High Incidence and Mortality of Pneumocystis Jiroveci Infection in Anti-MDA5-Antibody Positive Dermatomyositis: Experience From a Single Center

Abstract Background Idiopathic inflammatory myopathies (IIM) was associated with a significantly higher risk of opportunistic infections that including Pneumocystis jiroveci pneumonia (PJP), a potentially fatal opportunistic infection. However, no prior studies have evaluated the PJP infection in subtypes of IIM. Objectives To investigate the incidence rate and mortality rate of PJP infection in subgroups of Idiopathic inflammatory myopathies (IIM) patients according to myopathy specific antibodies. Methods In the first part, 463 consecutive patients with IIM were prospectively followed up for a period of at least one year to analyze incidence of PJP. In the next part, we enrolled 30 consecutive PJP patients with any rheumatic disease were to identify the mortality rate and risk factors by Cox regression. Kaplan-Meier curve with log-rank test was used to access differences in survival. Results We found that the incidence rate of PJP in IIM patients is 3.0/100 person-year, while in MDA5+DM patients is 7.5/100 person-year and in MDA5−IIM patients is 0.7/100 person-year. (P < 0.05). PJP typically happened in the first two months for MDA5 + DM patients who have a significant decrease in the CD4+ T cell counts and Lymphocyte counts (P < 0.05). In PJP + patients, the mortality was lethally higher in MDA5+DM patients than those with other rheumatic diseases (83.3% VS. 38.9%, P < 0.05). Unlike patients with other rheumatic diseases, MDA5 + patients seemed not to benefit from prompt anti-PJP treatment. For patients with other rheumatic diseases, anti-PJP treatment within 6 days was confirmed to crucially increased the survival (P < 0.05). Conclusion PJP has alarming high incidence and mortality in MDA5+DM patients. Timely treatment for PJP does not improve the prognosis of this particular subtype. Therefore, the necessity of further study of PJP prophylaxis treatment in MDA5+DM patients is verified.

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POS0885 HIGH INCIDENCE AND MORTALITY OF PNEUMOCYSTIS JIROVECI INFECTION IN ANTI-MDA5-ANTIBODY POSITIVE DERMATOMYOSITIS: EXPERIENCE FROM A SINGLE CENTER

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3693 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 698.2-699

Author(s):

Q. Yan ◽

S. Chen ◽

L. Huang ◽

Q. Fu ◽

Y. Ye

Keyword(s):

Mortality Rate ◽

Rheumatic Diseases ◽

Cox Regression ◽

Opportunistic Infections ◽

Rank Test ◽

Pneumocystis Jiroveci ◽

Pneumocystis Jiroveci Pneumonia ◽

Cell Counts ◽

Incidence And Mortality ◽

High Incidence

Background:Idiopathic inflammatory myopathies (IIM) was associated with a significantly higher risk of opportunistic infections that including Pneumocystis jiroveci pneumonia(PJP) which is potentially fatal opportunistic infection. However, no prior studies have evaluated the PJP infection in subtypes of IIM.Objectives:To investigate the incidence rate and mortality rate of PJP infection in subgroups of IIM patients according to myopathy specific antibodies.Methods:In the first part, we reviewed 463 consecutive patients with IIM retrospectively to analyze incidence of PJP infection. In the next part, we enrolled 30 consecutive PJP infection patients with any rheumatic disease was to identify the mortality rate and risk factors. Kaplan-Meier curve with log rank test was used to access differences in survival. Univariate and multivariate analyses were performed to identify prognostic factors using Cox regression.Results:We found that 12(7.5%) PJP cases occurred in 160 anti-MDA5-ab-positive DM patients, while only two (0.7%) PJP cases were found in 303 anti-MDA5-ab-negtive DM/PM patients(P < 0.05). PJP infection typically happened in the first two months of the treatment for anti-MDA5-ab-positive DM patients who have a significant decrease in the CD4+ T cell counts and Lymphocyte counts (P < 0.05). Only two (16.7%) anti-MDA5-ab-positive DM patients recover from PJP, with lethally higher mortality than those PJP infection with other rheumatic diseases (83.3% vs. 38.9%, P < 0.05). We found no association between the time to anti-PJP treatment and treatment outcomes in anti-MDA5-ab-positive DM; yet we confirmed in PJP infection with other rheumatic diseases that anti-PJP treatment within 6 days crucially increased the survival (P < 0.05).Conclusion:PJP infection has alarming high incidence and mortality in anti-MDA5-ab-positive DM patients. Unlike PJP infection with other rheumatic diseases, timely treatment for PJP doesn’t improve the prognosis of this particular subtype. Therefore, the necessity of further study of PJP prophylaxis treatment in anti-MDA5-ab-positive DM patients is verified.References:[1]Hsu CY, et al. Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study. ARTHRITIS RES THER 2019, 21(1):211.Acknowledgements:The authors thank Dr. An Sun,Disclosure of Interests:None declared

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High incidence and mortality of Pneumocystis jirovecii infection in anti-MDA5-antibody-positive dermatomyositis: experience from a single center

Arthritis Research & Therapy ◽

10.1186/s13075-021-02606-8 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Linlin Huang ◽

Qiong Fu ◽

Yan Ye ◽

Yanwei Lin ◽

Qingran Yan ◽

...

Keyword(s):

Mortality Rate ◽

Rheumatic Diseases ◽

Cox Regression ◽

Opportunistic Infections ◽

Unmet Need ◽

Pneumocystis Jirovecii ◽

Cox Regression Analysis ◽

Cell Counts ◽

Incidence And Mortality ◽

High Incidence

Abstract Background Idiopathic inflammatory myopathies (IIM) are associated with a significantly higher risk of opportunistic infections including Pneumocystis jirovecii pneumonia (PJP), a potentially fatal opportunistic infection. However, no prior studies have evaluated PJP infection in subtypes of IIM. Objectives To investigate the prevalence and mortality rate of PJP infection in subgroups of IIM patients stratified according to myopathy-specific antibodies. Methods In the first part of the study, 463 consecutive patients with IIM were prospectively followed for a period of at least 1 year to analyze the incidence of PJP. In the second part of the study, we enrolled 30 consecutive PJP patients with any rheumatic disease in order to identify the mortality rate and risk factors by Cox regression analysis. The Kaplan-Meier method with log-rank testing was used to assess differences in survival. Results The prevalence of PJP in IIM patients was found to be 3.0/100 person-years, while in MDA5+ DM patients it was 7.5/100 person-years and in MDA5− IIM patients 0.7/100 person-years (P < 0.05). PJP typically occurred in the first 2 months in the case of MDA5+ DM patients who had a significant decrease in their CD4+ T cell counts and lymphocyte counts (P < 0.05). In PJP patients, 3-month mortality was higher for MDA5+ DM patients than in those with other rheumatic diseases (83.3% vs 38.9%, P < 0.05). Alarmingly, MDA5+ DM patients seemed not to benefit from prompt anti-PJP treatment, unlike patients with other rheumatic diseases whose survival improved when anti-PJP treatment was started within 6 days (P < 0.05). Conclusion PJP has an alarming high incidence and mortality in MDA5+ DM patients. Timely treatment for PJP seems not to improve the prognosis of patients with this particular subtype. Hence, there remains a crucial unmet need to develop PJP prophylaxis for MDA5+ DM patients.

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Long-Term Exposure to Fine and Coarse Particulate Matter and COVID-19 Incidence and Mortality Rate in Chile during 2020

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147409 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7409

Author(s):

Macarena Valdés Salgado ◽

Pamela Smith ◽

Mariel Opazo ◽

Nicolás Huneeus

Keyword(s):

Mortality Rate ◽

Incidence Rate ◽

Air Pollutants ◽

Negative Binomial ◽

Transport Model ◽

Surface Concentration ◽

Mortality Rates ◽

Incidence And Mortality ◽

Pm2.5 And Pm10

Background: Several countries have documented the relationship between long-term exposure to air pollutants and epidemiological indicators of the COVID-19 pandemic, such as incidence and mortality. This study aims to explore the association between air pollutants, such as PM2.5 and PM10, and the incidence and mortality rates of COVID-19 during 2020. Methods: The incidence and mortality rates were estimated using the COVID-19 cases and deaths from the Chilean Ministry of Science, and the population size was obtained from the Chilean Institute of Statistics. A chemistry transport model was used to estimate the annual mean surface concentration of PM2.5 and PM10 in a period before the current pandemic. Negative binomial regressions were used to associate the epidemiological information with pollutant concentrations while considering demographic and social confounders. Results: For each microgram per cubic meter, the incidence rate increased by 1.3% regarding PM2.5 and 0.9% regarding PM10. There was no statistically significant relationship between the COVID-19 mortality rate and PM2.5 or PM10. Conclusions: The adjusted regression models showed that the COVID-19 incidence rate was significantly associated with chronic exposure to PM2.5 and PM10, even after adjusting for other variables.

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FRI0248 PROGNOSTIC FACTORS FOR STEROID-FREE REMISSION IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES: IMPORTANCE OF ANTHROPOMETRIC MEASUREMENTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3010 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 708.1-708

Author(s):

J. S. Lee ◽

S. H. Nam ◽

S. J. Choi ◽

W. J. Seo ◽

S. Hong ◽

...

Keyword(s):

Prognostic Factors ◽

Cox Regression ◽

Idiopathic Inflammatory Myopathies ◽

Inflammatory Myopathies ◽

Immunosuppressant Therapy ◽

Muscle Enzymes ◽

Cox Regression Analysis ◽

Factors Associated ◽

Early Use

Background:Several studies have been conducted on factors associated with mortality in idiopathic inflammatory myopathies (IIM), but few studies have assessed prognostic factors for steroid-free remission in IIM.Objectives:We investigated the various clinical factors, including body measurements, that affect IIM treatment outcomes.Methods:Patients who were newly diagnosed with IIM between 2000 and 2018 were included. Steroid-free remission was defined as at least three months of normalisation of muscle enzymes and no detectable clinical disease activity. The factors associated with steroid-free remission were evaluated by a Cox regression analysis.Results:Of the 106 IIM patients, 35 displayed steroid-free remission during follow-up periods. In the multivariable Cox regression analyses, immunosuppressants’ early use within one month after diagnosis [hazard ratio (HR) 6.21, 95% confidence interval (CI) 2.61–14.74, p < 0.001] and sex-specific height quartiles (second and third quartiles versus first quartile, HR 3.65, 95% CI 1.40–9.51, p = 0.008 and HR 2.88, 95% CI 1.13–7.32, p = 0.027, respectively) were positively associated with steroid-free remission. Polymyositis versus dermatomyositis (HR 0.21, 95% CI 0.09–0.53, p = 0.001), presence of dysphagia (HR 0.15, CI 0.05–0.50, p = 0.002) and highest versus lowest quartile of waist circumference (WC) (HR 0.24, 95% CI 0.07–0.85, p = 0.027) were negatively associated with steroid-free remission.Conclusion:The early initiation of immunosuppressant therapy, type of myositis and presence of dysphagia are strong predictors of steroid-free remission in IIM; moreover, height and WC measurements at baseline may provide additional important prognostic value.Disclosure of Interests:None declared

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Acute Coronary Syndrome in Idiopathic Inflammatory Myopathies: A Population-based Study

The Journal of Rheumatology ◽

10.3899/jrheum.181248 ◽

2019 ◽

Vol 46 (11) ◽

pp. 1509-1514 ◽

Cited By ~ 1

Author(s):

Valérie Leclair ◽

John Svensson ◽

Ingrid E. Lundberg ◽

Marie Holmqvist

Keyword(s):

Acute Coronary Syndrome ◽

General Population ◽

Incidence Rate ◽

Competing Risk ◽

First Year ◽

Idiopathic Inflammatory Myopathies ◽

Inflammatory Myopathies ◽

Risk Of Death ◽

Coronary Syndrome ◽

Increased Risk

Objective.Evidence suggests an increased risk of cardiovascular (CV) diseases, including acute coronary syndrome (ACS), in idiopathic inflammatory myopathies (IIM). The aim of this study was to investigate the risk of ACS in an incident IIM cohort compared to the general Swedish population.Methods.A cohort of 655 individuals with incident IIM and 6813 general population comparators were identified from national registries. IIM subjects were diagnosed from 2002 to 2011. Followup started at IIM diagnosis and corresponding date in the general population. ACS, CV comorbidities, and CV risk factors were defined using International Classification of Diseases codes. Incidence rates including 95% CI were calculated. Cox proportional hazards models were used to compare the risk of ACS in patients with IIM and the general population. The competing risk of death was accounted for using competing risk regression models.Results.The incidence rate of ACS in IIM was higher than in the general population, particularly within the first year of diagnosis and in older individuals. The overall ACS incidence rate in IIM was 15.6 (95% CI 11.7–20.4) per 1000 person-years, with an HR of 2.4 (95% CI 1.8–3.2) compared with the general population. When accounting for the competing risk of death, the risk of ACS in IIM remained increased with a cumulative incidence of 7% at 5 years compared to 3.3% in the general population.Conclusion.IIM individuals are at higher risk of ACS, particularly within the first year after diagnosis.

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THE STATE OF THE MEDICAL CARE FOR LUNG CANCER PATIENTS IN THE ALTAI REGION

Russian Journal of Oncology ◽

10.18821/1028-9984-2017-22-4-229-232 ◽

2017 ◽

Vol 22 (4) ◽

pp. 229-232

Author(s):

Tatyana M. Cherdantseva ◽

A. G Ageev ◽

A. V Fedoskina ◽

E. L Sekerinska ◽

V. A Popov ◽

...

Keyword(s):

Lung Cancer ◽

Mortality Rate ◽

Cancer Patients ◽

Prevalence Rate ◽

Malignant Tumors ◽

Specific Weight ◽

Lung Cancer Patients ◽

Incidence And Mortality ◽

High Incidence ◽

Gender Characteristics

The relevance of the study of lung cancer is associated with a high incidence and mortality rate. The article is devoted to the study of indices of the prevalence rate of the lung cancer in the Altai Territory for the period of from 2014 to 2016. An increase in the prevalence rate of lung cancer has been established to be of 61.4% (2016) per 100 00 population (both genders), the increase in the «rough index» accounted for 7.4%. With the bearing in mind the age-gender characteristics, statistical analysis showed the highest level of the prevalence rate of cancer of the trachea, bronchus and lung to be observed in males, that amounts of 19.3% among malignant tumors detected in 2016 in the Altai Territory. The greatest increase in the incidence rate of lung cancer is observed in both males and females in the age group of 60-69 years. In stage I-II lung cancer patients there is noted the gain of the specific weight and the decline in the mortality rate to 40.3 per 100 000 population of the Altai Krai.

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Evaluation of serum markers for gastric cancer and its precursor diseases among high incidence and mortality rate of gastric cancer area

Gastric Cancer ◽

10.1007/s10120-018-0844-8 ◽

2018 ◽

Vol 22 (1) ◽

pp. 104-112 ◽

Cited By ~ 5

Author(s):

Boldbaatar Gantuya ◽

Khasag Oyuntsetseg ◽

Dashdorj Bolor ◽

Yansan Erdene-Ochir ◽

Ruvjir Sanduijav ◽

...

Keyword(s):

Gastric Cancer ◽

Mortality Rate ◽

Serum Markers ◽

Incidence And Mortality ◽

High Incidence

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Cervical cancer screening: Twelve years experience of the Kazakhstan National Screening program.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e17520 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e17520-e17520

Author(s):

Raikhan Bolatbekova ◽

Dilyara Kaidarova ◽

Alma Zhylkaidarova ◽

Tolkyn Sadykova ◽

Yerlan Kukubassov ◽

...

Keyword(s):

Cervical Cancer ◽

Mortality Rate ◽

Incidence Rate ◽

Screening Program ◽

Gynecological Cancer ◽

Cervical Screening ◽

Precancerous Lesion ◽

Female Population ◽

Incidence And Mortality ◽

Screening Coverage

e17520 Background: Cervical cancer (CC) is the most common gynecological cancer in Kazakhstan (KZ). Standardized incidence rate of CC was 16.7 per 100, 000, while the mortality rate was 5, 9 per 100, 000, in 2020. The National Cervical Screening program in KZ uses cytology (Pap test) from 2008, which is free of charge for women aged 30 to 70 years of age with an interval of 4 years. In 2017 Experts from ImPact Mission and analyzed existing CC screening revealed a number of recommendations aimed at reducing the screening interval and increasing the coverage. The purpose of this study was to analyze results of CC screening in KZ and his impact on CC incidence and mortality. Methods: Coverage, the number of screened women, the level of pre-cancer detection and cervical cancer during screening have been obtained from specific reports (form № 025, № 08) for 2008-2020. Results: The total number of screened women for 2008 were 554 283 women. There is a decrease in screening coverage to 45.9% in 2017 due to a decrease in funding. in this regard, in 2017, a number of changes were made to the existing screening program. In 2020 after the CC screening improvement 786 690 women were examined during the screening program, coverage rate was 66, 2%, . Analysis of screening results showed a marked increase in the detection of precancerous lesion from 0, 136 in 2008 to 0, 87 with an increasing by 37%. The analysis of CC incidence revealed significant changes: after the introduction of screening, an increase in the incidence rate is noted from 15.5 in 2008 to 20.1 per 100, 000 female population in 2015. Since 2015, there has been a significant decrease to 16.7 per 100, 000 women. Conclusions: Despite the positive results of screening, an increse the screening coverage, improvement in the detection of the initial stage of CC, mortality rate from CC and a one-year mortality remain high, which makes it necessary to improve the screening of CC in KZ through the introduction of HPV-screening

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P346 The changing epidemiology of infective endocarditis in a tertiary center

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.199 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Denes ◽

A Bence ◽

T Ferenci ◽

S Borbas ◽

G Prinz ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Infective Endocarditis ◽

Mortality Rate ◽

Cox Regression ◽

Temporal Trends ◽

Tertiary Hospital ◽

Incidence And Mortality ◽

Tertiary Center ◽

Significant Difference ◽

Over Time

Abstract Background Despite the adequate antibiotic prophylaxis, the incidence and mortality rate of infective endocarditis (IE) is still high. In the past few decades, several studies have noted an increase in the proportion of IE caused by staphylococcal species. Aims The aim of our retrospective study was to assess the clinical and microbiological characteristics, trends, and the 1, 6 and 12-month cardiovascular (CV) mortality rate of patients administered for IE in our tertiary hospital between January 1, 2006 and December 31, 2016. Results We identified 465 cases (311 men, 154 women) of 448 patients, mean age was 56,1 ± 16,4 years (14-92). Native left-sided IE (NLIE) was assessed in 286 cases (61,5%, mitral in 117, aorta in 116, combined in 53 cases), prosthetic valve IE (PVIE) was in 111 cases (24%, early in 44, late in 67), right-sided IE (RIE) in 12 cases (2,5%), cardiac device related IE (CDRIE) in 50 cases (11%), other in 6 cases (1%). The underlying infection was caused by streptococci in 124 cases (27%), Staphylococcus aureus (SA) in 112 cases (24%, out of them 23 had MRSA), coagulase negative Staphylococcus (CoNS) in 39 cases (8%), enterococci in 75 cases (16%). Blood culture negative cases found in 61 patients (13%), in 38 cases (8%) other, diversified germs and in 16 cases (4%) there were no data on the pathogen agent. The mortality rates of the total population were one-month was 12.8%, six-month was 26.4%, one-year was 29.7%, and five-year was 40%. There was a significant difference in the mortality rate regarding both of the type of IE and in terms of the underlying microorganism (log-rank p = 0.03 and p = 0.04 resp). The worst survival rate was detected among patients with PVIE, and patients with staphylococcal infection, especially with MRSA. Cox regression found that age (HR: 1.4; CI:1.3-1.6; p <0.001), ejection fraction (HR: 1.4; CI:1.2-1.5; p <0.001), hemoglobin and creatinin levels (HR: 0.9; CI:0.8-0.97 p = 0.01; HR: 1.3; CI: 1.1-1.5; p = 0.001 resp.), MRSA compared to streptococcal infection (HR: 2.5; CI:1.4-4.5; p <0.001), stroke as complication (HR: 1.98; CI:1.4-2.8; p <0.001) were independent risk factors of mortality. In terms of temporal trends the rate of combined NLIE decreased over time (14.5% to 5.1%, p = 0.03), while the rate of other types of IE did not changed. Regarding the type of underlying microorganism the rate of SA infection increased (17% to 41%, p = 0.002) and the rate of CoNS decreased (16.1% - 1.3% p < 0.001) over time. The 1-year mortality rate did not change through the years. Conclusions During the observed 11 years 465 cases were administered with IE to our tertiary hospital, out of which two-third were NLIE. One-quarter of the underlying microorganism were streptococci, and the rate of Staphylococcus aureus infection was increased over time, which was associated with a worse prognosis. In addition IE had a high mortality, which unfortunately did not improve through the years.

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