Outcome following postneurosurgical Acinetobacter meningitis: an institutional experience of 72 cases

OBJECTIVEThe authors aimed to evaluate the antimicrobial susceptibility pattern of Acinetobacter isolates responsible for nosocomial meningitis/ventriculitis in the neurosurgical ICU. The authors also sought to identify the risk factors for mortality following Acinetobacter meningitis/ventriculitis.METHODSThis was a retrospective study of 72 patients admitted to the neurosurgical ICU between January 2014 and December 2018 with clinical and microbiological diagnosis of nosocomial postneurosurgical Acinetobacter baumanii meningitis/ventriculitis. Electronic medical data on clinical characteristics, underlying pathology, CSF cytology, antibiotic susceptibilities, and mortality were recorded. To evaluate the outcome following nosocomial postneurosurgical Acinetobacter meningitis/ventriculitis, patients were followed up until discharge or death in the hospital. Kaplan-Meier survival analysis and multivariable Cox proportional hazards models were used to compute factors affecting survival.RESULTSThe study population was divided into two groups depending on the final outcome of whether the patient died or survived. Forty-three patients (59.7%) were included in the survivor group and 29 patients (40.3%) were included in the nonsurvivor group. Total in-hospital mortality due to Acinetobacter meningitis/ventriculitis was 40.3% (29 cases), with a 14-day mortality of 15.3% and a 30-day mortality of 25%. The 43 (59.7%) patients who survived had a mean length of hospital stay of 44 ± 4 days with a median Glasgow Outcome Scale–Extended score at discharge of 6. On univariate analysis, age > 40 years (p = 0.078), admission Glasgow Coma Scale (GCS) score ≤ 8 (p = 0.003), presence of septic shock (p = 0.011), presence of external ventricular drain (EVD) (p = 0.03), CSF white blood cell (WBC) count > 200 cells/mm3 (p = 0.084), and comorbidities (diabetes, p = 0.036; hypertension, p = 0.01) were associated with poor outcome. Carbapenem resistance was not a risk factor for mortality. According to a multivariable Cox proportional hazards model, age cutoff of 40 years (p = 0.016, HR 3.21), GCS score cutoff of 8 (p = 0.006, HR 0.29), CSF WBC count > 200 cells/mm3 (p = 0.01, HR 2.76), presence of EVD (p = 0.001, HR 5.42), and comorbidities (p = 0.017, HR 2.8) were found to be significant risk factors for mortality.CONCLUSIONSThis study is the largest case series reported to date of postneurosurgical Acinetobacter meningitis/ventriculitis. In-hospital mortality due to Acinetobacter meningitis/ventriculitis was high. Age older than 40 years, GCS score less than 8, presence of EVD, raised CSF WBC count, and presence of comorbidities were risk factors for mortality.

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Risk Factors for Secondary Glaucoma in Patients with Vogt-Koyanagi-Harada Disease

10.21203/rs.3.rs-1150821/v1 ◽

2021 ◽

Author(s):

Carlos Alvarez-Guzman ◽

Curt Hartleben-Matkin ◽

Raul E. Ruiz-Lozano ◽

Alejandro Rodríguez-Garcia ◽

Manuel E. Quiroga-Garza ◽

...

Keyword(s):

Risk Factors ◽

Proportional Hazards ◽

Significant Risk ◽

Cox Proportional Hazards ◽

Secondary Glaucoma ◽

Angle Closure ◽

Mexican Mestizo ◽

Peripapillary Atrophy ◽

Clinically Significant ◽

Recurrent Inflammation

Abstract Background: To identify the prevalence and risk factors for secondary glaucoma among Mexican-mestizo patients with Vogt-Koyanagi-Harada Disease (VKH). A retrospective cohort study was conducted to identify the risk factors for developing secondary glaucoma based on demographic, clinical, and epidemiological variables of VKH Mexican-mestizo patients. Risk estimates were calculated using a Cox proportional hazards regression model. Main text: One hundred eyes of 50 patients, 44 (88%) women and 6 men (12%) with a median age of 35.5 years (IQR 29 – 46), and a median follow-up time of 72 months (IQR 13.7 – 126.7) were included for analysis. The prevalence of glaucoma was 20%, with angle-closure glaucoma accounting for 70% of all cases. Significant clinical risk factors for glaucoma development were a chronic recurrent stage at presentation (RR 2.88 95% CI 1.11 – 12.63, p=0.037), more than two episodes of recurrent anterior uveitis (RR 8.52 95% CI 2.02 – 35.92, p<0.001), angle-closure disease (ACD, RR 7.08 95% CI 2.44 – 20.48, p<0.001), iris bombé (RR 5.0 95% CI 2.10 – 11.90, p<0.001), and peripapillary atrophy (RR 3.56 95% CI 1.43 – 8.85, p<0.001). Exposure to prednisone for more than 24 months (RR 9.33 95% CI 2.21 – 39.28, p<0.001) or topical corticosteroid drops for more than 12 months (RR 3.88 95% CI 1.31 – 11.46, p=0.007) were associated with an increased likelihood for secondary glaucoma development. Conclusions: Glaucoma is a frequent complication in patients with VKH, often attributed to mixed pathogenic mechanisms. Chronic disease at presentation, recurrent inflammation, angle-closure mechanisms, iris bombé, and peripapillary atrophy represent clinically significant risk factors for secondary glaucoma development. Prompt and aggressive steroid-spearing immunosuppressive therapy for reaching adequate control of inflammation may lower the risk of glaucoma in VKH patients.

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Predictive determinants of overall survival among re-infected COVID-19 patients using the elastic-net regularized Cox proportional hazards model: a machine-learning algorithm

BMC Public Health ◽

10.1186/s12889-021-12383-3 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Vahid Ebrahimi ◽

Mehrdad Sharifi ◽

Razieh Sadat Mousavi-Roknabadi ◽

Robab Sadegh ◽

Mohammad Hossein Khademian ◽

...

Keyword(s):

Machine Learning ◽

Overall Survival ◽

Mortality Rate ◽

Serum Creatinine ◽

Hospital Mortality ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Elastic Net ◽

Hospital Death ◽

Wbc Count

Abstract Background Narrowing a large set of features to a smaller one can improve our understanding of the main risk factors for in-hospital mortality in patients with COVID-19. This study aimed to derive a parsimonious model for predicting overall survival (OS) among re-infected COVID-19 patients using machine-learning algorithms. Methods The retrospective data of 283 re-infected COVID-19 patients admitted to twenty-six medical centers (affiliated with Shiraz University of Medical Sciences) from 10 June to 26 December 2020 were reviewed and analyzed. An elastic-net regularized Cox proportional hazards (PH) regression and model approximation via backward elimination were utilized to optimize a predictive model of time to in-hospital death. The model was further reduced to its core features to maximize simplicity and generalizability. Results The empirical in-hospital mortality rate among the re-infected COVID-19 patients was 9.5%. In addition, the mortality rate among the intubated patients was 83.5%. Using the Kaplan-Meier approach, the OS (95% CI) rates for days 7, 14, and 21 were 87.5% (81.6-91.6%), 78.3% (65.0-87.0%), and 52.2% (20.3-76.7%), respectively. The elastic-net Cox PH regression retained 8 out of 35 candidate features of death. Transfer by Emergency Medical Services (EMS) (HR=3.90, 95% CI: 1.63-9.48), SpO2≤85% (HR=8.10, 95% CI: 2.97-22.00), increased serum creatinine (HR=1.85, 95% CI: 1.48-2.30), and increased white blood cells (WBC) count (HR=1.10, 95% CI: 1.03-1.15) were associated with higher in-hospital mortality rates in the re-infected COVID-19 patients. Conclusion The results of the machine-learning analysis demonstrated that transfer by EMS, profound hypoxemia (SpO2≤85%), increased serum creatinine (more than 1.6 mg/dL), and increased WBC count (more than 8.5 (×109 cells/L)) reduced the OS of the re-infected COVID-19 patients. We recommend that future machine-learning studies should further investigate these relationships and the associated factors in these patients for a better prediction of OS.

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Risk factors of recurrent erysipelas in adult Chinese patients: a prospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-020-05710-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ang Li ◽

Ni Wang ◽

Lingzhi Ge ◽

Hongyan Xin ◽

Wenfei Li

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Venous Insufficiency ◽

Proportional Hazards ◽

Univariate Analysis ◽

Cox Proportional Hazards ◽

Chinese Patients ◽

First Episode ◽

Common Skin

Abstract Background Erysipelas is a common skin infection that is prone to recur. Recurrent erysipelas has a severe effect on the quality of life of patients. The present study aimed to investigate the risk factors of recurrent erysipelas in adult Chinese patients. Methods A total of 428 Chinese patients with erysipelas who met the inclusion criteria were studied. The patients were divided into the nonrecurrent erysipelas group and the recurrent erysipelas group. Clinical data were collected on the first episode and relapse of erysipelas. The patients were followed up every 3 months. Statistical analysis was performed to analyze and determine the risk factors of erysipelas relapse. Results Univariate analysis was performed to analyze the data, including surgery, types of antibiotics administered in the first episode, obesity, diabetes mellitus, venous insufficiency, lymphedema, and malignancy. The differences between the groups were statistically significant (p < 0.05). The Cox proportional hazards regression model analysis showed that the final risk factors included surgery, obesity, diabetes mellitus, venous insufficiency, and lymphedema. Conclusions Surgery, obesity, diabetes mellitus, venous insufficiency, and lymphedema are considered as risk factors for recurrent erysipelas.

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A Modern Cohort of Duodenal Obstruction Patients: Predictors of Delayed Transition to Full Enteral Nutrition

Journal of Nutrition and Metabolism ◽

10.1155/2014/850820 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Sigrid Bairdain ◽

David C. Yu ◽

Chueh Lien ◽

Faraz Ali Khan ◽

Bhavana Pathak ◽

...

Keyword(s):

Risk Factors ◽

Enteral Nutrition ◽

Median Time ◽

Nutritional Support ◽

Proportional Hazards ◽

Significant Risk ◽

Cox Proportional Hazards ◽

Potential Risk Factors ◽

Cox Analysis ◽

Delayed Transition

Background. A common site for neonatal intestinal obstruction is the duodenum. Delayed establishment of enteral nutritional autonomy continues to challenge surgeons and, since early institution of nutritional support is critical in postoperative newborns, identification of patients likely to require alternative nutritional support may improve their outcomes. Therefore, we aimed to investigate risk factors leading to delayed establishment of full enteral nutrition in these patients.Methods. 87 patients who were surgically treated for intrinsic duodenal obstructions from 1998 to 2012 were reviewed. Variables were tested as potential risk factors. Median time to full enteral nutrition was estimated using the Kaplan-Meier method. Independent risk factors of delayed transition were identified using the multivariate Cox proportional hazards regression model.Results. Median time to transition to full enteral nutrition was 12 days (interquartile range: 9–17 days). Multivariate Cox analysis identified three significant risk factors for delayed enteral nutrition: gestational age (GA) ≤ 35 weeks (P < .001), congenital heart disease (CHD) (P=.02), and malrotation (P = .03).Conclusions. CHD and Prematurity are most commonly associated with delayed transition to full enteral nutrition. Thus, in these patients, supportive nutrition should strongly be considered pending enteral nutritional autonomy.

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Endoscopic third ventriculostomy with choroid plexus cauterization for the treatment of infantile hydrocephalus in Haiti

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.10.peds19433 ◽

2020 ◽

Vol 25 (4) ◽

pp. 411-416

Author(s):

Ashish H. Shah ◽

Yudy LaFortune ◽

George M. Ibrahim ◽

Iahn Cajigas ◽

Michael Ragheb ◽

...

Keyword(s):

Choroid Plexus ◽

Endoscopic Third Ventriculostomy ◽

Proportional Hazards ◽

Univariate Analysis ◽

Significant Risk ◽

Cox Proportional Hazards ◽

Third Ventriculostomy ◽

Infantile Hydrocephalus ◽

Middle Income ◽

Choroid Plexus Cauterization

OBJECTIVEUntreated hydrocephalus poses a significant health risk to children in the developing world. In response to this risk, global neurosurgical efforts have increasingly focused on endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) in the management of infantile hydrocephalus in low- and middle-income countries (LMICs). Here, the authors report their experience with ETV/CPC at the Hospital Bernard-Mevs/Project Medishare (HBMPM) in Port-au-Prince, Haiti.METHODSThe authors conducted a retrospective review of a series of consecutive children who had undergone ETV/CPC for hydrocephalus over a 1-year period at HBMPM. The primary outcome of interest was time to ETV/CPC failure. Univariate and multivariate analyses using a Cox proportional hazards regression were performed to identify preoperative factors that were associated with outcomes.RESULTSOf the 82 children who underwent ETV/CPC, 52.2% remained shunt free at the last follow-up (mean 6.4 months). On univariate analysis, the ETV success score (ETVSS; p = 0.002), success of the attempted ETV (p = 0.018), and bilateral CPC (p = 0.045) were associated with shunt freedom. In the multivariate models, a lower ETVSS was independently associated with a poor outcome (HR 0.072, 95% CI 0.016–0.32, p < 0.001). Two children (2.4%) died of postoperative seizures.CONCLUSIONSAs in other LMICs, ETV/CPC is an effective treatment for hydrocephalus in children in Haiti, with a low but significant risk profile. Larger multinational prospective databases may further elucidate the ideal candidate for ETV/CPC in resource-poor settings.

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Prognostic Variables of Younger-Aged Cervical Carcinoma Patients: A Retrospective Study

Journal of Oncology ◽

10.1155/2021/5540165 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Emmanuel Kwateng Drokow ◽

Lanlan Xu ◽

Gloria Selorm Akpabla ◽

Hafiz Abdul Waqas Ahmed ◽

Juanjuan Song ◽

...

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Lymph Node ◽

Proportional Hazards ◽

Univariate Analysis ◽

Surgical Margin ◽

Cox Proportional Hazards ◽

Tumour Stage ◽

Younger Women ◽

Node Metastases

Purpose. The prevalence of carcinoma of the cervix is increasing in younger women. This study aimed to evaluate the sociodemographic, pathological, and clinical features, prognosis, and treatment of women aged ≤35 years with carcinoma of the cervix (CC). Methods and Materials. We retrospectively analysed the clinical information of 352 younger women with carcinoma of the cervix aged ≤35 years at the Gynaecological Oncology Department of Zhengzhou University People’s Hospital from April 2000 to January 2018. The overall survival was evaluated with the Kaplan–Meier model, and the log-ranked analysis was compared with the univariate analysis to determine prognostic survival-related risk factors. Cox Proportional Hazards analysis was further used in analysing parameters correlated with survival after univariate analysis. A p value <0.05 was considered statistically significant. SPSS version 23.0 was used for the data analysis. Results. The most frequent histopathological type observed in the selected 352 younger women was squamous cell carcinoma (SCC) (n = 221, 62.9%), adenocarcinoma (n = 125, 35.5%), and adenosquamous carcinoma (n = 6, 1.7%). The 5-year overall survival time was 80.5%. The prognostic risk factors discovered through univariate analysis were tumour stage (IA1-IIB vs. IIIA-IVA) (89.2% vs. 35.1%: p value = 0.002), histological type (SCC vs. non-SCC) (95.7% vs. 56.2%: p value = 0.001), surgical margin (negative vs. positive) (90.9% vs. 41.2%: p value = 0.001), and pelvic lymph node metastasis (no vs. yes) (93.4% vs. 39.2%: p value = .001). The Cox proportional hazards test demonstrated that lymph node metastases ([HR] = 2.924, 95% CI: 1.432–7.426; p = 0.014 ), tumour stage IIIA-IVA ([HR] = 3.765, 95% CI: 1.398–9.765; p = 0.016 ), and surgical margin ([HR] = 2.167, 95% CI: 1.987–9.554; p = 0.019 ) were independent prognostic risk factors for overall survival in younger women with cervical carcinoma. Conclusion. In conclusion, the status of lymph node metastases, tumour stage, and surgical margin and the type of histopathology substantially influence the rate of survival.

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Predictive determinants of overall survival among re-infected COVID-19 patients using the elastic-net regularized Cox proportional hazards model: a machine-learning algorithm

10.21203/rs.3.rs-371941/v1 ◽

2021 ◽

Author(s):

Vahid Ebrahimi ◽

Mehrdad Sharifi ◽

Razieh Sadat Mousavi-Roknabadi ◽

Robab Sadegh ◽

Mohammad Hossein Khademian ◽

...

Keyword(s):

Machine Learning ◽

Overall Survival ◽

Mortality Rate ◽

Serum Creatinine ◽

Hospital Mortality ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Elastic Net ◽

Hospital Death ◽

Wbc Count

Abstract Background: Narrowing a large set of features to a smaller one can improve our understanding of the main risk factors for in-hospital mortality in patients with COVID-19. This study aimed to derive a parsimonious model for predicting overall survival (OS) among re-infected COVID-19 patients using machine-learning (ML) algorithms.Methods: The retrospective data of 283 re-infected COVID-19 patients admitted to twenty-six medical centers (affiliated with Shiraz University of Medical Sciences) from 10 June to 26 December 2020 were reviewed and analyzed. An elastic-net regularized Cox proportional hazards (PH) regression and model approximation via backward elimination were utilized to optimize a predictive model of time to in-hospital death. Then, the model was reduced to its core features to maximize simplicity and generalizability.Results: The empirical in-hospital mortality rate among the re-infected COVID-19 patients was obtained as 9.5%. In addition, the mortality rate among the intubated patients was 83.5%. Using the Kaplan-Meier approach, the OS (95% CI) rates for days 7, 14, and 21 were 87.5% (81.6-91.6%), 78.3% (65.0-87.0%), and 52.2% (20.3-76.7%), respectively. The elastic-net Cox PH regression retained 8 out of 35 candidate features of death. Transfer by Emergency Medical Services (EMS) (HR=3.90, 95% CI: 1.63-9.48), SpO2≤85% (HR=8.10, 95% CI: 2.97-22.00), increased serum creatinine (HR=1.85, 95% CI: 1.48-2.30), and increased white blood cells (WBC) count (HR=1.10, 95% CI: 1.03-1.15) were associated with higher in-hospital mortality rates in the re-infected COVID-19 patients.Conclusion: The results of the ML analysis demonstrated that transfer by EMS, profound hypoxemia (SpO2≤85%), increased serum creatinine (more than 1.6 mg/dL), and increased WBC count (more than 8.5 (×109 cells/L)) reduced the OS of the re-infected COVID-19 patients.

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Clinical and pathological risk factors for worse stage and mortality of eyelid and periocular squamous cell carcinoma

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317546 ◽

2021 ◽

pp. bjophthalmol-2020-317546

Author(s):

Yingxiu Luo ◽

Huifang Chen ◽

Shengfang Ge ◽

Yamin Rao ◽

Jie Yu ◽

...

Keyword(s):

Risk Factors ◽

Squamous Cell ◽

Distant Metastasis ◽

Regression Models ◽

Proportional Hazards ◽

Case Series ◽

Cox Proportional Hazards ◽

Retrospective Case ◽

T Stage ◽

Disease Specific

BackgroundThe clinical and pathological risk factors for worse T stage and prognosis in eyelid and periocular squamous cell carcinomas (SCCs) remain unclear. P63 was reported to predict a worse prognosis in other SCCs; however, this correlation was not validated in eyelid and periocular SCCs.MethodsWe reported on a retrospective case series of 85 consecutive patients with eyelid and periocular SCCs from 1995 to 2019. Cox proportional hazards regression models and logistic regression models were applied for risk factor analysis.ResultsThirty-nine (45.8%) patients were diagnosed with T4 SCCs. Four (5.1%) patients developed nodal metastasis, and five (6.4%) patients developed distant metastasis during the follow-up. 2-year and 5-year disease-specific survival rates were 95.3% and 86.4%, respectively. Poorly or moderately differentiated eyelid and periocular SCCs were associated with worse T stage (p=0.001; p=0.008). Poor differentiation was associated with a higher risk of recurrence (p=0.024). Disease-specific death was more common in patients with T4 stage SCCs (p=0.038, HR=9.05). P63 expression was more common in patients with T3c or worse stage (p=0.008, OR=3.77). P63 expression alone was associated with worse differentiation (p=0.029), higher risk of perineural invasion (p=0.042, OR=4.61) and metastasis (p=0.009, HR=3.99). P63 expression (p=0.012, HR=7.80), coexpression of P63 and Ki67 (p=0.007, HR=9.21) and distant metastasis (p=0.001, HR=11.23) were associated with disease-specific death.ConclusionPatients presented with more aggressive orbital invasion features and a higher rate of distant metastasis in this cohort. P63 and coexpression of Ki67 predicted a worse stage, differentiation and prognosis, including metastasis and death due to disease.

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Graft-Versus-Host Disease (GVHD) in Cord Blood Transplantation (CBT): Risk Factors, Clinical Manifestations and Outcomes.

Blood ◽

10.1182/blood.v110.11.2977.2977 ◽

2007 ◽

Vol 110 (11) ◽

pp. 2977-2977

Author(s):

Daniel Couriel ◽

Poliana Patah ◽

Rima Saliba ◽

Lawrence Cooper ◽

Laura Worth ◽

...

Keyword(s):

Risk Factors ◽

Cord Blood ◽

Proportional Hazards ◽

Cord Blood Transplantation ◽

Chronic Gvhd ◽

Clinical Manifestations ◽

Significant Risk ◽

Cox Proportional Hazards ◽

Hla Typing ◽

Significant Difference

Abstract Introduction: Umbilical CBT from mismatched donors can restore hematopoiesis both in children and adults with acceptable rates of severe acute (aGVHD) and chronic GVHD (cGVHD). Acute and chronic GVHD, including risk factors, clinical manifestations and its specific impact on outcomes has not been systematically evaluated in this particular patient population. Objective: To analyze the manifestations of GVHD in CBT, with emphasis on risk factors and impact on overall survival. Methods: Prospective evaluation of aGVHD and cGVHD in 138 adult and pediatric patients undergoing single or double CBT for hematological disorders and solid tumors from 3/96 and 6/07. cord blood units were selected on the basis of a maximum of 2 MM (HLA-A, B, DRB1) and the minimum of 1x107TNC/Kg. Risk factors for aGVHD after CBT were assessed using the Cox proportional hazards method. The estimates of aGVHD and cGVHD were performed accounting for competing risks such as death and engraftment using the cumulative incidence (CI) method. Results: A total of 138 adult (n=78) and pediatric (n=60) CBT were performed in the time period. Median age was 21 (1-64), 58 females and 80 males. The majority received a transplant for hematological malignancies (n= 132), mostly MDS/AML and ALL (n= 98, 71%). The remainder had AA (n= 3) and one a solid tumor (n=1). Seventy-seven patients (56%) were in remission of their disease at the time of transplant. Most patients received a myeloablative regimen (n= 125, 91%), and single cord grafts (n= 81, 59%). Of 100 CBT where HLA typing is available, 39%, 45 and 9% have 1, 2 and 3 mismatched loci respectively. Twenty-four patients (17%) did not engraft. At 3 months post transplant, the CI of grade II-IV aGVHD was 36% (adult 38%, pediatric 34%, p= 0.9), and that of grade III-IV was 12% (adult 14%, pediatric 10%, p= 0.9). Skin was the organ most often involved (84%, adult 71%, pediatric 100%, p= 0.017). In adults skin was the only organ involved in 80% of patients with skin GVHD. Lower GI, upper GI and liver involvement were observed in 24, 18, and 21% of patients respectively, without significant difference between adults and children. The total nucleated cell count (TNC) of the graft was the strongest predictor of aGVHD. In children, active disease at the time of transplant was also significantly associated with higher incidence aGVHD. Other factors analyzed, including number and type of mismatched HLA loci were not significant risk factors for aGVHD. CI of cGVHD was 20%, and significantly lower in children compared to adults (8 vs 31%, p= 0.002). Nonrelapse mortality (NRM) at 2 years was 30%, and significantly lower in children (18 vs 41%, p= 0.007). Only 7/43 (16%) deaths were attributed to aGVHD or cGVHD. Conclusions: CBT can be performed in children and adults with acceptable rates of GVHD, even in the presence of multiple HLA mismatched loci. Most cases of acute GVHD involved the skin, often as the only organ. Chronic GVHD and NRM are significantly higher in adults. GVHD accounts for a relatively small proportion of nonrelapse deaths.

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Incidence and risk factors for gangrene in patients with systemic sclerosis from the EUSTAR cohort

Rheumatology ◽

10.1093/rheumatology/kez558 ◽

2019 ◽

Vol 59 (8) ◽

pp. 2016-2023 ◽

Cited By ~ 2

Author(s):

Carina Mihai ◽

Oliver Distler ◽

Ana Maria Gheorghiu ◽

Paul I Constantin ◽

Rucsandra Dobrota ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Disease Duration ◽

Proportional Hazards ◽

Significant Risk ◽

Cox Proportional Hazards ◽

Digital Ulcers ◽

Cross Sectional ◽

The Cross

Abstract Objective In patients with SSc, peripheral vasculopathy can promote critical ischaemia and gangrene. The aim of this study was to investigate the prevalence, incidence and risk factors for gangrene in the EUSTAR cohort. Methods We included patients from the EUSTAR database fulfilling the ACR 1980 or the ACR/EULAR 2013 classification criteria for SSc, with at least one visit recording data on gangrene. Centres were asked for supplementary data on traditional cardiovascular risk factors. We analysed the cross-sectional relationship between gangrene and its potential risk factors by univariable and multivariable logistic regression. Longitudinal data were analysed by Cox proportional hazards regression. Results 1757 patients were analysed (age 55.9 [14.5] years, disease duration 7.9 [10.3] years, male sex 16.7%, 24.6% diffuse cutaneous subset [dcSSc]). At inclusion, 8.9% of patients had current or previous digital gangrene, 16.1% had current digital ulcers (DUs) and 42.7% had ever had DUs (current or previous). Older age, DUs ever and dcSSc were statistically significant risk factors for gangrene in the cross-sectional multivariable model. During a median follow-up of 13.1 months, 16/771 (0.9%) patients developed gangrene. All 16 patients who developed gangrene had previously had DUs and gangrene. Further risk factors for incident gangrene were the dcSSc subset and longer disease duration. Conclusion In unselected SSc patients, gangrene occurs in about 9% of SSc patients. DUs ever and, to a lesser extent, the dcSSc subset are strongly and independently associated with gangrene, while traditional cardiovascular risk factors could not be identified as risk factors.

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