Reconstructive Treatment of Ruptured Blood Blister–like Aneurysms With Stent and Coil

Neurosurgery ◽  
2013 ◽  
Vol 73 (3) ◽  
pp. 480-488 ◽  
Author(s):  
Yong Cheol Lim ◽  
Byung Moon Kim ◽  
Sang Hyun Suh ◽  
Pyoung Jeon ◽  
Sang Heum Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Complete Healing ◽  
Modified Rankin Scale ◽  
Systemic Lupus ◽  
Viable Option ◽  
Risk Factors For Recurrence ◽  
Independent Risk Factors

Abstract BACKGROUND: Controversy remains about the optimal treatment for blood blister--like aneurysms (BBAs). OBJECTIVE: To evaluate clinical and angiographic outcomes after reconstructive treatment for BBA with stent and coil. METHODS: Thirty-four patients (6 men, 28 women; mean age, 47.3 years) with ruptured BBAs underwent reconstructive treatment with stent and coil. Posttreatment courses and outcomes were retrospectively evaluated. RESULTS: Initial treatments were ≥ 2 overlapping stents with or without coiling (n = 28) and single stent with coiling (n = 6). Three BBAs rebled on days 9, 11, and 15 after treatment, resulting in 1 death. Except for 3 patients who died early, 31 patients were followed up for 7 to 80 months (median, 32 months). One patient recovered completely but died of complications of systemic lupus erythematosus at 25 months. Of the remaining 30 patients, 25 had favorable outcomes (modified Rankin scale, 0-2) and 5 had unfavorable outcomes. Angiographic follow-up was available in the 32 BBAs. Eight (25.0%) recurred, all within 5 weeks. In the multiple stents group (n = 26), 22 BBAs showed improvement or complete healing, but 4 (15.4%, 2 rebleedings) had recurrence. In the single stent with coiling group (n = 6), 2 BBAs were stable but 4 (66.7%, 1 rebleeding) had recurrence. Single stent with coiling and Hunt and Hess grade ≥ 4 were 2 independent risk factors for recurrence (P < .05). CONCLUSION: Reconstructive treatment with stent and coil appears a viable option for BBAs. Single stent with coiling and Hunt and Hess grade ≥ 4 were 2 independent risk factors for recurrence. Follow-up angiography should be considered mandatory soon after treatment.

scholarly journals FRI0549 RISK OF INVASIVE FUNGAL INFECTION IN SYSTEMIC LUPUS ERYTHEMATOSUS: A NATIONWIDE POPULATION-BASED STUDY IN TAIWAN

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 876.1-876
Author(s):  
C. F. Su ◽  
C. C. Lai ◽  
T. H. LI ◽  
Y. F. Chang ◽  
Y. T. Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Mortality Rate ◽  
Fungal Infection ◽  
Incidence Rate ◽  
Invasive Fungal Infection ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Intravenous Steroid ◽  
Independent Risk Factors

Background:Infectious disease is one of the leading causes of mortality in systemic lupus erythematosus (SLE). Among these infections, invasive fungal infection (IFI) carries high mortality rate (25-70%), but the literature of IFI in SLE is limited.Objectives:To investigate the epidemiology and risk factors of invasive fungal infection and its subtypes, including candidiasis, aspergillosis, and cryptococcosis, in SLE patients.Methods:All patients with newly diagnosed SLE between 1997-2012 were enrolled from Taiwan National Health Insurance Research Database, with an age- and sex-matched non-SLE control group in a ratio of 1:10. IFI was identified by ICD9 codes1from discharge record and validated by use of systemic anti-fungal agents. The incidence rate (IR), incidence rate ratio (IRR), cause mortality rate of IFI and its subtypes were compared. A Cox multivariate model with time-dependent covariates was applied to analyse the independent risk factors of IFI.Results:A total of 269 951 subjects (24 541 SLE and 245 410 control) were included. There were 445 episodes of IFI in SLE group. Candida was the most common pathogen (52.8%), followed by cryptococcus and aspergillus. The IR of IFI in SLE was 20.83 per 10,000 person-years with an IRR of 11.1 (95% CI 9.8-12.6) compared to the control (figure 1). Kaplan-Meier curve also disclosed a lower IFI-free survival in SLE (figure 2). The all-cause mortality rate was similar between SLE and the control (26.7 vs 25.7%). In SLE, treatment with mycophenolate mofetil (HR=2.24, 95% CI 1.48-3.37), cyclosporin (HR=1.65, 95% CI 1.10-1.75), cyclophosphamide (HR=1.37, 95% CI 1.07-1.75), oral daily dose of steroid>5 mg prednisolone (HR=1.26, 95% CI 1.01-1.58), and intravenous steroid therapy (HR=29.11, 95% CI 23.30-36.37) were identified as independent risk factors of IFI. Similar analyses were performed for subtypes of IFI. Distinctive risk factors were found between different subtypes of IFI (table 1).Conclusion:SLE patients have a higher risk of IFI. Intravenous steroid therapy is the most important risk factor of IFI. This study provides crucial information for risk stratification of IFI in SLE.References:[1] Winthrop KL, Novosad SA, Baddley JW, et al. Opportunistic infections and biologic therapies in immune-mediated inflammatory diseases: consensus recommendations for infection reporting during clinical trials and postmarketing surveillance. Ann Rheum Dis. 2015 Dec; 74(12):2107-2116.Disclosure of Interests:None declared

scholarly journals Risk factors for progression of carotid intima-media thickness in patients with systemic lupus erythematosus: protocol for an observational cohort study in China

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030721
Author(s):  
Haiyu Pang ◽  
Yicong Ye ◽  
Faming Ding ◽  
Mengtao Li ◽  
Xinglin Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Informed Consent ◽  
Lupus Erythematosus ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Systemic Lupus ◽  
Media Thickness ◽  
Artery Disease

IntroductionAccelerated atherosclerosis is a major complication of systemic lupus erythematosus (SLE), and it leads to increased cardiovascular morbidity and mortality in patients with SLE. This study aimed to investigate the natural progression of carotid intima-media thickness (CIMT), and to examine the risk factors for progression of CIMT and atherosclerotic plaques based on a Chinese SLE cohort.Methods and analysisParticipants were continuously enrolled as outpatients of the Department of Rheumatology in Peking Union Medical College Hospital (PUMCH) from October 2013 to December 2016. Inclusion criteria were as follows: (1) age ≥18 years, (2) fulfilment of clinical classification criteria of SLE and (3) provision of signed written informed consent. Patients with clinically overt coronary artery disease, a history of cardiovascular disease (previous stroke, heart failure, myocardial infarction, angina or symptomatic peripheral artery disease) and malignancy, and pregnant/lactating women were excluded. The primary outcome is progression of CIMT from baseline. A total of 440 patients with SLE will be enrolled. Participants will receive follow-up surveys ~5 years after their baseline visit. A standard structural survey form, including demographic data, medical history, clinical and laboratory assessments and CIMT measurement, is planned for data collection at baseline and follow-up. The risk prediction model for progression of CIMT will be created by using a mixed effect model.Ethics and disseminationThe study protocol was approved by the institutional review board of PUMCH (S-599). Informed consent was obtained from all participants according to the Declaration of Helsinki on Biomedical Research Involving Human Studies. All data will be managed confidentially according to guidelines and legislation. Dissemination will include publication of scientific papers and/or presentations of the study findings at international conferences.

scholarly journals Impact of the new American College of Cardiology/American Heart Association definition of hypertension on atherosclerotic vascular events in systemic lupus erythematosus

2020 ◽  
Vol 79 (5) ◽  
pp. 612-617 ◽  
Author(s):  
Konstantinos Tselios ◽  
Dafna D Gladman ◽  
Jiandong Su ◽  
Murray Urowitz
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Cerebrovascular Event ◽  
Systemic Lupus ◽  
Vascular Events

BackgroundThe 2017 American College of Cardiology/American Heart Association guidelines defined hypertension at ≥130/80 mm Hg. Studies on patients with connective tissue diseases were not considered. Our aim was to assess the impact of this definition on atherosclerotic vascular events (AVEs) in systemic lupus erythematosus.Patients methodsIndividuals from the Toronto Lupus Clinic with at least 2 years of follow-up and no prior AVE were divided in three groups according to their mean blood pressure (BP) over that period (≥140/90 mm Hg, 130-139/80-89 mm Hg and <130/80 mm Hg). They were followed until the first occurrence of an AVE (fatal or non-fatal coronary artery disease, cerebrovascular event and peripheral vascular disease) or last visit. Groups were compared as per the baseline atherosclerotic risk factors. A multivariable time-dependent analysis was performed to adjust for the presence of other risk factors.ResultsOf 1532 patients satisfying the inclusion criteria, 155 (10.1%) had a BP ≥140/90 mm Hg, 316 (20.6%) 130–139/80–89 mm Hg and 1061 (69.3%) were normotensives. After a mean follow-up of 10.8 years, 124 AVEs were documented. The incidence rates were 18.9, 11.5 and 4.5 per 1000 patient-years for the three groups, respectively (p=0.0007 between the 130–139/80–89 mm Hg group and the normotensives). A mean BP of 130–139/80–89 mm Hg over the first 2 years was independently associated with the occurrence of AVEs (HR 1.73, 95% CI 1.13 to 2.65, p=0.011).ConclusionPatients with lupus with a sustained mean BP of 130–139/80–89 mm Hg over 2 years had a significantly higher incidence of AVEs compared with normotensive individuals. This BP level should be the target for antihypertensive therapy to minimise their cardiovascular risk.

Incidence of cardiovascular risk factors in female patients with systemic lupus erythematosus: a 3-year follow-up cohort

Lupus ◽  
2018 ◽  
Vol 27 (11) ◽  
pp. 1790-1798 ◽  
Author(s):  
C S A Monção ◽  
L N Martins ◽  
M P S Penteado ◽  
R C P Reis ◽  
F M M Santos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Cumulative Incidence ◽  
Cardiometabolic Risk ◽  
Cardiometabolic Risk Factors ◽  
Systemic Lupus ◽  
Prednisone Dose ◽  
Cad Risk

Objectives To evaluate the incidence and variability of traditional coronary artery disease (CAD) risk factors in a cohort of lupus patients and to investigate if prednisone use predicts an increase in the number of risk factors. Methods A total of 151 women, 37.8 ± 11.1 (mean ± SD) years old at baseline, were reevaluated after a median period of 39 (interquartile range 36.5–42.0) months. The cumulative incidence of traditional risk factors, the incidence rate (with 95% confidence interval) of hypertension, diabetes, dyslipidemia and hypertriglyceridemia, and the frequency of the risk factors’ disappearance were calculated. Metabolic syndrome (MetS) and Framingham risk score (FRS) were computed. Logistic regression was used to investigate if maximum or cumulative prednisone dose used during follow-up predicted an increase in the cardiometabolic risk factors’ number. Results The cumulative incidence of risk factors varied from 39.1% (abdominal obesity) to zero (smoking), and the incidence rate varied from 133.2 (87.8–178.6) per 1000 person-years (dyslipidemia) to 10.4 (1.3–19.5) per 1000 person-years (diabetes). The cumulative incidence for MetS was 18.8%, and 11.7% of 143 patients with low FRS at baseline (T1) were classified in the high-risk category at the end of the study (T2). Dyslipidemia was the most variable risk factor, with 43.5% disappearance at T2. The maximum prednisone dose used during follow-up was borderline ( p = 0.050) for prediction of an increase in the number of cardiometabolic risk factors in an adjusted model for antimalarial use, modified Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and age. Conclusion The authors described high incidence and variability of CAD risk factors in female lupus patients, with higher prednisone dose being borderline for an increase in the number of cardiometabolic risk factors.

Severe pneumonia in Chinese patients with systemic lupus erythematosus

Lupus ◽  
2020 ◽  
Vol 29 (7) ◽  
pp. 735-742 ◽  
Author(s):  
Lingli Peng ◽  
Yaling Wang ◽  
Lin Zhao ◽  
Ting Chen ◽  
Anbin Huang
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
T Lymphocytes ◽  
Lupus Erythematosus ◽  
Central Nervous System Involvement ◽  
Severe Pneumonia ◽  
Chinese Patients ◽  
Systemic Lupus ◽  
Cell Counts ◽  
Independent Risk Factors

Objective This study aimed to investigate the clinical characteristics and risk factors associated with severe pneumonia in systemic lupus erythematosus (SLE) patients from China. Method We performed a retrospective study in 112 hospitalized SLE patients who had had pneumonia for 8 years. The primary outcome was severe pneumonia, followed by descriptive analysis, group comparison and bivariate analysis. Results A total of 28 SLE patients were diagnosed with severe pneumonia, with a ratio of 5:23 between men and women. The mean age at diagnosis was 44.36 ± 12.389 years. The median disease duration was 72 months, and the median SLE Disease Activity Index 2000 (SLEDAI 2K) score was 8. The haematological system was the most affected, with an incidence of anaemia in 85.7% of cases and thrombocytopenia in 75% of cases, followed by lupus nephritis in 50% of cases and central nervous system involvement in 10.71% of cases. Cultured sputum specimens were positive in 17 (68%) SLE patients with severe pneumonia, of whom nine (36%) were cases of fungal infection, five (20%) were cases of bacterial infection and three (12%) were cases of mixed infection. Using multivariate logistic regression analysis, we concluded that a daily dosage of prednisone (>10 mg; odds ratio (OR) = 3.193, p = 0.005), a low percentage of CD4+ T lymphocytes (OR = 0.909, p = 0.000), a high SLEDAI 2K score (OR = 1.182, p = 0.001) and anaemia (OR = 1.182, p = 0.001) were all independent risk factors for pneumonia in SLE patients, while a low percentage of CD4+ T lymphocytes (OR = 0.908, p = 0.033), a daily dose of prednisone of >10 mg (OR = 35.67, p = 0.001) were independent risk factors for severe pneumonia in SLE patients. Conclusion Severe pneumonia is not rare in lupus, and is associated with high mortality and poor prognosis. Monitoring CD4+ T-cell counts and giving a small dose of glucocorticoids can reduce the occurrence of severe pneumonia and improve the prognosis of patients with lupus.

Clinical features, outcomes and risk factors for posterior reversible encephalopathy syndrome in systemic lupus erythematosus: a case-control study

Lupus ◽  
2019 ◽  
Vol 28 (8) ◽  
pp. 961-969 ◽  
Author(s):  
H- W Cui ◽  
R- Y Lei ◽  
S- G Zhang ◽  
L- S Han ◽  
B- A Zhang
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Lupus Erythematosus ◽  
Neuropsychiatric Lupus ◽  
Systemic Lupus ◽  
Posterior Reversible Encephalopathy ◽  
Younger Age ◽  
Reversible Encephalopathy

Objective The objective of this paper is to investigate the clinical features, outcomes, and risk factors for posterior reversible encephalopathy syndrome (PRES) in systemic lupus erythematosus (SLE). Methods From 2011 to October 2017, SLE patients with PRES were identified from the First Affiliated Hospital of Zhengzhou University, China. Patients presenting with neuropsychiatric lupus hospitalized in the same period were included as controls. Additionally, survival status was acquired via telephone follow-up in March 2018. Results Thirty episodes of PRES were identified in 29 SLE patients from a total of 7059 SLE patients (prevalence 0.43%). Patients with PRES had a younger age at onset than controls, with seizures more commonly the initial clinical manifestation (80.00% vs 42.37%, p = 0.001). Multiple logistic regression yet again confirmed several known risk factors, including younger age (odds ratio (OR) 1.15 (95% confidence interval (CI) 1.13–1.16)), nephritis (OR 20.74 (18.10–23.75)), history of hypertension (OR 1.17 (1.05–1.31)), SLE Disease Activity Index without neurologic symptoms (SLEDAI-N) score >12 (OR 1.14 (1.11–1.18)) and eclampsia (OR 9.38 (7.84–11.23)). Furthermore, we identified two novel independent risk factors for PRES in SLE: white blood cells >9 × 109/l (OR 2.33 (2.05–2.64)) and heart failure (OR 2.10 (1.18–2.42)). At follow-up, SLE patients with PRES had higher mortality than controls (30.77% vs 8.33%, respectively, p = 0.012). Conclusions PRES may be a reversible neurological deficit in patients with SLE other than neuropsychiatric lupus. Our results indicate two new risk factors for PRES and that PRES is associated with a higher mortality rate.

scholarly journals Low bone mineral density in Thai children with systemic lupus erythematosus: prevalence and risk factors

2021 ◽  
Vol 15 (5) ◽  
pp. 245-250
Author(s):  
Ankanee Chanakul ◽  
Suriyaphon Khunrattanaphon ◽  
Tawatchai Deekajorndech
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Systemic Lupus Erythematosus ◽  
Bone Mineral ◽  
Lupus Erythematosus ◽  
Mineral Density ◽  
Systemic Lupus ◽  
Median Difference ◽  
Over Time

Abstract Background Improvement of disease recognition and management has increased the survival of children with systemic lupus erythematosus (SLE), but has shifted the morbidity focus toward long-term complications, such as low bone mass and osteoporosis. Studies in adults with SLE show older age, chronic inflammation, and corticosteroid therapy are risk factors for low bone mineral density (BMD) and osteoporosis. Objectives To determine the prevalence of and identify risk factors associated with low BMD in Thai children with SLE. Methods We conducted a retrospective review of demographic data and clinical variables for a cohort of 60 Thai children with SLE who underwent 2 dual-energy X-ray absorptiometry (DXA) at their initial examination and later follow-up. We considered a BMD z score ≤ −2.0 to indicate low BMD. Binary logistic regression was used to assess risk factors potentially associated with low BMD. Results The prevalence of low BMD at the first visit was 40% and increased to 55% over follow-up. We found a significantly decreased hip BMD z score (median difference −0.25, 95% confidence interval [CI] −0.40 to −0.05; P = 0.016) and lumbar BMD z score (median difference −0.49, 95% CI −0.69 to −0.28; P < 0.001) over time. The cumulative steroid dose tended to be higher for patients with low BMD (adjusted odds ratio [OR] = 1.08, 95% CI 1.00 to 1.17; P = 0.050). Conclusion Low BMD has a 40% prevalence in Thai children newly diagnosed with SLE and progresses significantly over time. Higher cumulative corticosteroid dose tended to be associated with a low BMD, but we did not find a significant risk in this small sample.

Risk factors for development of early infectious and noninfectious complications in systemic lupus erythematosus patients undergoing major surgery

Lupus ◽  
2018 ◽  
Vol 27 (12) ◽  
pp. 1960-1972 ◽  
Author(s):  
L Quintanilla-González ◽  
G Torres-Villalobos ◽  
A Hinojosa-Azaola
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Postoperative Complications ◽  
Lupus Erythematosus ◽  
Postoperative Mortality ◽  
Infectious Complications ◽  
Major Surgery ◽  
Systemic Lupus ◽  
Comparative Cohort Study ◽  
Independent Risk Factors

Background We aimed to identify risk factors for early complications in systemic lupus erythematosus (SLE) patients undergoing major surgery. Methods We conducted a retrospective comparative cohort study including patients with SLE undergoing major surgery, and non-SLE patients matched 1:1. Main outcomes were development of infectious and noninfectious complications, and 30-day postoperative mortality. Results A total of 382 patients (191 SLE and 191 non-SLE) were included. Postoperative complications occurred in 82 (43%) SLE patients and 58 (30%) without SLE, ( p = 0.01). Variables associated with infectious complications in SLE patients: prednisone use (OR 1.81, 95% CI 1.13–2.90), anemia (OR 2.43, 95% CI 1.45–4.08), hypoalbuminemia (OR 2.58, 95% CI 1.55–4.30) and lymphopenia (OR 2.43, 95% CI 1.52–3.89), p < 0.05. Variables associated with noninfectious complications: anemia (OR, 1.93, 95% CI 1.03–3.64) and hypoalbuminemia (OR 2.11, 95% CI 1.16–3.86), p < 0.05. Variables associated with any complication: SLEDAI-2K (OR 1.1, 95% CI 1.01–1.20), nephritis (OR 10.08, 95% CI 1.21–83.63), aspirin use (OR 2.68, 95% CI 1.19–6.02, p = 0.01), low C3 (OR 2.00, 95% CI 1.06–3.80), anemia (OR 2.68, 95% CI 1.39–5.18), hypoalbuminemia (OR 3.49, 95% CI 1.83–6.66) and lymphopenia (OR 2.36, 95% CI 1.30–4.26), p < 0.05. More patients with SLE died (6% vs 1%, p = 0.02). Conclusions SLE patients present higher frequency of postoperative complications and mortality compared with non-SLE patients. Hypoalbuminemia, anemia, lymphopenia and aspirin use are independent risk factors.

scholarly journals Identification of Risk and Prognostic Factors for Transverse Myelitis in Systemic Lupus Erythematosus

2021 ◽  
Author(s):  
Minhui Wang ◽  
Ziqian Wang ◽  
Li Zhang ◽  
Jiuliang Zhao ◽  
Di Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Prognostic Factors ◽  
Lupus Erythematosus ◽  
Spinal Injury ◽  
Early Stage ◽  
Transverse Myelitis ◽  
American Spinal Injury Association ◽  
Systemic Lupus ◽  
Independent Risk Factors

Abstract Purpose: Our aim in this study was to describe the clinical characteristics and outcomes of patients with transverse myelitis (TM) as a rare phenotype of systemic lupus erythematosus (SLE) and to identify the risk and prognostic factors for SLE-related TM.Methods: The analysis was based on 58 patients with SLE-related TM admitted to Peking Union Medical College Hospital between January 1993 and May 2021.The control group included 101 patients, randomly selected from our SLE patient group, without TM, using propensity score matching for age at SLE diagnosis, sex, and SLE disease course. Conditional logistic regression and Cox proportional hazard regression were used to identify risk and prognostic factors for SLE-related TM. Results: Multivariate analysis revealed that anti-SSA(p<0.001) and anti-RNP positivity (p=0.005) were independent risk factors for SLE-related TM. With regard to prognosis, an American Spinal Injury Association Impairment Scale (AIS) grade of A or B at the early stage of TM (p<0.001) and hypoglycorrhachia (p=0.016) were independent risk factors for unfavourable neurological outcomes. In regard to neurological recovery at 3 months, an American Spinal Injury Association Impairment Scale (AIS) grade of A, B, or C at the early stage of TM was the only prognostic factor for SLE-related TM (hazard ratio, 0.26; 95% confidence interval, 0.08-0.91; p=0.035). Conclusions: Anti-SSA and anti-RNP positivity were independent risk factors for TM in patients with SLE. Initial severe myelitis and hypolycorrhachia are predictive of a poor prognosis. Glucocorticoid pulse therapy provided within 2 weeks of TM onset may improve TM prognosis. Understanding the risk and prognostic factors of TM is important as permanent neurological disability persists in a significant proportion of patients with SLE-related TM.

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