Infectious complications in bullous pemphigoid: An analysis of risk factors
Background Infections are common in bullous pemphigoid and contribute to significant mortality. Objectives We sought to define the spectrum of infectious complications and to identify associated risk factors in a bullous pemphigoid cohort. Design A retrospective cohort study conducted at an academic...
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| Veröffentlicht in: | Journal of the American Academy of Dermatology 2015-05, Vol.72 (5), p.834-839 |
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| creator | Phoon, Yee Wei, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (Edinburgh) Fook-Chong, Stephanie M.C., MSc (Statistics), Cstat Koh, Hong Yi, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK) Thirumoorthy, Thamotharampillai, MBBS (Malaya), FRCP, FAMS (Dermatology) Pang, Shiu Ming, MBBS (Hong Kong), FRCP (London), FAMS (Dermatology) Lee, Haur Yueh, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK), FAMS (Dermatology) |
| description | Background Infections are common in bullous pemphigoid and contribute to significant mortality. Objectives We sought to define the spectrum of infectious complications and to identify associated risk factors in a bullous pemphigoid cohort. Design A retrospective cohort study conducted at an academic medical center. Results In all, 97 patients were included. Infectious complications occurred in 54 patients (56%) and the median duration from diagnosis to first episode of infection was 3 months. Bacteremia occurred in 14 patients (26%) and 26 of 30 deaths (87%) were attributable to infections. On univariate analysis, significant risk factors include low Karnofsky score ( |
| doi_str_mv | 10.1016/j.jaad.2015.01.029 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1674693139</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0190962215000948</els_id><sourcerecordid>1674693139</sourcerecordid><originalsourceid>FETCH-LOGICAL-c477t-ee7c1d650dfd3e63e4d84f787e51db1c4ed57595932d22750acf789f109d87e13</originalsourceid><addsrcrecordid>eNp9kUtP3DAUhS3UCobHH-gCZdlNUl_n4XFVISEEFHUkFpS15bFvioMTB3uCNP--DjPtggUry7rnXN3zHUK-AC2AQvOtKzqlTMEo1AWFgjJxQBZABc8bvuSfyIKCoLloGDsixzF2lFJRlfyQHLGa14xDtSC_7oYW9cb6KWba96OzWqXfEDM7ZOvJuXkwYj8-2T_emu_Z5ZCpQblttDHzbRZsfM5apTc-xFPyuVUu4tn-PSGPN9e_r37mq_vbu6vLVa4rzjc5Itdgmpqa1pTYlFiZZdWmi7EGswZdoUnniVqUzDDGa6p0moo2JTNJBOUJ-brbOwb_MmHcyN5Gjc6pAdO5EhpeNaKEUiQp20l18DEGbOUYbK_CVgKVM0TZyRminCFKCjJBTKbz_f5p3aP5b_lHLQl-7ASYUr5aDDJqi4NGY0OCKY23H--_eGfXzg4JvHvGLcbOTyERTjlkZJLKh7nGuUWo3xpcln8BQLOXxw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1674693139</pqid></control><display><type>article</type><title>Infectious complications in bullous pemphigoid: An analysis of risk factors</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Phoon, Yee Wei, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (Edinburgh) ; Fook-Chong, Stephanie M.C., MSc (Statistics), Cstat ; Koh, Hong Yi, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK) ; Thirumoorthy, Thamotharampillai, MBBS (Malaya), FRCP, FAMS (Dermatology) ; Pang, Shiu Ming, MBBS (Hong Kong), FRCP (London), FAMS (Dermatology) ; Lee, Haur Yueh, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK), FAMS (Dermatology)</creator><creatorcontrib>Phoon, Yee Wei, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (Edinburgh) ; Fook-Chong, Stephanie M.C., MSc (Statistics), Cstat ; Koh, Hong Yi, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK) ; Thirumoorthy, Thamotharampillai, MBBS (Malaya), FRCP, FAMS (Dermatology) ; Pang, Shiu Ming, MBBS (Hong Kong), FRCP (London), FAMS (Dermatology) ; Lee, Haur Yueh, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK), FAMS (Dermatology)</creatorcontrib><description>Background Infections are common in bullous pemphigoid and contribute to significant mortality. Objectives We sought to define the spectrum of infectious complications and to identify associated risk factors in a bullous pemphigoid cohort. Design A retrospective cohort study conducted at an academic medical center. Results In all, 97 patients were included. Infectious complications occurred in 54 patients (56%) and the median duration from diagnosis to first episode of infection was 3 months. Bacteremia occurred in 14 patients (26%) and 26 of 30 deaths (87%) were attributable to infections. On univariate analysis, significant risk factors include low Karnofsky score (<60) (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-8.3; P < .01), high Charlson comorbidity index score (≥6) (OR 2.4, 95% CI 1.1-5.5; P = .04), and dementia (OR 4.9, 95% CI 1.5-15.8; P = .01). On multivariate analysis, low Karnofsky score and dementia remained significant with an OR of 3.3 (95% CI 1.1-10.0; P = .03) and OR of 4.2 (95% CI 1.2-14.7; P = .03), respectively. Limitations Limitations include potential selection bias as a result of study design and primary outcome measures focused on significant infections requiring hospitalizations. Minor infections were not included. Conclusions Identified risk factors for infectious complications include functional impairment and the presence of dementia, which may allow for better risk stratification and individualized treatment of bullous pemphigoid.</description><identifier>ISSN: 0190-9622</identifier><identifier>EISSN: 1097-6787</identifier><identifier>DOI: 10.1016/j.jaad.2015.01.029</identifier><identifier>PMID: 25752714</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Bacteremia - etiology ; bullous pemphigoid ; Cohort Studies ; dementia ; Dementia - complications ; Dermatology ; Female ; Humans ; Infection - etiology ; infectious complications ; Karnofsky Performance Status ; low Karnofsky score ; Male ; morbidity ; mortality ; Pemphigoid, Bullous - complications ; Retrospective Studies ; Risk Factors</subject><ispartof>Journal of the American Academy of Dermatology, 2015-05, Vol.72 (5), p.834-839</ispartof><rights>American Academy of Dermatology, Inc.</rights><rights>2015 American Academy of Dermatology, Inc.</rights><rights>Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-ee7c1d650dfd3e63e4d84f787e51db1c4ed57595932d22750acf789f109d87e13</citedby><cites>FETCH-LOGICAL-c477t-ee7c1d650dfd3e63e4d84f787e51db1c4ed57595932d22750acf789f109d87e13</cites><orcidid>0000-0003-1432-5810</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0190962215000948$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25752714$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Phoon, Yee Wei, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (Edinburgh)</creatorcontrib><creatorcontrib>Fook-Chong, Stephanie M.C., MSc (Statistics), Cstat</creatorcontrib><creatorcontrib>Koh, Hong Yi, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK)</creatorcontrib><creatorcontrib>Thirumoorthy, Thamotharampillai, MBBS (Malaya), FRCP, FAMS (Dermatology)</creatorcontrib><creatorcontrib>Pang, Shiu Ming, MBBS (Hong Kong), FRCP (London), FAMS (Dermatology)</creatorcontrib><creatorcontrib>Lee, Haur Yueh, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK), FAMS (Dermatology)</creatorcontrib><title>Infectious complications in bullous pemphigoid: An analysis of risk factors</title><title>Journal of the American Academy of Dermatology</title><addtitle>J Am Acad Dermatol</addtitle><description>Background Infections are common in bullous pemphigoid and contribute to significant mortality. Objectives We sought to define the spectrum of infectious complications and to identify associated risk factors in a bullous pemphigoid cohort. Design A retrospective cohort study conducted at an academic medical center. Results In all, 97 patients were included. Infectious complications occurred in 54 patients (56%) and the median duration from diagnosis to first episode of infection was 3 months. Bacteremia occurred in 14 patients (26%) and 26 of 30 deaths (87%) were attributable to infections. On univariate analysis, significant risk factors include low Karnofsky score (<60) (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-8.3; P < .01), high Charlson comorbidity index score (≥6) (OR 2.4, 95% CI 1.1-5.5; P = .04), and dementia (OR 4.9, 95% CI 1.5-15.8; P = .01). On multivariate analysis, low Karnofsky score and dementia remained significant with an OR of 3.3 (95% CI 1.1-10.0; P = .03) and OR of 4.2 (95% CI 1.2-14.7; P = .03), respectively. Limitations Limitations include potential selection bias as a result of study design and primary outcome measures focused on significant infections requiring hospitalizations. Minor infections were not included. Conclusions Identified risk factors for infectious complications include functional impairment and the presence of dementia, which may allow for better risk stratification and individualized treatment of bullous pemphigoid.</description><subject>Aged</subject><subject>Bacteremia - etiology</subject><subject>bullous pemphigoid</subject><subject>Cohort Studies</subject><subject>dementia</subject><subject>Dementia - complications</subject><subject>Dermatology</subject><subject>Female</subject><subject>Humans</subject><subject>Infection - etiology</subject><subject>infectious complications</subject><subject>Karnofsky Performance Status</subject><subject>low Karnofsky score</subject><subject>Male</subject><subject>morbidity</subject><subject>mortality</subject><subject>Pemphigoid, Bullous - complications</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><issn>0190-9622</issn><issn>1097-6787</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUtP3DAUhS3UCobHH-gCZdlNUl_n4XFVISEEFHUkFpS15bFvioMTB3uCNP--DjPtggUry7rnXN3zHUK-AC2AQvOtKzqlTMEo1AWFgjJxQBZABc8bvuSfyIKCoLloGDsixzF2lFJRlfyQHLGa14xDtSC_7oYW9cb6KWba96OzWqXfEDM7ZOvJuXkwYj8-2T_emu_Z5ZCpQblttDHzbRZsfM5apTc-xFPyuVUu4tn-PSGPN9e_r37mq_vbu6vLVa4rzjc5Itdgmpqa1pTYlFiZZdWmi7EGswZdoUnniVqUzDDGa6p0moo2JTNJBOUJ-brbOwb_MmHcyN5Gjc6pAdO5EhpeNaKEUiQp20l18DEGbOUYbK_CVgKVM0TZyRminCFKCjJBTKbz_f5p3aP5b_lHLQl-7ASYUr5aDDJqi4NGY0OCKY23H--_eGfXzg4JvHvGLcbOTyERTjlkZJLKh7nGuUWo3xpcln8BQLOXxw</recordid><startdate>20150501</startdate><enddate>20150501</enddate><creator>Phoon, Yee Wei, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (Edinburgh)</creator><creator>Fook-Chong, Stephanie M.C., MSc (Statistics), Cstat</creator><creator>Koh, Hong Yi, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK)</creator><creator>Thirumoorthy, Thamotharampillai, MBBS (Malaya), FRCP, FAMS (Dermatology)</creator><creator>Pang, Shiu Ming, MBBS (Hong Kong), FRCP (London), FAMS (Dermatology)</creator><creator>Lee, Haur Yueh, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK), FAMS (Dermatology)</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1432-5810</orcidid></search><sort><creationdate>20150501</creationdate><title>Infectious complications in bullous pemphigoid: An analysis of risk factors</title><author>Phoon, Yee Wei, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (Edinburgh) ; Fook-Chong, Stephanie M.C., MSc (Statistics), Cstat ; Koh, Hong Yi, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK) ; Thirumoorthy, Thamotharampillai, MBBS (Malaya), FRCP, FAMS (Dermatology) ; Pang, Shiu Ming, MBBS (Hong Kong), FRCP (London), FAMS (Dermatology) ; Lee, Haur Yueh, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK), FAMS (Dermatology)</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-ee7c1d650dfd3e63e4d84f787e51db1c4ed57595932d22750acf789f109d87e13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Bacteremia - etiology</topic><topic>bullous pemphigoid</topic><topic>Cohort Studies</topic><topic>dementia</topic><topic>Dementia - complications</topic><topic>Dermatology</topic><topic>Female</topic><topic>Humans</topic><topic>Infection - etiology</topic><topic>infectious complications</topic><topic>Karnofsky Performance Status</topic><topic>low Karnofsky score</topic><topic>Male</topic><topic>morbidity</topic><topic>mortality</topic><topic>Pemphigoid, Bullous - complications</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Phoon, Yee Wei, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (Edinburgh)</creatorcontrib><creatorcontrib>Fook-Chong, Stephanie M.C., MSc (Statistics), Cstat</creatorcontrib><creatorcontrib>Koh, Hong Yi, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK)</creatorcontrib><creatorcontrib>Thirumoorthy, Thamotharampillai, MBBS (Malaya), FRCP, FAMS (Dermatology)</creatorcontrib><creatorcontrib>Pang, Shiu Ming, MBBS (Hong Kong), FRCP (London), FAMS (Dermatology)</creatorcontrib><creatorcontrib>Lee, Haur Yueh, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK), FAMS (Dermatology)</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Academy of Dermatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Phoon, Yee Wei, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (Edinburgh)</au><au>Fook-Chong, Stephanie M.C., MSc (Statistics), Cstat</au><au>Koh, Hong Yi, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK)</au><au>Thirumoorthy, Thamotharampillai, MBBS (Malaya), FRCP, FAMS (Dermatology)</au><au>Pang, Shiu Ming, MBBS (Hong Kong), FRCP (London), FAMS (Dermatology)</au><au>Lee, Haur Yueh, MBBS (Singapore), MMed (Int Med) (Singapore), MRCP (UK), FAMS (Dermatology)</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Infectious complications in bullous pemphigoid: An analysis of risk factors</atitle><jtitle>Journal of the American Academy of Dermatology</jtitle><addtitle>J Am Acad Dermatol</addtitle><date>2015-05-01</date><risdate>2015</risdate><volume>72</volume><issue>5</issue><spage>834</spage><epage>839</epage><pages>834-839</pages><issn>0190-9622</issn><eissn>1097-6787</eissn><abstract>Background Infections are common in bullous pemphigoid and contribute to significant mortality. Objectives We sought to define the spectrum of infectious complications and to identify associated risk factors in a bullous pemphigoid cohort. Design A retrospective cohort study conducted at an academic medical center. Results In all, 97 patients were included. Infectious complications occurred in 54 patients (56%) and the median duration from diagnosis to first episode of infection was 3 months. Bacteremia occurred in 14 patients (26%) and 26 of 30 deaths (87%) were attributable to infections. On univariate analysis, significant risk factors include low Karnofsky score (<60) (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-8.3; P < .01), high Charlson comorbidity index score (≥6) (OR 2.4, 95% CI 1.1-5.5; P = .04), and dementia (OR 4.9, 95% CI 1.5-15.8; P = .01). On multivariate analysis, low Karnofsky score and dementia remained significant with an OR of 3.3 (95% CI 1.1-10.0; P = .03) and OR of 4.2 (95% CI 1.2-14.7; P = .03), respectively. Limitations Limitations include potential selection bias as a result of study design and primary outcome measures focused on significant infections requiring hospitalizations. Minor infections were not included. Conclusions Identified risk factors for infectious complications include functional impairment and the presence of dementia, which may allow for better risk stratification and individualized treatment of bullous pemphigoid.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25752714</pmid><doi>10.1016/j.jaad.2015.01.029</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-1432-5810</orcidid></addata></record> |
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| subjects | Aged Bacteremia - etiology bullous pemphigoid Cohort Studies dementia Dementia - complications Dermatology Female Humans Infection - etiology infectious complications Karnofsky Performance Status low Karnofsky score Male morbidity mortality Pemphigoid, Bullous - complications Retrospective Studies Risk Factors |
| title | Infectious complications in bullous pemphigoid: An analysis of risk factors |
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