Search

Background: Hospital-acquired bacterial infections are associated with high morbidity and mortality rates in patients with systemic lupus erythematosus (SLE). This study aimed to develop and validate predictive models for the risk of hospital-acquired bacterial infections in patients with SLE., Methods: A historical cohort study was designed for development, and another bidirectional cohort study was used for external validation. The risk of bacterial infection was assessed upon admission and after 5 days of hospitalization. Predictor selection employed the least absolute shrinkage and selection operator (LASSO) techniques. Multiple imputations were used to handle missing data. Logistic regression models were applied, and the properties of discrimination, calibration, and decision curve analysis were evaluated., Results: The development cohort comprised 1686 patients and 237 events (14.1%) from 3 tertiary hospitals. The external validation cohort included 531 patients and 84 infection outcomes (15.8%) from 10 hospital centers in Colombia (secondary and tertiary level). The models applied at admission and after 120 hours of stay exhibited good discrimination (AUC > 0.74). External validation demonstrated good performance among patients from the same tertiary institutions where the models were developed. However, geographic validation at other institutions has been suboptimal., Conclusions: Two predictive models for nosocomial bacterial infections in patients with SLE are presented. All infection prevention recommendations should be maximized in patients at moderate/high risk. Further validation studies in diverse contexts, as well as clinical impact trials, are necessary before potential applications in research and clinical care., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To standardly assess and describe nailfold videocapillaroscopy (NVC) assessment in children and adolescents with juvenile rheumatic and musculoskeletal diseases (jRMD) vs healthy controls (HCs)., Material and Methods: In consecutive jRMD children and matched HCs from 13 centres worldwide, 16 NVC images per patient were acquired locally and read centrally per international consensus standard evaluation of the EULAR Study Group on Microcirculation in Rheumatic Diseases. A total of 95 patients with JIA, 22 with JDM, 20 with childhood-onset SLE (cSLE), 13 with juvenile SSc (jSSc), 21 with localized scleroderma (lSc), 18 with MCTD and 20 with primary RP (PRP) were included. NVC differences between juvenile subgroups and HCs were calculated through multivariable regression analysis., Results: A total of 6474 images were assessed from 413 subjects (mean age 12.1 years, 70.9% female). The quantitative NVC characteristics were significantly lower or higher in the following subgroups compared with HCs: for density: lower in jSSc, JDM, MCTD, cSLE and lSc; for dilations: higher in jSSc, MCTD and JDM; for abnormal shapes: higher in JDM and MCTD; for haemorrhages: higher in jSSc, MCTD, JDM and cSLE. The qualitative NVC assessment of JIA, lSc and PRP did not differ from HCs, whereas the cSLE and jSSc, MCTD, JDM and cSLE subgroups showed more non-specific and scleroderma patterns, respectively., Conclusions: This analysis resulted from a pioneering registry of NVC in jRMD. The NVC assessment in jRMD differed significantly from HCs. Future prospective follow-up will further elucidate the role of NVC in jRMD., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Objective: Describe the clinical and epidemiologic characteristics of patients with systemic lupus erythematosus (SLE) admitted to the intensive care unit (ICU)., Methods: a retrospective study with medical records review of patients with systemic lupus erythematosus (SLE) admitted to the ICU between 2004 and 2015 were included. Qualitative variables were described using absolute and relative frequencies. For quantitative variables mean value and standard deviation (SD) or median value with the interquartile range (IQR) depending on data distribution. To compare groups, it was used the Student t-test or Mann Whitney U test as appropriate and Fisher's exact test., Results: 33 patients were included, with a total of 45 ICU admissions, 29 (87.9%) were females with a median age of 26 years. The median time of diagnosis of SLE was two years, (IQR 1.5-5). The most common SLE manifestation and comorbidity were renal disease and hypertension with 27 (81.8%) and 14 (42.4%) respectively. The main reason for admittance was lupus flare with 25 events (55.5%). Infection was the second cause of admission with 19 events (42.2%). The median stay time in the ICU was four days (IQR 2-7). LODS score was 6 (RIQ 5-8), and APACHE II score was 13 (RIQ 11-17.7). There were 29 infections (64.5%) of which 20 (69%) were hospital-acquired. Four (12.1%) patients died., Conclusion: Unlike most of the previously reported series, in this study SLE activity was the most common cause of admission in the ICU. A more aggressive disease and difficulties in the ambulatory setting could explain this behavior. Despite the higher percentage of lupus flares, there was lower mortality.

Aim: To determine the correlation and concordance between different clinimetric scores in patients with rheumatoid arthritis in two high-complexity reference centers in northwestern Colombia., Method: A cross-sectional study in adults diagnosed with rheumatoid arthritis was conducted according to the 2010 American College of Rheumatology and European League Against Rheumatism Classification Criteria, between January and June, 2013. The correlation was evaluated using Spearman's correlation coefficient, and concordance with quadratic weighted kappa with the respective confidence intervals, for which patients were classified into different categories of disease activity., Results: One hundred patients were included, of whom 83% were women; 58 and 75% received methotrexate and glucocorticoids, respectively. Most individuals were in remission or low activity. High correlations between Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS28-ESR) values with DAS28 C-reactive protein and Simple Disease Activity Index (SDAI) with Clinical Disease Activity Index (P < 0.0001; r = 0.82 and r = 0.86, respectively) were observed; likewise, the scores obtained with different indices correlated well with gold standard values for remission (SDAI), where the correlation with DAS28-ESR was slightly lower. Excellent concordance among all clinimetric scores was observed, although it was lower among DAS28-ESR and SDAI., Conclusion: Clinimetric indices had high concordance and correlation, especially for rheumatoid arthritis patients in remission or low disease activity, without being interchangeable among them., (© 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Organ damage predicts mortality, increased accrual of detriment, and poor quality of life in systemic lupus erythematosus patients. The objective of this study is to determine the damage-free survival and its predictive factors in a population of Colombian subjects. The method used in this study is the retrospective follow-up of a cohort; damage was measured with SLICC/ACR index. Predictors of impairment were assessed by logistic regression and survival analysis. One hundred sixty-one individuals were included; 28.9% suffered damage, primarily neuropsychiatric, renal, and vascular. Arterial hypertension, antiphospholipid antibodies, prednisone dose, and number of relapses were all predictors of detriment. Onset after age 50 and daily prednisone dose higher than 7.5 mg determined earlier occurrence of damage.

Introduction: Tuberculosis (TB) remains an entity of high prevalence and mortality worldwide. The rising drug resistance is a public health problem. Besides, non-tuberculosis mycobacterial (NTM) infections are described with increasing frequency in areas of high prevalence of TB., Objectives: To determine epidemiological, clinical and microbiological characteristics of mycobacterial infections documented by culture., Materials and Methods: An observational, descriptive study in hospitalized patients., Results: M. tuberculosis complex was identified in 90,9% of 187 patients; 9,1% had NTM, 64% were male and the mean age was 40 years (range 1-88 years). The main co-morbidities were HIV / AIDS (23.5%), use of corticosteroids (13.3%) and chronic kidney disease (9.6%). Clinical forms were pulmonary (56.6%), extra-pulmonary (23.9%) and disseminated (19.2 The most common extra-pulmonary compromise was nodal (7.4%) and gastrointestinal (7%). 10.6% of M. tuberculosis were multi-drug resistant (MDR) and 2.12% had extended drug resistance (XDR). Mycobacterium avium andM. abscessus were the most frequent NTM. Overall mortality was 10%., Conclusions: In our study immune suppression is the main risk factor for extrapulmonary and disseminated disease. Resistance, MDR and XDR is higher in inpatients with TB. MNT infections are not uncommon in our country.