scholarly journals Risk of first and recurrent serious infection in sarcoidosis: a Swedish register-based cohort study

2020 ◽  
Vol 56 (3) ◽  
pp. 2000767 ◽  
Author(s):  
Marios Rossides ◽  
Susanna Kullberg ◽  
Anders Eklund ◽  
Daniela Di Giuseppe ◽  
Johan Grunewald ◽  
...  
Keyword(s):  
General Population ◽  
International Classification Of Diseases ◽  
Parametric Models ◽  
National Patient Register ◽  
Patient Register ◽  
Drug Register ◽  
Serious Infection ◽  
Increased Risk ◽  
Serious Infections ◽  
National Patient

Serious infections impair quality of life and increase costs. Our aim was to determine if sarcoidosis is associated with a higher rate of serious infection and whether this varies by age, sex, time since diagnosis or treatment status around diagnosis.We compared individuals with sarcoidosis (at least two International Classification of Diseases codes in the Swedish National Patient Register 2003–2013; n=8737) and general population comparators matched 10:1 on age, sex and residential location (n=86 376). Patients diagnosed in 2006–2013 who were dispensed at least one immunosuppressant ±3 months from diagnosis (Swedish Prescribed Drug Register) were identified. Cases and comparators were followed in the National Patient Register for hospitalisations for infection. Using Cox and flexible parametric models, we estimated adjusted hazard ratios (aHR) and 95% confidence intervals for first and recurrent serious infections (new serious infection >30 days after previous).We identified 895 first serious infections in sarcoidosis patients and 3881 in comparators. The rate of serious infection was increased 1.8-fold in sarcoidosis compared to the general population (aHR 1.81, 95% CI 1.65–1.98). The aHR was higher in females than males and during the first 2 years of follow-up. Sarcoidosis cases treated with immunosuppressants around diagnosis had a three-fold increased risk, whereas nontreated patients had a 50% increased risk. The rate of serious infection recurrence was 2.8-fold higher in cases than in comparators.Serious infections are more common in sarcoidosis than in the general population, particularly during the first few years after diagnosis. Patients who need immunosuppressant treatment around diagnosis are twice as likely to develop a serious infection than those who do not.

scholarly journals Type 2 diabetes risk in sarcoidosis patients untreated and treated with corticosteroids

2021 ◽  
pp. 00028-2021
Author(s):  
Joshua P. Entrop ◽  
Susanna Kullberg ◽  
Johan Grunewald ◽  
Anders Eklund ◽  
Kerstin Brismar ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
General Population ◽  
Sex Education ◽  
Cox Regression ◽  
Parametric Models ◽  
Family History Of Diabetes ◽  
Drug Register ◽  
Increased Risk ◽  
Icd Codes

BackgroundThe rate of type 2 diabetes mellitus (T2D) is increased in sarcoidosis patients but it is unknown if corticosteroid treatment plays a role. We investigated whether the T2D risk is higher in untreated and corticosteroid-treated sarcoidosis patients compared to the general population.MethodsIn this cohort study individuals with ≥2 ICD codes for sarcoidosis were identified from the Swedish National Patient Register (NPR; n=5754). Corticosteroid dispensations ±3 months from first sarcoidosis diagnosis were identified from the Prescribed Drug Register (PDR). General population comparators without sarcoidosis were matched to cases 10:1 on age, sex and region of residence (n=61 297). Incident T2D was identified using ICD codes (NPR) and antidiabetic drug dispensations (PDR). Follow-up was from second sarcoidosis diagnosis/matching date until T2D, emigration, death or study end (Dec 2013). Cox regression models adjusted for age, sex, education, country of birth, healthcare regions and family history of diabetes estimated hazard ratios (HR 95%CI). We used flexible parametric models to examine the T2D risk over time.Results40% of sarcoidosis patients were corticosteroid-treated at diagnosis. The T2D rate was 7.7/1000 person-years in untreated sarcoidosis, 12.7 in corticosteroid-treated sarcoidosis and 5.5 in comparators. The HR for T2D was 1.4 (95%CI 1.2–1.8) associated with untreated sarcoidosis and 2.3 (95%CI 2.0–3.0) associated with corticosteroid-treated sarcoidosis. The T2D risk was highest for corticosteroid-treated sarcoidosis in the first 2 years after diagnosis.ConclusionSarcoidosis is associated with an increased risk of T2D especially in older, male, corticosteroid-treated patients at diagnosis. Screening for T2D for these patients is advisable.

scholarly journals Sarcoidosis mortality in Sweden: a population-based cohort study

2018 ◽  
Vol 51 (2) ◽  
pp. 1701815 ◽  
Author(s):  
Marios Rossides ◽  
Susanna Kullberg ◽  
Johan Askling ◽  
Anders Eklund ◽  
Johan Grunewald ◽  
...  
Keyword(s):  
General Population ◽  
Large Population ◽  
Population Based ◽  
Disease Heterogeneity ◽  
International Classification Of Disease ◽  
Risk Of Death ◽  
Drug Register ◽  
Hazard Ratios ◽  
Increased Risk ◽  
National Patient

We aimed to investigate sarcoidosis mortality in a large, population-based cohort, taking into account disease heterogeneity.Individuals with incident sarcoidosis (n=8207) were identified from the Swedish National Patient Register using International Classification of Disease codes (2003‒2013). In a subset, cases receiving treatment ±3 months from diagnosis were identified from the Prescribed Drug Register. Nonsarcoidosis comparators from the general population were matched to cases 10:1 on birth year, sex and county. Individuals were followed for all-cause death in the Cause of Death Register. Adjusted mortality rates, rate differences and hazard ratios (HRs) were estimated, stratifying by age, sex and treatment status.The mortality rate was 11.0 per 1000 person-years in sarcoidosis versus 6.7 in comparators (rate difference 2.7 per 1000 person-years). The HR for death was 1.61 (95% CI 1.47‒1.76), with no large variation by age or sex. For cases not receiving treatment within the first 3 months, the HR was 1.13 (95% CI 0.94‒1.35). The HR was 2.34 (95% CI 1.99‒2.75) for those receiving treatment.Individuals with sarcoidosis are at a higher risk of death compared to the general population. For the majority, the increased risk is small. However, patients whose disease leads to treatment around diagnosis have a two-fold increased risk of death. Future interventions should focus on this vulnerable group.

The use of hospitalizations by persistent somatizing patients

1992 ◽  
Vol 22 (1) ◽  
pp. 173-180 ◽  
Author(s):  
Per Fink
Keyword(s):  
General Population ◽  
General Hospital ◽  
Medical Records ◽  
Physical Symptoms ◽  
Organic Basis ◽  
General Hospitals ◽  
National Patient Register ◽  
Patient Register ◽  
National Patient ◽  
Danish National Patient Register

SYNOPSISMedical records were selected from the Danish National Patient Register in order to study individuals between the ages of 17 and 49 years in the general population who, during an 8-year period, were admitted at least 10 times to a general hospital (N = 282). Fifty-six subjects (19%) were found to be persistent somatizers, i.e. they were admitted repeatedly to general hospitals for physical symptoms without an organic basis. This corresponded to a frequency of persistent somatization in the population 0·6 per 1000 men and 3·2 per 1000 women.

Gender differences in delays to diagnosis of acromegaly: data from the Swedish National Patient Register

2018 ◽  
Author(s):  
Daniel Granfeldt ◽  
AEse Bjorstad ◽  
Marlow Tom ◽  
Anthony Berthon ◽  
Jerome Dinet ◽  
...  
Keyword(s):  
Gender Differences ◽  
National Patient Register ◽  
Patient Register ◽  
National Patient

scholarly journals 1095. Investigation of Risk Factors Associated with Serious Bacterial, Viral and Invasive Fungal Infections in Hematologic Patients on Ibrutinib

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S576-S577
Author(s):  
Thomas Holowka ◽  
Harry Cheung ◽  
Maricar F Malinis ◽  
Sarah Perreault ◽  
Iris Isufi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fungal Infections ◽  
Antimicrobial Prophylaxis ◽  
Hematologic Malignancy ◽  
Invasive Fungal Infections ◽  
Risk Of Infection ◽  
Factors Associated ◽  
Serious Infection ◽  
Increased Risk ◽  
Serious Infections

Abstract Background Ibrutinib is a tyrosine kinase inhibitor used to treat hematologic malignancies that may increase the risk of serious infection including invasive fungal infections (IFI). In a study of 378 patients with hematologic malignancy on ibrutinib, serious infection and IFI occurred in 11% and 4% respectively (Varughese et al. Clin Infect Dis). The primary aims of our study were to determine the incidence of serious infection and associated risk factors in patients on ibrutinib. Methods We performed a retrospective analysis of patients with hematologic malignancy prescribed ibrutinib for ≥ 1 week at Yale New Haven Hospital from 2014 to 2019 to identify serious infections defined as those requiring inpatient management. We collected demographic, clinical and oncologic data. Chi-squared tests were used to determine factors associated with an increased risk of infection. Results A total of 254 patients received ibrutinib including 156 with CLL, 89 with NHL and 9 with other leukemias. Among these, 21 underwent HSCT, 9 complicated by GVHD. There were 51 (20%) patients with serious infections including 45 (17.7%) bacterial, 9 (3.5%) viral and 5 (2%) IFI (1 pulmonary cryptococcosis, 4 pulmonary aspergillosis). Anti-mold prophylaxis was prescribed to 7 (2.8%) patients, none of whom developed IFI. Risk factors associated with serious infection included ECOG score ≥ 2 (OR 4.6, p < 0.001), concurrent steroid use (≥ 10 mg prednisone daily for ≥ 2 weeks; OR 3.0, p < 0.001), neutropenia (OR 3.6, p < 0.01), lymphopenia (OR 2.4, p < 0.05) and maximum ibrutinib dose of 560 mg (OR 2, p < 0.05). There was a dose dependent increase in infections based on number of chemotherapy regimens prior to ibrutinib initiation: 14.3% with 0, 19.7% with 1-2 and 28.7% with ≥ 3 prior treatments. Conclusion The incidence of serious infection in hematologic patients on ibrutinib was higher than previously reported (20% versus 11%) but the rate of IFI was lower (2% versus 4%). High ECOG score, leukopenia, steroids, and higher ibrutinib doses were associated with an increased risk for serious infection. Targeted antimicrobial prophylaxis should be considered for patients on ibrutinib with these risk factors. Improving functional status may also reduce the risk of infection in patients on ibrutinib. Disclosures All Authors: No reported disclosures

scholarly journals Validity and reliability of social anxiety disorder diagnoses in the Swedish National Patient Register

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Alba Vilaplana-Pérez ◽  
Josef Isung ◽  
Sonja Krig ◽  
Sarah Vigerland ◽  
Maral Jolstedt ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Social Anxiety Disorder ◽  
Validity And Reliability ◽  
National Patient Register ◽  
Patient Register ◽  
National Patient

scholarly journals Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register

2019 ◽  
Author(s):  
Anders Forss ◽  
Pär Myrelid ◽  
Ola Olén ◽  
Åsa H Everhov ◽  
Caroline Nordenvall ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Sensitivity And Specificity ◽  
Bowel Disease ◽  
Surgical Procedure ◽  
High Sensitivity ◽  
National Patient Register ◽  
Patient Register ◽  
National Patient ◽  
Inflammatory Bowel ◽  
Procedure Codes

Abstract Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register Background: About 50% of patients with Crohn’s disease (CD) and about 20% of those with ulcerative colitis (UC) undergo surgery at some point during the course of the disease. The diagnostic validity of the Swedish National Patient Register (NPR) has previously been shown to be high for inflammatory bowel disease (IBD), but there are little data on the validity of IBD-related surgical procedure codes. Methods: Using patient chart data as the gold standard, surgical procedure codes registered between 1966 and 2014 in the NPR were abstracted and validated in 262 patients with a medical diagnosis of IBD. Of these, 53 patients had reliable data about IBD-related surgery. The positive predictive value (PPV), sensitivity and specificity of the surgical procedure codes were calculated. Results: In total, 158 codes were registered in the NPR. 155 of these, representing 60 different surgical procedure codes, were also present in the patient charts and validated using a standardized form. Of the validated codes 153/155 were concordant against the patient charts, corresponding to a PPV of 96.8% (95%CI=93.9-99.1). Stratified in abdominal, perianal and other surgery, the corresponding PPVs were 94.1% (95%CI=88.7-98.6), 100% (95%CI=100-100) and 98.1% (95%CI=93.1-100), respectively. Of 164 surgical procedure codes in the validated patient charts, 155 were registered in the NPR, corresponding to a sensitivity of the surgical procedure codes of 94.5% (95%CI=89.6-99.3). The specificity of the NPR was 98.5% (95%CI=97.6-100). Conclusions: Data on IBD-related surgical procedure codes are reliable, with the Swedish National Patient Register showing a high sensitivity and specificity for such surgery. Keywords: Epidemiology, Inflammatory bowel disease, Validation, National Patient Register, Procedure code

scholarly journals Validation of multiple sclerosis diagnoses in the Swedish National Patient Register

2019 ◽  
Vol 34 (12) ◽  
pp. 1161-1169 ◽  
Author(s):  
Chantelle Murley ◽  
Emilie Friberg ◽  
Jan Hillert ◽  
Kristina Alexanderson ◽  
Fei Yang
Keyword(s):  
Multiple Sclerosis ◽  
National Patient Register ◽  
Patient Register ◽  
National Patient
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