Factors influencing the EULAR Sjögren's Syndrome Patient-Reported Index in primary Sjögren's syndrome.

OBJECTIVES: The ESSPRI is a validated tool for measuring pain, fatigue and dryness in primary Sjögren's syndrome (pSS). We evaluated its association with disease and non-disease related variables, and its variation though the follow-up. METHODS: We included 130 pSS patients who were interviewed to register demographics, schooling, smoking, menopause, body mass index (BMI), disease duration, use of hormonal replacement, associated sicca drugs, prednisone, immunosuppressors/antimalarials, comorbidities such as diabetes mellitus, hypothyroidism, depression, fibromyalgia and scored the Charlson comorbidity index. We assessed the non-stimulated whole salivary flow (NSWSF), Schirmer-I test, ESSDAI and ESSPRI scores. In a subset of patients, we scored a second ESSPRI. RESULTS: Most patients were women, mean age 57 years and median disease duration 9.3 years. The median ESSPRI score was 6 (fatigue 6, pain 4, dryness 8). Eighty patients (61.5%) had an ESSPRI ≥5 points and were characterized by a higher prevalence of depression (OR 3.7, 95% 1.2-11.3) and lower NSWSF (OR 0.59, 95% CI 0.36-0.97). Among 62 patients with a second ESSPRI (median time 25 months), 44 (70%) experienced a decrement/increment ≥1 in the ESSPRI (16 were decrement). We did not find any of the studied variables associated with this variation, also including change in prednisone or immunosuppressors. CONCLUSIONS: An ESSPRI ≥5 (unsatisfactory symptom state) was associated with low NSWSF and depression. Most of the patients experienced a clinically significant ESSPRI variation (increment or decrement), nevertheless, we were not able to identify any variable associated with this change. Further studies would be helpful to understand the underlying causes.

Factores de riesgo para mortalidad en pacientes con infección por Clostridium difficile.

INTRODUCTION: Clostridium difficile infection (CDI) causes potentially lethal diarrhea. OBJECTIVE: To identify the risk factors for mortality in hospitalized patients with CDI. METHOD: Cross-sectional, retrospective study. The analyzed risk factors were age, comorbidities, nutritional status, past and current use of antibiotics, proton pump inhibitors, steroids, immunosuppressive therapy and chemotherapy, as well as development of acute kidney injury (AKI). RESULTS: Sixty-eight cases were assessed. Mean age was 51.4 ± 19.37 years. Mortality was 22.2 %. Moderate to severe undernutrition (Odds ratio [OR] = 20.15; 95% confidence interval [CI] = 1.13-35; p = 0.004), use of more than 2 antibiotics (OR = 1.61; 95% CI = 0.39-6.65; p = 0.01), AKI as determined by creatinine levels (OR = 1.34; 95% CI = 0.09-2.21; p = 0.02), hypotension with vasopressor use (OR = 1.28; 95% CI = 0.30-1.23; p = 0.001) and multiple organ failure (OR = 1.13; 95% CI = 0.31-4.92; p = 0.002) were associated with mortality. CONCLUSIONS: CDI represents an important problem in hospitalized patients and confers them an additional morbidity and mortality risk.

INTRODUCCIÓN: La infección por Clostridium difficile (ICD) es causa de diarrea hospitalaria potencialmente letal. OBJETIVO: Identificar los factores de riesgo para mortalidad en pacientes hospitalizados con ICD. MÉTODO: Estudio transversal y retrospectivo. Se analizaron factores de riesgo: edad, comorbilidades, estado nutricional, antecedente y uso de antibióticos, de inhibidores de bomba de protones, esteroides, inmunosupresores, quimioterapia y desarrollo de lesión renal aguda (LRA). RESULTADOS: Fueron evaluados 68 casos (incidencia de 25.7/10 000 egresos hospitalarios). La edad fue de 51.4 ± 19.37 años y la mortalidad de 22.2 %. La desnutrición moderada a severa mostró RM = 20.15, IC 95 % = 1.13-35, p = 0.004; el uso de más de dos antibióticos, RM = 1.61, IC 95 % = 0.39-6.65, p = 0.01; la LRA determinada por elevación de los niveles de creatinina, RM = 1.34, IC 95 % = 0.09-2.21, p = 0.02; la hipotensión con uso de vasopresores, RM = 1.28, IC 95 % = 0.30-1.23, p = 0.001; y el desarrollo de falla orgánica múltiple (FOM), RM = 1.13, IC 95 % = 0.31-4.92, p = 0.002. CONCLUSIONES: La desnutrición moderada a severa, el uso de más de dos antibióticos, la LRA, la hipotensión con uso de vasopresores y la FOM se asocian con incremento en la mortalidad en pacientes con ICD.

The value of repeat kidney biopsy in lupus nephritis. A systematic review / La utilidad de la biopsia renal repetida en nefritis lúpica. Una revisión sistemática

ABSTRACT A renal biopsy is the 'gold standard' for diagnosis and classification of lupus nephritis (LN). The role of repeat renal biopsy in lupus nephritis (LN) to guide treatment or predict prognosis has been controversial. A systematic literature review was conducted based on retrospective and prospective studies. The studies were identified using English electronic scientific databases, including MEDLINE PUBMED, published between January 1990 and August 2020. The eligibility criteria were studies including adult LN patients with at least one follow-up renal biopsy with appropriate longitudinal information. Case reports, studies with incomplete information or including duplicate patients were excluded. Based on the inclusion and exclusion criteria, a total of 73 publications were identified. This study included a total of 1167 repeat biopsies in LN patients from 15 studies. The primary indication for a repeat biopsy was relapse in 44-78% of the cases, and lack of response in 13-51%. Additionally, several repeat biopsies were done according to the protocol, after induction and maintenance therapy. In terms of histopathological class switches, there was a higher frequency of changes from nonproliferative to proliferative lesions. Only two studies provide a definition of histological response. There were often changes in the therapeutic approach after a repeat biopsy. Repeat kidney biopsies are helpful in patients with LN flare/relapse, and in patients with poor treatment response. Histological transformation was a common finding. The histologic and clinical responses are discordant. A repeat biopsy could be of prognostic value for therapeutic decision-making.

RESUMEN La biopsia renal es el «estándar de oro¼ para el diagnóstico y la clasificación de la nefritis lúpica (NL). El papel de la biopsia renal repetida en nefritis lúpica para orientar el tratamiento o predecir el pronóstico ha sido controversial. Se llevó a cabo una revisión sistemática de la literatura basada en estudios retrospectivos y prospectivos. Los estudios se identificaron a través de bases de datos científicas electrónicas en inglés, incluyendo Medline PubMed, de publicaciones entre enero de 1990 y agosto del 2020. Los criterios de elegibilidad fueron estudios que incluyeran a pacientes adultos con NL, quienes tuvieran al menos una biopsia renal de seguimiento, con información longitudinal apropiada. Se excluyeron informes de casos, estudios con información incompleta o con pacientes duplicados. Basándose en los criterios de inclusión y exclusión, se identificaron 73 publicaciones. En la presente revisión se analizaron un total de 1.167 biopsias repetidas en pacientes con NL en 15 estudios. Las principales indicaciones para la biopsia repetida fueron: recidiva en 44-78% de los casos, y falta de respuesta en 13-51%. Adicionalmente, varias biopsias repetidas se hicieron conforme al protocolo, luego de la terapia de inducción y de mantenimiento. Con respecto a los cambios de clase histopatológica, hubo una mayor frecuencia de cambios de lesiones no proliferativas a lesiones proliferativas. Solamente dos estudios ofrecen una definición de respuesta histológica. Con frecuencia hubo cambios en el abordaje terapéutico después de realizar la biopsia repetida. Las biopsias renales repetidas son útiles en pacientes con exacerbación/recidiva y en pacientes con falta de respuesta a tratamiento. La transformación histológica fue un hallazgo frecuente; las respuestas histológicas y clínicas son discordantes. Una biopsia repetida puede ser de valor pronóstico para la toma de decisiones terapéuticas.

Factores de riesgo para mortalidad en pacientes con infección por Clostridium difficile / Risk factors for mortality in patients with Clostridium difficile infection

Resumen Introducción: La infección por Clostridium difficile (ICD) es causa de diarrea hospitalaria potencialmente letal. Objetivo: Identificar los factores de riesgo para mortalidad en pacientes hospitalizados con ICD. Método: Estudio transversal y retrospectivo. Se analizaron factores de riesgo: edad, comorbilidades, estado nutricional, antecedente y uso de antibióticos, de inhibidores de bomba de protones, esteroides, inmunosupresores, quimioterapia y desarrollo de lesión renal aguda (LRA). Resultados: Fueron evaluados 68 casos (incidencia de 25.7/10 000 egresos hospitalarios). La edad fue de 51.4 ± 19.37 años y la mortalidad de 22.2 %. La desnutrición moderada a severa mostró RM = 20.15, IC 95 % = 1.13-35, p = 0.004; el uso de más de dos antibióticos, RM = 1.61, IC 95 % = 0.39-6.65, p = 0.01; la LRA determinada por elevación de los niveles de creatinina, RM = 1.34, IC 95 % = 0.09-2.21, p = 0.02; la hipotensión con uso de vasopresores, RM = 1.28, IC 95 % = 0.30-1.23, p = 0.001; y el desarrollo de falla orgánica múltiple (FOM), RM = 1.13, IC 95 % = 0.31-4.92, p = 0.002. Conclusiones: La desnutrición moderada a severa, el uso de más de dos antibióticos, la LRA, la hipotensión con uso de vasopresores y la FOM se asocian con incremento en la mortalidad en pacientes con ICD.

Abstract Introduction: Clostridium difficile infection (CDI) causes potentially lethal diarrhea. Objective: To identify the risk factors for mortality in hospitalized patients with CDI. Method: Cross-sectional, retrospective study. The analyzed risk factors were age, comorbidities, nutritional status, past and current use of antibiotics, proton pump inhibitors, steroids, immunosuppressive therapy and chemotherapy, as well as development of acute kidney injury (AKI). Results: Sixty-eight cases were assessed. Mean age was 51.4 ± 19.37 years. Mortality was 22.2 %. Moderate to severe undernutrition (Odds ratio [OR] = 20.15; 95% confidence interval [CI] = 1.13-35; p = 0.004), use of more than 2 antibiotics (OR = 1.61; 95% CI = 0.39-6.65; p = 0.01), AKI as determined by creatinine levels (OR = 1.34; 95% CI = 0.09-2.21; p = 0.02), hypotension with vasopressor use (OR = 1.28; 95% CI = 0.30-1.23; p = 0.001) and multiple organ failure (OR = 1.13; 95% CI = 0.31-4.92; p = 0.002) were associated with mortality. Conclusions: CDI represents an important problem in hospitalized patients and confers them an additional morbidity and mortality risk.