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Factors associated with active tuberculosis in Colombian patients with systemic lupus erythematosus: a case-control study / Ruth María Eraso Garnica  

Público ISBD Título : Factors associated with active tuberculosis in Colombian patients with systemic lupus erythematosus: a case-control study Tipo de documento : documento electrónico Autores : Ruth María Eraso Garnica, Fecha de publicación : 2021 Títulos uniformes : Clinical Rheumatology Idioma : Inglés (eng) Palabras clave : Glucocorticoids  Immunosuppressants  Opportunistic infections  Systemic lupus erythematosus  Tuberculosis Resumen : Objective: To identify factors associated with active tuberculosis (TB) in patients with systemic lupus erythematosus (SLE). Methods: We performed a retrospective case-control study in two tertiary care teaching hospitals in Medellín, Colombia. From January 2007 to December 2017, a total of 268 patients with SLE were included. SLE patients with TB (cases) were matched 1:3 with SLE patients without TB (controls) by disease duration and the date of the hospitalization in which the diagnosis of TB was made (index date of cases) to the nearest available rheumatology hospitalization in the matched controls (± 2 years). Conditional univariable and multivariable logistic regression analyses were performed. Results: Sixty-seven cases and 201 controls were assessed. Only pulmonary TB occurred in 46.3%, only extrapulmonary TB in 16.4% and disseminated TB in 37.3% of cases. Multivariable logistic regression analysis showed that lymphopenia (OR, 2.91; 95% CI 1.41-6.03; P = 0.004), 12-month cumulative glucocorticoid dose ≥ 1830 mg (OR, 2.74; 95% CI 1.26-5.98; P = 0.011), and having been treated with ≥ 2 immunosuppressants during the last 12 months (OR, 2.81; 95% CI 1.16-6.82; P = 0.022) were associated with TB after adjusting for age, sex, ethnicity, disease duration, disease activity, and comorbidity index. A trend towards an association of kidney transplantation with TB was also found (OR, 3.77; 95% CI 0.99-14.30; P = 0.051). Conclusion: Among SLE patients, cumulative glucocorticoid dose, lymphopenia, and the use of ≥ 2 immunosuppressants during the last 12 months were associated with active TB infection. Key Points • Among SLE patients, a cumulative dose of glucocorticoids equivalent to 5 mg/day of prednisone during the last 12 months is independently associated with the development of TB. • The use of two or more immunosuppressants during the last 12 months is also a risk factor for TB infection development is SLE patients. • Lymphopenia is predominant in SLE patients with TB, being especially profound in those with disseminated TB. • Renal transplant recipients with SLE also have an elevated risk of TB. Mención de responsabilidad : Luis Alonso González-Naranjo, Jaime Alberto Coral-Enríquez, Mauricio Restrepo-Escobar, Carlos Horacio Muñoz-Vahos, Daniel Jaramillo-Arroyave, Adriana Lucía Vanegas-García, Ruth Eraso, Gloria Vásquez & Fabián Jaimes Referencia : Clin Rheumatol. 2021 Jan;40(1):181-191. DOI (Digital Object Identifier) : 10.1007/s10067-020-05225-x PMID : 32529420 En línea : https://link.springer.com/article/10.1007%2Fs10067-020-05225-x Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5753 Factors associated with active tuberculosis in Colombian patients with systemic lupus erythematosus: a case-control study [documento electrónico] / Ruth María Eraso Garnica,  . - 2021. Obra : Clinical Rheumatology Idioma : Inglés (eng) Palabras clave : Glucocorticoids  Immunosuppressants  Opportunistic infections  Systemic lupus erythematosus  Tuberculosis Resumen : Objective: To identify factors associated with active tuberculosis (TB) in patients with systemic lupus erythematosus (SLE). Methods: We performed a retrospective case-control study in two tertiary care teaching hospitals in Medellín, Colombia. From January 2007 to December 2017, a total of 268 patients with SLE were included. SLE patients with TB (cases) were matched 1:3 with SLE patients without TB (controls) by disease duration and the date of the hospitalization in which the diagnosis of TB was made (index date of cases) to the nearest available rheumatology hospitalization in the matched controls (± 2 years). Conditional univariable and multivariable logistic regression analyses were performed. Results: Sixty-seven cases and 201 controls were assessed. Only pulmonary TB occurred in 46.3%, only extrapulmonary TB in 16.4% and disseminated TB in 37.3% of cases. Multivariable logistic regression analysis showed that lymphopenia (OR, 2.91; 95% CI 1.41-6.03; P = 0.004), 12-month cumulative glucocorticoid dose ≥ 1830 mg (OR, 2.74; 95% CI 1.26-5.98; P = 0.011), and having been treated with ≥ 2 immunosuppressants during the last 12 months (OR, 2.81; 95% CI 1.16-6.82; P = 0.022) were associated with TB after adjusting for age, sex, ethnicity, disease duration, disease activity, and comorbidity index. A trend towards an association of kidney transplantation with TB was also found (OR, 3.77; 95% CI 0.99-14.30; P = 0.051). Conclusion: Among SLE patients, cumulative glucocorticoid dose, lymphopenia, and the use of ≥ 2 immunosuppressants during the last 12 months were associated with active TB infection. Key Points • Among SLE patients, a cumulative dose of glucocorticoids equivalent to 5 mg/day of prednisone during the last 12 months is independently associated with the development of TB. • The use of two or more immunosuppressants during the last 12 months is also a risk factor for TB infection development is SLE patients. • Lymphopenia is predominant in SLE patients with TB, being especially profound in those with disseminated TB. • Renal transplant recipients with SLE also have an elevated risk of TB. Mención de responsabilidad : Luis Alonso González-Naranjo, Jaime Alberto Coral-Enríquez, Mauricio Restrepo-Escobar, Carlos Horacio Muñoz-Vahos, Daniel Jaramillo-Arroyave, Adriana Lucía Vanegas-García, Ruth Eraso, Gloria Vásquez & Fabián Jaimes Referencia : Clin Rheumatol. 2021 Jan;40(1):181-191. DOI (Digital Object Identifier) : 10.1007/s10067-020-05225-x PMID : 32529420 En línea : https://link.springer.com/article/10.1007%2Fs10067-020-05225-x Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5753

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Hospitalization causes and outcomes in HIV patients in the late antiretroviral era in Colombia / Alicia Inés Hidrón Botero    

Público ISBD Título : Hospitalization causes and outcomes in HIV patients in the late antiretroviral era in Colombia Tipo de documento : documento electrónico Autores : Alicia Inés Hidrón Botero, Fecha de publicación : 2017 Títulos uniformes : AIDS Research and Therapy Idioma : Inglés (eng) Palabras clave : Acquired immune defciency syndrome  Human immunodefciency virus  Hospitalization  Opportunistic infections  Antiretroviral  Adherence Resumen : Background: Antiretroviral therapy (ART) has modifed the natural history of HIV-infection: the incidence of opportunistic nfections (OIs) has decreased and mortality associated to HIV has improved dramatically. The reasons for hospitalization have changed; OIs are no longer the most common reason for admission. This study describes the patient population, admission diagnosis and hospital course of HIV patients in Colombia in the ART era. Methods: Patients admitted with HIV/AIDS at six hospitals in Medellin, Colombia between August 1, 2014 and July 31, 2015 were included. Demographic, laboratory, and clinical data were prospectively collected. Results: 551 HIV-infected patients were admitted: 76.0% were male, the median age was 37 (30–49). A new diagnosis of HIV was made in 22.0% of patients during the index admission. 56.0% of patients of the entire cohort had been diagnosed with HIV for more than 1 year and 68.9% were diagnosed in an advanced stage of the disease. More than 50.0% of patients had CD4 counts less than 200 CD4 cells/μL and viral loads greater than 100,000 copies. The main reasons for hospital admissions were OIs, tuberculosis, esophageal candidiasis and Toxoplasma encephalitis. The median hospital stay was 14 days (IQR 8–23). Admission to the intensive care unit (ICU) was required in 10.3% of patients and 14.3% were readmitted to the hospital; mortality was 5.4%. Conclusions: Similar to other countries in the developing world, in Colombia, the leading cause of hospitalization among HIV-infected patients remain opportunistic infections. However, in-hospital mortality was low, similar to those described for high-income countries. Strategies to monitor and optimize the adherence and retention in HIV programs are fundamental to maximize the beneft of ART. Mención de responsabilidad : María Fernanda Álvarez Barreneche, Carlos Andrés Restrepo Castro, Alicia Hidrón Botero, Juan Pablo Villa Franco, Ivan Mauricio Trompa Romero, Laura Restrepo Carvajal, Alejandro Eusse García, Adriana Ocampo Mesa, Lina María Echeverri Toro, Glenys Patricia Porras Fernández de Castro, Jaime Mauricio Ramírez Rivera, Carlos Andrés Agudelo Restrepo Referencia : AIDS Res Ther. 2017 Nov 13;14(1):60. DOI (Digital Object Identifier) : 10.1186/s12981-017-0186-3 PMID : 29132400 Derechos de uso : CC BY En línea : https://aidsrestherapy.biomedcentral.com/articles/10.1186/s12981-017-0186-3 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4062 Hospitalization causes and outcomes in HIV patients in the late antiretroviral era in Colombia [documento electrónico] / Alicia Inés Hidrón Botero,  . - 2017. Obra : AIDS Research and Therapy Idioma : Inglés (eng) Palabras clave : Acquired immune defciency syndrome  Human immunodefciency virus  Hospitalization  Opportunistic infections  Antiretroviral  Adherence Resumen : Background: Antiretroviral therapy (ART) has modifed the natural history of HIV-infection: the incidence of opportunistic nfections (OIs) has decreased and mortality associated to HIV has improved dramatically. The reasons for hospitalization have changed; OIs are no longer the most common reason for admission. This study describes the patient population, admission diagnosis and hospital course of HIV patients in Colombia in the ART era. Methods: Patients admitted with HIV/AIDS at six hospitals in Medellin, Colombia between August 1, 2014 and July 31, 2015 were included. Demographic, laboratory, and clinical data were prospectively collected. Results: 551 HIV-infected patients were admitted: 76.0% were male, the median age was 37 (30–49). A new diagnosis of HIV was made in 22.0% of patients during the index admission. 56.0% of patients of the entire cohort had been diagnosed with HIV for more than 1 year and 68.9% were diagnosed in an advanced stage of the disease. More than 50.0% of patients had CD4 counts less than 200 CD4 cells/μL and viral loads greater than 100,000 copies. The main reasons for hospital admissions were OIs, tuberculosis, esophageal candidiasis and Toxoplasma encephalitis. The median hospital stay was 14 days (IQR 8–23). Admission to the intensive care unit (ICU) was required in 10.3% of patients and 14.3% were readmitted to the hospital; mortality was 5.4%. Conclusions: Similar to other countries in the developing world, in Colombia, the leading cause of hospitalization among HIV-infected patients remain opportunistic infections. However, in-hospital mortality was low, similar to those described for high-income countries. Strategies to monitor and optimize the adherence and retention in HIV programs are fundamental to maximize the beneft of ART. Mención de responsabilidad : María Fernanda Álvarez Barreneche, Carlos Andrés Restrepo Castro, Alicia Hidrón Botero, Juan Pablo Villa Franco, Ivan Mauricio Trompa Romero, Laura Restrepo Carvajal, Alejandro Eusse García, Adriana Ocampo Mesa, Lina María Echeverri Toro, Glenys Patricia Porras Fernández de Castro, Jaime Mauricio Ramírez Rivera, Carlos Andrés Agudelo Restrepo Referencia : AIDS Res Ther. 2017 Nov 13;14(1):60. DOI (Digital Object Identifier) : 10.1186/s12981-017-0186-3 PMID : 29132400 Derechos de uso : CC BY En línea : https://aidsrestherapy.biomedcentral.com/articles/10.1186/s12981-017-0186-3 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4062

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