1.16–1.49) for CLE and 2.05 (95% CI 1.15–3.44) for SLE. The corresponding HRs for all-cause mortality were 1.32 (95% CI 1.20–1.45) for CLE and 2.21 (95% CI 2.03–2.41) for SLE. CLE and SLE were associated with a significantly increased risk of CVD and all-cause mortality. Local and chronic inflammation may be the driver of low-grade systemic inflammation.

scholarly journals Increased risk of malignancy in patients with systemic lupus erythematosus: population-based cohort study in Korea

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Jung-Yong Han ◽  
Hyoungyoung Kim ◽  
Sun-Young Jung ◽  
Eun Jin Jang ◽  
Soo-Kyung Cho ◽  
...  
Keyword(s):  
Cohort Study ◽  
General Population ◽  
Reproductive System ◽  
Incidence Rates ◽  
Crude Incidence ◽  
Korean Patients ◽  
Solid Malignancies ◽  
Increased Risk ◽  
Risk Of Malignancy ◽  
Haematologic Malignancies

Abstract Background This study aimed to evaluate the crude incidence rates and relative risk of malignancy in Korean patients with SLE. Methods We conducted a retrospective nationwide cohort study using databases from the National Health Insurance Service in Korea. All prevalent SLE patients aged over 19 were identified from January 2012 to December 2014 and observed until the diagnosis of malignancy, death, or end of the study, December 2015. The crude incidence rates (IRs) and standardised incidence ratios (SIRs) of overall and site-specific malignancies in SLE patients were estimated. Results We identified 17,854 SLE patients and during the observation period (60,511 person-years [PYs]), 768 solid malignancies (126.9/10,000 PYs) and 68 haematologic malignancies (11.2/10,000 PYs) occurred in SLE patients. In SLE patients, breast and reproductive system and thyroid cancers occurred predominantly, followed by liver and colon cancers. The SIRs of overall, solid, and haematologic malignancies of SLE patients compared to the general population were 1.8 (95% confidence interval [CI] 1.6–1.9), 1.7 (95% CI 1.5–1.8), and 5.9 (95% CI 4.8–7.3), respectively. In solid malignancies, head and neck (2.7, 95% CI 1.1–4.2), bladder (2.4, 95% CI 1.1–3.8), liver (1.9, 95% CI 1.4–2.3), pancreas (1.9, 95% CI 1.3–2.6), lung (1.8, 95% CI 1.2–2.4), colon (1.7, 95% CI 1.3–2.2), thyroid (1.6, 95% CI 1.3–1.8) and breast and reproductive system (1.5, 95% CI 1.2–1.7) cancers are at increased risk in SLE patients. Conclusion An increased risk of haematologic and solid malignancies was observed in Korean patients with SLE compared to the general population.

Risk of venous thromboembolism in ankylosing spondylitis: a general population-based study

2019 ◽  
Vol 78 (4) ◽  
pp. 480-485 ◽  
Author(s):  
Juan Antonio Aviña-Zubieta ◽  
Jonathan Chan ◽  
Mary De Vera ◽  
Eric C Sayre ◽  
Hyon Choi ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Ankylosing Spondylitis ◽  
General Population ◽  
Population Based ◽  
Incidence Rates ◽  
First Year ◽  
Healthcare Database ◽  
Cox Models ◽  
Increased Risk ◽  
Incident Cases

BackgroundVenous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), can be life threatening. An increased frequency of VTE has been found in inflammatory conditions. To date, evidence assessing whether this risk is also greater in patients with ankylosing spondylitis (AS) is scarce.MethodsUsing the provincial British Columbia, Canada healthcare database that encompasses all residents within the province, we conducted matched cohort analyses of incident PE, DVT and overall VTE among incident cases of AS and compared them with individuals randomly selected from the general population without AS. We calculated incidence rates (IRs) of VTE and multivariable analyses after adjusting for traditional risk factors using Cox models.ResultsAmong 7190 incident cases of AS, 35 developed PE and 47 developed DVT. IRs of PE, DVT and overall VTE per 1000 person-years for patients with AS were 0.79, 1.06, 1.56 compared with 0.40, 0.50, 0.77 in the control cohort. Corresponding fully adjusted HRs (95% CI) of PE, DVT and VTE were 1.36 (0.92 to 1.99), 1.62 (1.16 to 2.26) and 1.53 (1.16 to 2.01), respectively. The risks of PE, DVT and VTE were highest in the first year of diagnosis with HR (95% CI) of 2.88 (0.87 to 9.62), 2.20 (0.80 to 6.03) and 2.10 (0.88 to 4.99), respectively.ConclusionsThese findings demonstrate an increased risk of VTE in the general AS population. This risk appears the most prominent in the first year after diagnosis.

scholarly journals Increased Risk of Malignancy in Patients With Systemic Lupus Erythematosus: Population-based Cohort Study in Korea

2021 ◽  
Author(s):  
Jung-Yong Han ◽  
Hyoungyoung Kim ◽  
Sun-Young Jung ◽  
Eun Jin Jang ◽  
Soo-Kyung Cho ◽  
...  
Keyword(s):  
Cohort Study ◽  
General Population ◽  
Reproductive System ◽  
Incidence Rates ◽  
Crude Incidence ◽  
Korean Patients ◽  
Solid Malignancies ◽  
Increased Risk ◽  
Risk Of Malignancy ◽  
Haematologic Malignancies

Abstract Background This study aimed to evaluate the crude incidence rates and relative risk of malignancy in Korean patients with SLE.Methods We conducted a retrospective nationwide cohort study using databases from the National Health Insurance Service in Korea. All prevalent SLE patients aged over 19 were identified from January 2012 to December 2014 and observed until the diagnosis of malignancy, death, or end of the study, December 2015. The crude incidence rates (IRs) and standardized incidence ratios (SIRs) of overall and site-specific malignancies in SLE patients were estimated.Results We identified 17,854 SLE patients and during the observation period (60,511 person-years [PYs]), 768 solid malignancies (126.9/10,000 PYs) and 68 haematologic malignancies (11.2/10,000 PYs) occurred in SLE patients. In SLE patients, breast and reproductive system and thyroid cancers occurred predominantly, followed by liver and colon cancers. The SIRs of overall, solid, and haematologic malignancies of SLE patients compared to the general population were 1.8 (95% confidence interval [CI] 1.6-1.9), 1.7 (95% CI 1.5-1.8), and 5.9 (95% CI 4.8-7.3), respectively. In solid malignancies, head and neck (2.7, 95% CI 1.1-4.2), bladder (2.4, 95% CI 1.1-3.8), liver (1.9, 95% CI 1.4-2.3), pancreas (1.9, 95% CI 1.3-2.6), lung (1.8, 95% CI 1.2-2.4), colon (1.7, 95% CI 1.3-2.2), thyroid (1.6, 95% CI 1.3-1.8) and breast and reproductive system (1.5, 95% CI 1.2-1.7) cancers are at increased risk in SLE patients.Conclusion An increased risk of haematologic and solid malignancies was observed in Korean patients with SLE compared to the general population.

scholarly journals Chronic hypersensitivity pneumonitis is associated with an increased risk of venous thromboembolism: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Małgorzata Sobiecka ◽  
Monika Szturmowicz ◽  
Katarzyna Lewandowska ◽  
Agata Kowalik ◽  
Ewa Łyżwa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Venous Thromboembolism ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hypersensitivity Pneumonitis ◽  
Significant Risk ◽  
Increased Risk ◽  
Chronic Hypersensitivity Pneumonitis ◽  
Incident Cases

Abstract Background Idiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis share commonalities in pathogenesis shifting haemostasis balance towards the procoagulant and antifibrinolytic activity. Several studies have suggested an increased risk of venous thromboembolism in IPF. The association between venous thromboembolism and chronic hypersensitivity pneumonitis has not been studied yet. Methods A retrospective cohort study of IPF and chronic hypersensitivity pneumonitis patients diagnosed in single tertiary referral center between 2005 and 2018 was conducted. The incidence of symptomatic venous thromboembolism was evaluated. Risk factors for venous thromboembolism and survival among those with and without venous thromboembolism were assessed. Results A total of 411 (259 IPF and 152 chronic hypersensitivity) patients were included (mean age 66.7 ± 8.4 vs 51.0 ± 13.3 years, respectively). There were 12 (4.6%) incident cases of venous thromboembolism in IPF and 5 (3.3%) in chronic hypersensitivity pneumonitis cohort. The relative risk (RR) of venous thromboembolism in chronic hypersensitivity pneumonitis was not significantly different to that found in patients with IPF (7.1 vs 11.8/1000 person-years, RR 1.661 95% CI 0.545–6.019, respectively). The treatment with systemic steroids (OR 5.38; 95% CI 1.65–18.8, p = 0.006) and GAP stage 3 (OR 7.85; 95% CI 1.49–34.9; p = 0.037) were significant risk factors for venous thromboembolism in IPF. Arterial hypertension and pulmonary hypertension significantly increased risk of venous thromboembolism in chronic hypersensitivity pneumonitis. There were no significant differences in survival between patients with and without venous thromboembolism. Conclusions The patients with chronic hypersensitivity pneumonitis have a marked increase in the risk of venous thromboembolism, similar to the patients with IPF. Venous thromboembolism does not affect the survival of patients with IPF and chronic hypersensitivity pneumonitis.

scholarly journals Risk of a permanent work-related disability pension after incident venous thromboembolism in Denmark: A population-based cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. e1003770
Author(s):  
Helle Jørgensen ◽  
Erzsébet Horváth-Puhó ◽  
Kristina Laugesen ◽  
Sigrid Brækkan ◽  
John-Bjarne Hansen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Cardiovascular Diseases ◽  
General Population ◽  
Disability Pension ◽  
Population Based ◽  
Social Consequences ◽  
Work Related ◽  
Increased Risk ◽  
Permanent Work

Background Long-term complications of venous thromboembolism (VTE) hamper physical function and impair quality of life; still, it remains unclear whether VTE is associated with risk of permanent work-related disability. We aimed to assess the association between VTE and the risk of receiving a permanent work-related disability pension and to assess whether this association was explained by comorbidities such as cancer and arterial cardiovascular disease. Methods and findings A Danish nationwide population-based cohort study consisting of 43,769 individuals aged 25 to 66 years with incident VTE during 1995 to 2016 and 218,845 birth year-, sex-, and calendar year-matched individuals from the general population, among whom 45.9% (N = 120,540) were women, was established using Danish national registries. The cohorts were followed throughout 2016, with permanent work-related disability pension as the outcome. Hazard ratios (HRs) with 95% confidence intervals (CIs) for disability pension were computed and stratified by sex and age groups (25 to 34, 35 to 44, 45 to 54, and 55 to 66 years of age) and adjusted for comorbidities and socioeconomic variables. Permanent work-related disability pensions were granted to 4,415 individuals with VTE and 9,237 comparison cohort members (incidence rates = 17.8 and 6.2 per 1,000 person-years, respectively). VTE was associated with a 3-fold (HR 3.0, 95% CI: 2.8 to 3.1) higher risk of receiving a disability pension. Adjustments for socioeconomic status and comorbidities such as cancer and cardiovascular diseases reduced the estimate (HR 2.3, 95% CI: 2.2 to 2.4). The risk of disability pension receipt was slightly higher in men than in women (HR 2.5, 95% CI: 2.3 to 2.6 versus HR 2.1, 95% CI: 2.0 to 2.3). As this study is based on medical and administrative registers, information on post-VTE care, individual health behavior, and workplace factors linked to disability pension in the general population are lacking. Furthermore, as disability pension schemes vary, our results might not be directly generalizable to other countries or time periods. Conclusions In this study, incident VTE was associated with increased risk of subsequent permanent work-related disability, and this association was still observed after accounting for comorbidities such as cancer and cardiovascular diseases. Our results emphasize the social consequences of VTE and may help occupational and healthcare professionals to identify vulnerable individuals at risk of permanent exclusion from the labor market after a VTE event.

scholarly journals Incidence of COVID-19 Hospitalisation in Patients with Systemic Lupus Erythematosus: A Nationwide Cohort Study from Denmark

2021 ◽  
Vol 10 (17) ◽  
pp. 3842
Author(s):  
René Cordtz ◽  
Salome Kristensen ◽  
Louise Plank Holm Dalgaard ◽  
Rasmus Westermann ◽  
Kirsten Duch ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
General Population ◽  
Lupus Erythematosus ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Study Results ◽  
The Impact

Background: Patients with systemic lupus erythematosus (SLE) have an increased risk of infections due to impaired immune functions, disease activity, and treatment. This study investigated the impact of having SLE on the incidence of hospitalisation with COVID-19 infection. Methods: This was a nationwide cohort study from Denmark between 1 March 2020 to 2 February 2021, based on the linkage of several nationwide registers. The adjusted incidence of COVID-19 hospitalisation was estimated for patients with SLE compared with the general population in Cox-regression models. Among SLE patients, the hazard ratio (HR) for hospitalisation was analysed as nested case-control study. Results: Sixteen of the 2533 SLE patients were hospitalised with COVID-19 infection. The age-sex adjusted rate per 1000 person years was 6.16 (95% CI 3.76–10.08) in SLE patients, and the corresponding hazard ratio was 2.54 (95% CI 1.55–4.16) compared with the matched general population group after adjustment for comorbidities. Among SLE patients, hydroxychloroquine treatment was associated with a HR for hospitalisation of 0.61 (95% CI 0.19–1.88), and 1.06 (95% CI 0.3–3.72) for glucocorticoid treatment. Conclusion: Patients with SLE were at increased risk of hospitalisation with COVID-19.

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