Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

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Estimation of risk factors associated with difficult birth in ewes

Animal Production Science ◽

10.1071/an16339 ◽

2018 ◽

Vol 58 (6) ◽

pp. 1125 ◽

Cited By ~ 3

Author(s):

B. J. Horton ◽

R. Corkrey ◽

G. N. Hinch

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Litter Size ◽

Low Birthweight ◽

Condition Score ◽

Cause Of Deaths ◽

Ease Score ◽

Very High ◽

Australian Merino

In eight closely recorded Australian Merino and crossbred sheep flocks, all lamb deaths were examined and the cause of deaths identified if possible. Dystocia was identified as one of the major causes of lamb death and this study examined factors that could be used to identify ewes at high risk of dystocia, either to avoid dystocia or to assist with early intervention where possible. Dystocia was least common in lambs of ~4.8 kg, but there was a higher risk at both lower and higher birthweights. Dystocia with both low and high birthweight was more common in older ewes, ranging from negligible low birthweight dystocia in ewes less than 3 years old at lambing, to 5% in older ewes. Low birthweight dystocia increased with increasing litter size, with 40% dystocia in ewes at least 4 years of age with triplets. In contrast, high birthweight dystocia was not affected by litter size. A previous record of low birthweight dystocia was a risk factor for future low birthweight dystocia, but the same relationship was not observed for high birthweight dystocia. A high lambing ease score (difficult birth) with high birthweight was a risk factor for future high birthweight dystocia, but this was not the case for low birthweight dystocia. These differences between the risk factors for low and high birthweight dystocia suggest that they have different causes. High ewe liveweight and condition score during pregnancy may be additional indicators of the risk of dystocia, particularly for ewes with high liveweight in the first 60 days of pregnancy. For most ewes dystocia was difficult to predict, but there was a small proportion of ewes with a very high risk of dystocia and if these could be identified in advance they could be monitored much more closely than the rest of the flock.

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A Risk Score to Predict CMV Viremia within the First 100 Days after Allogeneic Stem Cell Transplantation Based on Pre-Transplant Parameters

Blood ◽

10.1182/blood.v124.21.3877.3877 ◽

2014 ◽

Vol 124 (21) ◽

pp. 3877-3877

Author(s):

Feras Alfraih ◽

John Kuruvilla ◽

Naheed Alam ◽

Anna Lambie ◽

Vikas Gupta ◽

...

Keyword(s):

Risk Factors ◽

Stem Cell ◽

High Risk ◽

Risk Score ◽

Risk Group ◽

Risk Groups ◽

Low Risk ◽

Cmv Infection ◽

Allogeneic Hsct ◽

Very High

Abstract Introduction: Cytomegalovirus (CMV) is a major infectious complication following allogeneic hematopoietic stem cell transplantation (HSCT). Risk of CMV infection varies between patients and individualized strategies for monitoring and therapy for CMV are needed. In this study, we attempted to establish a clinical score based on patient and transplant characteristics in order to predict the probability for early CMV viremia (CMV-V) within the first 100 days after HSCT. Methods: A total of 548 patients were evaluated after receiving HSCT between 2005 and 2012 at Princess Margaret Cancer Centre. CMV sero-negative recipients with CMV sero-negative donors (R-D-) were excluded. CMV-V was diagnosed in peripheral blood samples obtained on two occasions either by PCR (>200 IU/ml) or antigenemia testing (>2 positive cells/100000). A total of 378 patients were included into the study. Uni- and multivariable analyses were performed to identify risk factors for CMV-V. A weighted score was assigned to each factor based on the odds ratios determined by the multivariable analysis. A total score was calculated for each patient and used for assignment into one of 4 risk categories, the low risk (score 0-1), the intermediate (score 2-3), the high (score 4-5) and the very high (score 6-8). Median age for all patients was 51 years (range 17-71) and 173 (46%) were female. Matched related donors were used for two hundred fifteen patients (57%). Two hundred forty-three patients (64%) were transplanted for myeloid and 108 (29%) for lymphoid malignancies. One hundred thirteen patients (30%) were CMV sero-positive with a negative donor (R+D-) while 191 (51%) were recipient and donor CMV sero-positivity (R+D+). Graft versus host disease (GVHD) prophylaxis included CSA/MMF (n=200, 52%), and CSA/MTX (n=178, 48%). Myeloablative conditioning regimens were administered to 220 patients (58%), 158 patients (42%) were treated with a reduced intensity regimen. Three hundred-thirty seven patients (89%) received peripheral blood stem cells as a stem cell source. In vivo T cell depletion (TCD) with alemtuzumab was used in 138 (37%). Results: CMV-V occurred in 246 (64%) patients by day 100 post HSCT. The impact of patient and HSCT characteristics on the risk of CMV-V was assessed by multivariable analysis. The significant factors were CMV sero-status R+D- and R+D+, TCD, GVHD prophylaxis with MMF administration of myeloablative preparative regimens (Table 1). Table 1. Multivariate analysis for risk factors of CMV infection following allogeneic HSCT Table 1. Multivariate analysis for risk factors of CMV infection following allogeneic HSCT CMV-V rates on the 4 new risk categories amounted to 93% in the very high-risk, 78% in high-risk, 41% in intermediate-risk and 11% in low-risk group (Fig 1). The risk score was also predictive for the occurrence of multiple CMV-V reactivations with rates of 71%, 45%, 19% and 4% for the very high, high, intermediate and low-risk groups, respectively. The overall survival (OS) rate at 2 years was 33%(n=56) in the very high-risk group compared to 50% in other-risk groups (n=147) (P=0.01) (Fig 2). Non-relapse mortality (NRM) was 53% in the very high-risk versus 33% in other-risk groups (P<0.001). However, there was no difference on cumulative incidence of relapse between the groups (P=0.3). The cumulative incidence of grades 1-4 acute GVHD, grades 2-4, grades 3-4 at day 120 and overall chronic GVHD at 2 years was 68%, 47%, 25% and 39% in very high-risk group versus 65%, 52%, 21% and 52% in other-risk groups, suggesting slightly lower incidence of chronic GVHD in very high-risk vs other-risk groups. Conclusion: We present a new clinical scoring system to stratify the risk of early CMV viremia after allogeneic HSCT based on patients and HSCT characteristics. Identifying the risk for each patient would facilitate decision making with respect to strategies including CMV prophylaxis, pre-emptive treatment or inclusion into clinical trials, as well directing the CMV monitoring policy post-transplant. In addition, the risk score was associated with higher risk of overall mortality and NRM in the very high-risk versus other-risk groups. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

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WILD FIRE RISK MAP IN THE EASTERN STEPPE OF MONGOLIA USING SPATIAL MULTI-CRITERIA ANALYSIS

ISPRS - International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences ◽

10.5194/isprsarchives-xli-b1-469-2016 ◽

2016 ◽

Vol XLI-B1 ◽

pp. 469-473 ◽

Cited By ~ 1

Author(s):

Elbegjargal Nasanbat ◽

Ochirkhuyag Lkhamjav

Keyword(s):

High Risk ◽

Social Economic ◽

Risk Index ◽

Fire Risk ◽

Low Risk ◽

Moderate Risk ◽

Validation Data ◽

Risk Zone ◽

Wildfire Risk ◽

Very High

Grassland fire is a cause of major disturbance to ecosystems and economies throughout the world. This paper investigated to identify risk zone of wildfire distributions on the Eastern Steppe of Mongolia. The study selected variables for wildfire risk assessment using a combination of data collection, including Social Economic, Climate, Geographic Information Systems, Remotely sensed imagery, and statistical yearbook information. Moreover, an evaluation of the result is used field validation data and assessment. The data evaluation resulted divided by main three group factors Environmental, Social Economic factor, Climate factor and Fire information factor into eleven input variables, which were classified into five categories by risk levels important criteria and ranks. All of the explanatory variables were integrated into spatial a model and used to estimate the wildfire risk index. Within the index, five categories were created, based on spatial statistics, to adequately assess respective fire risk: very high risk, high risk, moderate risk, low and very low. Approximately more than half, 68 percent of the study area was predicted accuracy to good within the very high, high risk and moderate risk zones. The percentages of actual fires in each fire risk zone were as follows: very high risk, 42 percent; high risk, 26 percent; moderate risk, 13 percent; low risk, 8 percent; and very low risk, 11 percent. The main overall accuracy to correct prediction from the model was 62 percent. The model and results could be support in spatial decision making support system processes and in preventative wildfire management strategies. Also it could be help to improve ecological and biodiversity conservation management.

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The Effect of Ethnicity on Preterm Birth and its Influence on the Risk Factors for Prematurity

Current Opinion in Gynecology and Obstetrics ◽

10.18314/cogo.v2i1.1456 ◽

2019 ◽

pp. 180-192

Author(s):

P Bachkangi ◽

AH Taylor ◽

JC Konje

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Preterm Birth ◽

High Risk ◽

Risk Groups ◽

Individual Risk ◽

Individual Risk Factor ◽

Increased Risk ◽

Gestational Age At Delivery ◽

Very High

Preterm birth (PTB) affects 9.6% of pregnancies worldwide and is associated with a very high perinatal mortality that depends on the gestational age at delivery. As a result, PTB has a significant health and financial impact on health systems, families and societies. Its aetiology is not fully understood, but in most cases it is multifactorial, with several maternal, paternal, and epidemiological factors associated with increased risk. Other factors include parental ethnicity, maternal age and body mass index, socioeconomic status, and where the families live. This review examines the influence of ethnicity as an individual risk factor for PTB. It also explores its influence on the epidemiology of PTB and demonstrates that data on certain ethnicities are lacking, despite the fact that these ethnic clusters are within the very ‘high-risk groups’ that are adequately represented in some Western societies. This review examines the influence of ethnicity as an individual risk factor for PTB and also explores its influence on the different epidemiological aspects. A thorough revisit of the ethnic epidemiology unveiled other unnoticed risk factors that if addressed appropriately prematurity can be prevented. Moreover, certain ethnicities were not within the attention of researchers, despite the facts that they are very ‘high-risk groups’ and are also adequately represented in some Western societies.

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Pre-existing Cardiovascular Disease in United States Population at High Risk for Severe COVID-19 Infection

10.1101/2020.05.11.20089714 ◽

2020 ◽

Author(s):

Adnan I Qureshi

Keyword(s):

United States ◽

Risk Factors ◽

Cardiovascular Disease ◽

At Risk ◽

High Risk ◽

Low Risk ◽

Chronic Obstructive ◽

Moderate Risk ◽

High Risk Patients ◽

Risk Patients

Background and Purpose There is increasing recognition of a relatively high burden of pre-existing cardiovascular disease in Corona Virus Disease 2019 (COVID 19) infected patients. We determined the burden of pre-existing cardiovascular disease in persons residing in United States (US) who are at risk for severe COVID-19 infection. Methods Age (60 years or greater), presence of chronic obstructive pulmonary disease, diabetes, mellitus, hypertension, and/or malignancy were used to identify persons at risk for admission to intensive care unit, or invasive ventilation, or death with COVID-19 infection. Persons were classified as low risk (no risk factors), moderate risk (1 risk factor), and high risk (two or more risk factors present) using nationally representative sample of US adults from National Health and Nutrition Examination Survey 2017 and 2018 survey. Results Among a total of 5856 participants, 2386 (40.7%) were considered low risk, 1325 (22.6%) moderate risk, and 2145 persons (36.6%) as high risk for severe COVID-19 infection. The proportion of patients who had pre-existing stroke increased from 0.6% to 10.5% in low risk patients to high risk patients (odds ratio [OR]19.9, 95% confidence interval [CI]11.6-34.3). The proportion of who had pre-existing myocardial infection (MI) increased from 0.4% to 10.4% in low risk patients to high risk patients (OR 30.6, 95% CI 15.7-59.8). Conclusions A large proportion of persons in US who are at risk for developing severe COVID 19 infection are expected to have pre-existing cardiovascular disease. Further studies need to identify whether targeted strategies towards cardiovascular diseases can reduce the mortality in COVID-19 infected patients.

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Nutritional Risk and Health-Related Quality of Life in Older Adults Aging With HIV

Innovation in Aging ◽

10.1093/geroni/igab046.3413 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 954-954

Author(s):

Nicole Viviano ◽

Ann Gruber-Baldini ◽

Sarah Schmalzle ◽

Kristen Stafford ◽

Sarah Chard ◽

...

Keyword(s):

High Risk ◽

Low Risk ◽

Nutritional Risk ◽

Moderate Risk ◽

Related Quality ◽

Health Related ◽

Mental Hrqol ◽

Physical Hrqol ◽

Very High

Abstract Due to antiretroviral treatment success, individuals with HIV are living longer. People aging with HIV (PAWH, 50+) may be more likely to experience nutritional risk compared to their HIV-negative counterparts due to biopsychosocial factors. The DETERMINE checklist measure accounts for social and economic factors as well as aspects of the aging process that are not typically considered when examining nutritional risk and are important for PAWH. The current study examined nutritional risk and health-related quality of life (HRQoL) in PAWH using the DETERMINE checklist and PROMIS t-scores (mental and physical HRQoL) through secondary analyses of 158 participants in the Strengthening Therapeutic Resources in Older patients agiNG with HIV (STRONG) study. DETERMINE nutritional risk scores (0-21) were separated into 4 groups (low-risk [0-2, n=13], moderate-risk [3-5, n=28], high-risk [6-12, n=78], very high-risk [13-21, n=39]). The sample was 55% male, 94% Black/African American and had a mean age=59 (SD=5.5). Most of the sample (74%) were at high or very high nutritional risk and low HRQoL t-score: physical M=43.7 (SD=9.5), and mental M=45.7 (SD=10.1). Mental and physical HRQoL were significantly (p<.001) associated with nutritional risk group as tested through linear regressions. Means were as follows: physical HRQoL low-risk M=53.4 (SD=10.6), moderate-risk M=47.4 (SD=8.9), high-risk M=43.5 (SD=8.1), very high-risk M=38.4 (SD=8.9); mental HRQoL low-risk M=54.0 (SD=8.9), moderate-risk M=49.1(SD=7.9), high-risk M=46.1(SD=9.5), and very high-risk M=39.5 (SD=9.7). These associations remained significant after controlling for age and sex. Higher nutritional risk as measured by the DETERMINE checklist in PAWH was associated with poorer physical and mental HRQoL.

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Treatment stratification in B-cell PTLD after solid organ transplantation (SOT) by international prognostic index (IPI) and response to rituximab: Interim results from the PTLD-2 trial.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.8045 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 8045-8045

Author(s):

Ralf Ulrich Trappe ◽

Christian Koenecke ◽

Martin H. Dreyling ◽

Christiane Pott ◽

Ulrich Duehrsen ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Risk Stratification ◽

B Cell ◽

Primary Endpoint ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

Solid Organ ◽

Very High

8045 Background: The PTLD-1 trials have established risk-stratified sequential treatment of B-cell PTLD. After rituximab induction, patients (pts) in complete remission (25 %) received rituximab consolidation, while all others received R-CHOP. The PTLD-2 trial tests modified risk-stratification including clinical risk factors. These are the results of the 2nd scheduled interim analysis (40/60 planned pts). Methods: The prospective, multicenter phase II PTLD-2 trial (NCT02042391) enrols treatment-naïve adult SOT recipients with CD20-positive PTLD. Key exclusion criteria are CNS involvement, ECOG > 2, pregnancy, and severe organ dysfunction or severe, active infection. Treatment consists of rituximab (1400 mg SC; first application 375 mg/m2 IV) on days 1, 8, 15 and 22. After restaging, pts in CR as well as those in PR with ≤ 2 IPI risk factors at diagnosis (low-risk group) continue with four three-weekly courses of rituximab. Most other pts (high-risk group) receive 4 cycles of R-CHOP-21, while thoracic SOT recipients who progress under rituximab (very-high-risk group) receive six cycles of alternating R-CHOP-21 and R-DHAOx. The primary endpoint (event-free survival in the low-risk group) is not analyzed here. Secondary endpoints presented here are response and overall response (ORR) by computed tomography, overall survival (OS), time to progression (TTP) and treatment-related mortality (TRM) overall and by risk group. Results: 40 pts were recruited at 12 centers (2015 – 2019). 21/40 were kidney, 11 lung, 4 liver, 3 heart, and 1 liver/kidney transplant recipients. Median age was 54 years. 38/40 PTLD were monomorphic and 15/40 EBV-associated. 38 pts were evaluated for response at interim staging: 13 were allocated to the low-risk, 17 to the high-risk and 8 to the very-high-risk group. ORR was 28/30 (93 %, CR: 16/30 [53 %]). With a median follow-up of 1.9 years, the 1-year/3-year Kaplan-Meier (KM) estimates of TTP and OS in the intention-to-treat population (40 pts) were 85 %/80 % and 70 %/70 %, respectively. In the low-risk group, the 2-year KM estimate of OS was 100 %. The frequency of infections (all grades) was 50 %, and TRM occurred in 3/40 pts (8 %). Conclusions: One third of enrolled pts were treated in the low-risk group and the recruitment goal for evaluation of the primary endpoint will likely be reached. Interim efficacy and toxicity data with rituximab SC and modified risk-stratification are encouraging despite the inclusion of 35 % thoracic SOT recipients. Clinical trial information: NCT02042391 .

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Risk factor assessment of endoscopically removed malignant colorectal polyps

Gut ◽

10.1136/gut.43.5.669 ◽

1998 ◽

Vol 43 (5) ◽

pp. 669-674 ◽

Cited By ~ 82

Author(s):

P Netzer ◽

C Forster ◽

R Biral ◽

C Ruchti ◽

J Neuweiler ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Adverse Outcome ◽

Venous Invasion ◽

Colorectal Polyps ◽

Adverse Outcomes ◽

Low Risk ◽

Malignant Polyps ◽

Grade Iii

Background—Malignant colorectal polyps are defined as endoscopically removed polyps with cancerous tissue which has invaded the submucosa. Various histological criteria exist for managing these patients.Aims—To determine the significance of histological findings of patients with malignant polyps.Methods—Five pathologists reviewed the specimens of 85 patients initially diagnosed with malignant polyps. High risk malignant polyps were defined as having one of the following: incomplete polypectomy, a margin not clearly cancer-free, lymphatic or venous invasion, or grade III carcinoma. Adverse outcome was defined as residual cancer in a resection specimen and local or metastatic recurrence in the follow up period (mean 67 months).Results—Malignant polyps were confirmed in 70 cases. In the 32 low risk malignant polyps, no adverse outcomes occurred; 16 (42%) of the 38 patients with high risk polyps had adverse outcomes (p<0.001). Independent adverse risk factors were incomplete polypectomy and a resected margin not clearly cancer-free; all other risk factors were only associated with adverse outcome when in combination.Conclusion—As no patients with low risk malignant polyps had adverse outcomes, polypectomy alone seems sufficient for these cases. In the high risk group, surgery is recommended when either of the two independent risk factors, incomplete polypectomy or a resection margin not clearly cancer-free, is present or if there is a combination of other risk factors. As lymphatic or venous invasion or grade III cancer did not have an adverse outcome when the sole risk factor, operations in such cases should be individually assessed on the basis of surgical risk.

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A retrospective cohort study examining secondary prevention post stroke in primary care in an Asian setting

BMC Family Practice ◽

10.1186/s12875-021-01412-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Vivek Bansal ◽

Eng Sing Lee ◽

Helen Smith

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Primary Care ◽

Risk Factor ◽

Cohort Study ◽

High Risk ◽

Secondary Prevention ◽

Retrospective Cohort ◽

Low Risk ◽

Risk Factor Control

Abstract Background Stroke is one of the top contributors to burden of disability-adjusted life-years worldwide. Family physicians have key role in optimising secondary prevention following stroke by managing clinical risk factors and promoting overall control in accordance with clinical practice guidelines. Methods Our objectives were: (i) to examine level of overall risk factor control together with control of singular risk factors one-year after an index-stroke event in individuals attending primary care facility and (ii) to describe factors associated with satisfactory risk factors control in individuals following stroke. Study Design: Retrospective cohort study. We conducted a study looking retrospectively at records from our electronic chronic disease database. Our study included individuals following stroke who visited primary care setting in Singapore between January 2012 to December 2016. Results There were 24,240 individuals in our study. Overall control was better in individuals without diabetes following stroke (49.2%) as compared to those with diabetes (28.1%). Among individuals without diabetes following stroke, factors significantly associated with overall control were sex (male) [OR (reference: female): 1.23, 95% CI: 1.10, 1.39], ethnicity (Malay) [OR (reference: Chinese): 0.72, 95% CI: 0.58, 0.90], BMI (high risk) [OR (reference: low risk): 0.72, 95% CI: 0.62, 0.84) and atrial fibrillation [OR: 1.47, 95% CI: 1.21, 1.78]. Among individuals with diabetes following stroke, factors significantly associated with overall control were sex (male) [OR (reference: female): 1.28, 95% CI: 1.12, 1.46], ethnicity (Malay) [OR (reference: Chinese): 0.81, 95% CI: 0.65, 0.99], ethnicity (Indian) [OR (reference: Chinese): 0.70, 95% CI: 0.55, 0.88], BMI (high risk) [OR (reference: low risk): 0.71, 95% CI: 0.59, 0.84), BMI (moderate risk) [OR (reference: low risk): 0.84, 95% CI: 0.72, 0.98), atrial fibrillation [OR: 1.24; 95% CI: 1.02, 1.51], chronic kidney disease [OR: 0.63, 95% CI: 0.54, 0.72] and smoking status [OR: 0.68, 95% CI: 0.54, 0.88]. Conclusion We reported sub-optimal level of overall control. Among individuals following stroke, those with diabetes had higher proportion of sub-optimal control as compared to those without diabetes. Irrespective of diabetic status, being female, having high BMI, and of Malay ethnicity as compared to Chinese ethnicity were associated with poorer overall risk factor control.

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AB0613 FREQUENCY AND RISK OF FRAGILITY FRACTURES IN PATIENTS WITH SYSTEMIC SCLEROSIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1502 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1342.1-1342

Author(s):

A. Efremova ◽

O. Nikitinskaya ◽

N. Toroptsova ◽

O. Dobrovolskaya ◽

N. Demin

Keyword(s):

High Risk ◽

Fracture Risk ◽

Osteoporotic Fractures ◽

Fragility Fractures ◽

Low Risk ◽

Moderate Risk ◽

Major Osteoporotic Fractures ◽

Fracture Risk Assessment Tool ◽

History Of ◽

Very High

Background:Objectives:To assess the frequency of fragility fractures and the 10-year risk of major osteoporotic fractures using the fracture risk assessment tool (FRAX) tool in patients with systemic sclerosis (SSc).Methods:The study included 136 patients with SSc who met the ACR/EULAR 2013 criteria: 110 (80.9%) postmenopausal women and 26 (19.1%) men over 50 years of age, mean age 59,3 + 7.5 years. The duration of the disease was 10,0 [6.0; 15.0] years in women and 6,0 [3.5; 9.0] years in men. A questionnaire was conducted and the risk of major osteoporotic fractures was calculated according to FRAX tool, as a result of which patients were divided into groups of low, moderate or high risk. Individuals at moderate risk underwent dual-energy X-ray absorptiometry (DXA) of the proximal femur, followed by a 10-year probability of major osteoporotic fractures recalculation with the inclusion of the femoral neck T-score. According to the obtained fracture risk assessment tool value, patients were assigned as having a low, high or very high risk.Results:Fragility fractures of various localization were found in 50 (36,7%) people: 41 (37,3%) women and 9 (34.6%) men. Vertebral and peripheral bone fractures occurred with the same frequency (19,8%) without significant differences depending on the patient’s gender. Only 1 (3,8%) male had a history of proximal femoral fracture. Fractures of both the vertebra and the peripheral bone occurred in 4 (2,9%) people: 3 (2,7%) women and 1 (3,8%) man.9 (8,2%) women and 16 (61,5%) men had a low risk of major osteoporotic fractures according to FRAX, 60 (54,5%) and 10 (38,5%) - a moderate risk, respectively, while 41 (37,3%) women were at high risk. Among 86 patients without a history of low-energy fractures (69 women and 17 men), 8 (11,6%) women and 16 (94,1%) men were at low risk of major osteoporotic fractures, and 57 (82,6%) and 1 (5,9%), respectively, were at moderate risk. Only 4 (5,8%) women were assigned to the high-risk group. After recalculation of the fracture risk assessment tool with inclusion of the femoral neck T-score in persons with moderate risk without a history of fragility fractures, 9 (13,0%) women and 1 (5,9%) man were found to be at high risk, 14 (20,3%) women - at very high risk and 34 (49,3%) women - at low risk.Among moderate-risk patients with prior fractures after FRAX recalculation 3 (7,3%) women and 7 (77,8%) men became at low risk, 1 (11,1%) male - at high and 1(11,1%) male – at very high risk. Thus, 55 (50,0%) women and 1 (3,8%) man were at very high, 12 (10,9%) and 2 (7,7%), respectively, - at high, and 43 (39,1%) and 23 (88,5%), respectively, - at low risk of major osteoporotic fractures.Conclusion:In the examined cohort of patients with SSc, the frequency of fragility fractures was 37,3% in women and 34,6% in men. A high and very high risk of major osteoporotic fractures was found in 60,9% of women and 11,5% of men. 3 (2,7%) women and 6 (23,1%) men with a history of previous fractures were in the low-risk group by FRAX, but they need to consider the appointment of anti-osteoporotic therapy as for patients at high and very high risk.Disclosure of Interests:None declared.

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