Age at diagnosis and health-related quality of life are associated with fatigue in systemic lupus erythematosus patients: Data from the Almenara Lupus Cohort.

OBJECTIVE: To define the factors associated with fatigue in Mestizo patients with Systemic Lupus Erythematosus (SLE). METHODS: This is a cross-sectional study of SLE patients from a single center cohort. Visits were performed every six months. For these analyses, the first visit between October 2017 and December 2018 was included. Demographic and clinical characteristics as well as treatment were recorded at every visit. Fatigue was ascertained with the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-FT), Health-Related Quality of Life (HRQoL) with the LupusQoL, disease activity with the Systemic Lupus Erythematosus Disease Activity Index -2 K (SLEDAI-2K), and damage with the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology damage index (SDI). Prednisone use was recorded as current daily dose. Immunosuppressive drugs and antimalarial use were recorded as current, past or never. Univariable and multivariable analyses were performed using linear regression models. For the multivariable analyses, model selection followed a backward elimination procedure. RESULTS: Two hundred and twenty-six patients were evaluated. The mean (SD) age at diagnosis was 35.6 (13.1) years, 211 (93.4%) were female; and disease duration was 11.0 (7.3) years. The mean SLEDAI and SDI were 2.4 (3.5) and 1.3 (1.5), respectively. The mean FACIT-FT was 33.1 (10.8). On the multivariable analysis, age at diagnosis and some domains of HRQoL (physical health, emotional health and fatigue) remained associated. CONCLUSIONS: Age at diagnosis is negatively associated with fatigue whereas HRQoL domains like physical health, emotional health and fatigue are positively associated with fatigue.

Factores asociados a desnutrición en pacientes hospitalizados en el servicio de cirugía de emergencia de un hospital del seguro social peruano / Malnutrition-associated factors in patients hospitalized in an emergency surgical ward in a Peruvian social security hospital

RESUMEN Objetivo : identificar los factores asociados a desnutrición en pacientes hospitalizados en el Servicio de Cirugía de Emergencia del Hospital Nacional Guillermo Almenara Irigoyen. Materiales y métodos : estudio analítico donde se realizó un tamizaje inicial mediante el Nutritional Risk Screening 2002, posteriormente una evaluación nutricional al ingreso y egreso mediante la Valoración global subjetiva en 206 pacientes adultos y adultos mayores. Se analizaron variables clínicas mediante regresión logística y un valor de p<0,05 fue considerado como significativo. Resultados : el 16% de pacientes agravó su estado nutricional durante la hospitalización. Los factores asociados fueron alguna comorbilidad (odds ratio [OR] 2,32; intervalo de confianza [IC]95%:1,07-5,01); neoplasias (OR: 2,83; IC95%:1,21-6,63), enfermedades del sistema nervioso (OR: 5,66; IC95%: 1,24-25,82); ausencia del registro de peso y talla (OR: 4,18; IC95%: 1,29-13,41); cirugía abdominal (OR: 6,67; IC95%: 3,08-14,89); apendicitis aguda disminuía 85%; colecistitis aguda disminuía 91%; reintervención quirúrgica (OR: 13,91; IC95%: 4,82-40,06); consumo regular dieta indicada (OR: 8,78; IC 95%: 3,01-25,63); no consumir dieta indicada (OR: 39,97; IC95%: 11,39-140,23); uso de soporte nutricional disminuía la exposición en un 83%. La desnutrición incrementaba 6 veces el riesgo de mortalidad. El número de días de ayuno, (OR: 1,73; IC95%: 1,31-2,27). La mortalidad fue 8,7%. Conclusiones : existen una serie de factores asociados a la desnutrición durante la hospitalización, por lo que es necesario realizar un tamizaje para la detección temprana de desnutrición al ingreso de los pacientes que serán hospitalizados y posteriormente una evaluación nutricional en aquellos que estén en riesgo.

ABSTRACT Objective : to identify malnutrition-associated factors in patients hospitalized in the emergency surgical ward in Guillermo Almenara-Irigoyen National Hospital. Materials and methods : this is an analytical study in which an initial nutritional evaluation was performed using the 2002 Nutritional Risk Screening. Afterwards, a nutritional assessment was performed on admission and at discharge using a subjective overall assessment in 206 adult and elderly subjects. Clinical variables were analyzed using logistic regression and p<0.05 was considered as significant. Results : sixteen per cent of all patients worsened their nutritional status during hospitalization. Associated factors were some comorbidity (odds ratio [OR] 2.32; 95% confidence interval [CI]: 1.07-5.01); neoplasms (OR: 2.83; 95% CI: 1.21-6.63), nervous system diseases (OR: 5.66; 95% CI: 1.24-25.82); absence of weight and height recording (OR: 4.18; 95% CI: 1.29-13.41); abdominal surgery (OR: 6.67; 95% CI: 3.08-14.89); acute appendicitis decreased 85%; acute cholecystitis decreased 91%; surgical reintervention (OR: 13.91; 95% CI: 4.82-40.06); regular consumption of the indicated diet (OR: 8.78; 95% CI: 3.01-25.63); not consuming the indicated diet (OR: 39.97; 95% CI: 11.39-140.23); use of nutritional support decreased exposure by 83%. Malnutrition increased the risk of mortality 6 times. The number of days of fasting, (OR: 1.73; 95% CI: 1.31-2.27). Mortality was 8.7%. Conclusions : there are some factors associated to malnutrition during hospitalization, so it is necessary to perform screening for early detection of malnutrition when patients are admitted, and also, nutritional assessments of those found to be at risk are necessary..

Correction to: Homocysteine levels are independently associated with damage accrual in systemic lupus erythematosus patients from a Latin-American cohort.

The affiliations of Manuel F. Ugarte-Gil, one of the author of the above article has a discrepancy between the online version of the publisher's internet portal ( Springerlink.com ) and the online pdf version.

Homocysteine levels are independently associated with damage accrual in systemic lupus erythematosus patients from a Latin-American cohort.

OBJECTIVE: To determine the impact of homocysteine levels on damage accrual in systemic lupus erythematosus (SLE) patients. METHODS: This longitudinal study was conducted in consecutive patients seen every 6 months at our Rheumatology Department since 2012. Patients with available homocysteine levels and who had at least one subsequent visit were included. Univariable and multivariable Cox regression models were done to determine if homocysteine levels were predictive of damage accrual as per the SLICC Damage Index (SDI). The multivariable model was adjusted for pertinent variables (age at diagnosis, gender, socioeconomic status, disease duration, disease activity (SLEDAI), Framingham score, antimalarial and immunosuppressive drug use, average daily dose, and exposure time to prednisone (PDN)). RESULTS: One hundred forty-five patients were included; their mean (SD) age at diagnosis was 43.70 (12.09) years, 136 (93.8%) were female, and nearly all were Mestizo. At baseline, disease duration was 7.55 (6.73) years; patients were followed for 3.54 (1.27) years. The SLEDAI was 5.60 (4.34), and the SDI 0.97 (1.35). The average daily PDN dose was 7.30 (5.78) mg/day and the time of PDN exposure was 7.36 (6.73) years. Mean homocysteine levels were 10.07 (3.71) µmol/L. The highest tertile of homocysteine levels predicted new damage accrual in the univariable and multivariable models [HR 1.78 (95% CI, 1.042-3.039); p = 0.035 and HR 2.045 (95% CI, 1.077-3.883); p = 0.029, respectively]. Increased levels (> 15 µmol/L) were found in 12 (8.3%) patients; 75 (51.7%) patients increased ≥ 1 SDI point. CONCLUSION: In SLE patients, homocysteine levels predicted damage accrual independently of other well-known risk factors for such occurrence.