ABSTRACT
AIM: To assess risk factors of retroperitoneal and lower extremity musculoskeletal bleed in acquired haemophilia (AHA) and perform an objective assessment of disability and influence on survival. METHODS: We included 49 patients with AHA from November 2017 to May 2023. The occurrence of any retroperitoneal or/and lower extremities bleeding manifestation was investigated. On clinical follow-up, we search for compressive femoral neuropathy and quadriceps amyotrophy. The lower extremity functional scale (LEFS) was carried out one year after the last bleeding event in all AHA patients. RESULTS: A 61.2% of patients in our AHA cohort presented with any retroperitoneal and/or lower extremities musculoskeletal manifestation. Those patients had higher percentage of major bleeding EACH2/ISTH criteria (90% vs. 57%, p = .01), needs of blood transfusions (86% vs. 57% of patients, p = .03), and haemostatic by-pass products (90% vs. 63%, p = .02). Hypertension (HR 2.6, 95% CI 1.1-5.9, p = .02), presence of autoimmune disease (HR 13, 95% CI 1.7-99, p = .01), and inhibitor level > 20 BU (HR 2.6 95% CI 1.0-6.8, p = .04) significantly predicted retroperitoneal/lower extremities clinical manifestations. Most frequent sequelae were quad atrophy (30.6%) and femoral nerve palsy (20.4%). Quad atrophy and LEFS scores under 50 were associated with increased mortality (HR 3, 95% CI 1.1-8.6 and HR 12, 95% CI 3.3-45, respectively). CONCLUSION: AHA with retroperitoneal/lower extremities bleeding involvement is of greater severity and shows high disability and worst survival outcomes. Quadriceps atrophy and LEFS scale scoring under 50 predicted mortality in our AHA patients.
ABSTRACT
BACKGROUND: Long-term anticoagulant therapy is generally recommended for thrombotic antiphospholipid syndrome (TAPS) patients, however it may be withdrawn or not introduced in routine practice. OBJECTIVES: To prospectively evaluate the risk of thrombosis recurrence and major bleeding in non-anticoagulated TAPS patients, compared to anticoagulated TAPS, and secondly, to identify different features between those two groups. PATIENTS/METHODS: Using an international registry, we identified non-anticoagulated TAPS patients at baseline, and matched them with anticoagulated TAPS patients based on gender, age, type of previous thrombosis, and associated autoimmune disease. Thrombosis recurrence and major bleeding were prospectively analyzed using Kaplan-Meier method and compared using a marginal Cox's regression model. RESULTS: As of June 2022, 94 (14 %) of the 662 TAPS patients were not anticoagulated; and 93 of them were matched with 181 anticoagulated TAPS patients (median follow-up 5 years [interquartile range 3 to 8]). The 5-year thrombosis recurrence and major bleeding rates were 12 % versus 10 %, and 6 % versus 7 %, respectively (hazard ratio [HR] 1.38, 95 % confidence interval [CI] 0.53 to 3.56, p = 0.50 and HR 0.53; 95 % CI 0.15 to 1.86; p = 0.32, respectively). Non-anticoagulated patients were more likely to receive antiplatelet therapy (p < 0.001), and less likely to have more than one previous thrombosis (p < 0.001) and lupus anticoagulant positivity (p = 0.01). CONCLUSION: Fourteen percent of the TAPS patients were not anticoagulated at recruitment. Their recurrent thrombosis risk did not differ compared to matched anticoagulated TAPS patients, supporting the pressing need for risk-stratified secondary thrombosis prevention trials in APS investigating strategies other than anticoagulation.
Subject(s)
Antiphospholipid Syndrome , Thrombosis , Humans , Anticoagulants/therapeutic use , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/drug therapy , Hemorrhage/etiology , Prospective Studies , Recurrence , Registries , Thrombosis/complications , Clinical Trials as Topic , Male , FemaleABSTRACT
Acquired hemophilia A (AHA) is a rare bleeding disorder caused by the presence of autoantibodies against factor VIII (FVIII). As with other autoimmune diseases, its etiology is complex and its genetic basis is unknown. The aim of this study was to identify the immunogenetic background that predisposes individuals to AHA. HLA and KIR gene clusters, as well as KLRK1, were sequenced using next-generation sequencing in 49 AHA patients. Associations between candidate genes involved in innate and adaptive immune responses and AHA were addressed by comparing the alleles, genotypes, haplotypes, and gene frequencies in the AHA cohort with those in the donors' samples or Spanish population cohort. Two genes of the HLA cluster, as well as rs1049174 in KLRK1, which tags the natural killer (NK) cytotoxic activity haplotype, were found to be linked to AHA. Specifically, A*03:01 (p = 0.024; odds ratio (OR) = 0.26[0.06-0.85]) and DRB1*13:03 (p = 6.8 × 103, OR = 7.56[1.64-51.40]), as well as rs1049174 (p = 0.012), were significantly associated with AHA. In addition, two AHA patients were found to carry one copy each of the low-frequency allele DQB1*03:09 (nallele = 2, 2.04%), which was completely absent in the donors. To the best of our knowledge, this is the first time that the involvement of these specific alleles in the predisposition to AHA has been proposed. Further molecular and functional studies will be needed to unravel their specific contributions. We believe our findings expand the current knowledge on the genetic factors involved in susceptibility to AHA, which will contribute to improving the diagnosis and prognosis of AHA patients.
Subject(s)
Hemophilia A , Humans , Hemophilia A/genetics , Genotype , Haplotypes/genetics , Alleles , Gene Frequency , High-Throughput Nucleotide Sequencing , Immune System , Genetic Predisposition to DiseaseABSTRACT
Our report shows a case of primary light-chain amyloidosis in a young patient that reflects the potential severity of bleeding diathesis associated with this plasma cell dyscrasia and the difficulty of diagnosis when only hemorrhagic manifestations are present at the onset of disease. The patient presented with recurrent and severe muscular bleeding secondary to associated acquired von Willebrand disease and fibrinolysis dysfunction. Treatment with bortezomib-cyclophosphamide and sequential hematopoietic stem cell transplantation solved coagulation alterations. On the basis of our case, we review previous reports and discuss the potential mechanism of dysfunction of coagulation in light-chain amyloidosis.
Subject(s)
Amyloidosis , Hemorrhagic Disorders , von Willebrand Diseases , Humans , Fibrinolysis , Disease Susceptibility , Amyloidosis/complications , Hemorrhage/etiologyABSTRACT
OBJECTIVES: To investigate the impact of thrombocytopenia on survival in patients with APS. METHODS: Thrombocytopenia and other predictors of outcome were retrospectively evaluated in an aPL-positive and APS cohort with 38-year follow-up (1980-2018). Thrombocytopenia was defined as <150 × 109 platelets/l. Hazard ratios (HR) of mortality were calculated using Cox-regression models. RESULTS: Among 114 patients, 64% had primary APS, 25% secondary APS and 10% asymptomatic aPL. Mean follow-up was 19 (range 5-38) years. ANA [hazard ratio (HR) 1.8, 95% CI 0.8, 3.6, P = 0.10], arterial thrombotic events (HR 7.0, 95% CI 1.4, 3.5, P = 0.016), myocardial infarction (HR 8.3, 95% CI 1.1, 59, P = 0.03), intracardiac thrombosis (HR 17, 95% CI 1, 279, P = 0.04) and thrombocytopenia (HR 2.9, 95% CI 1.4, 6.1, P = 0.004) were risk factors for all-cause mortality, but in multivariate analysis only thrombocytopenia (HR 2.7, 95% CI 1.3, 6.0, P = 0.01) remained significant. Persistent (HR 4.4, 95% CI 2.1, 9.2, P = 0.001) and low-moderate thrombocytopenia (HR 2.8, 95% CI 1.2, 6.4, P = 0.01) were associated with a significant increase in mortality compared with acute (HR 1.6, 95% CI 0.5, 5.3, P = 0.40) and severe (HR 2.1, 95% CI 0.5, 9.2, P = 0.30) forms. APS patients with vs without thrombocytopenia were more frequently male (58 vs 24%, P = 0.001) with arterial thrombosis (55 vs 32%, P = 0.04), LA positivity (100 vs 87%, P = 0.04), type I aPL profile (89% vs 71%, P = 0.05) and anticoagulant treatment (89 vs 63%, P = 0.01). Thrombosis caused 13% of deaths in thrombocytopenic patients and 1% in those without (P = 0.01). CONCLUSION: Thrombocytopenia is an aPL-related manifestation that identifies patients with severe disease phenotype and high thrombotic risk. Persistent low-moderate thrombocytopenia is associated with a reduced long-term survival.
Subject(s)
Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/mortality , Thrombocytopenia/complications , Thrombocytopenia/mortality , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
: Acquired von Willebrand syndrome (AVWS) is a rare hemorrhagic condition that poses both a diagnostic and a therapeutic challenge. Here we report a singular case of AVWS with two associated conditions, small lymphocytic lymphoma (SLL) and Sjögren's syndrome. The patient presented with recurrent and severe digestive bleeding that forced us to raise a curative attempt of AVWS. A first immunosuppressive therapy with immunoglobulins was unsuccessful and it was later decided to treat lymphoproliferative entity with bendamustine and rituximab effectively achieving SLL and AVWS remission. On the basis of our case and through literature review, we discuss potential strategies to achieve AVWS remission when it appears in the setting of several causative associated conditions.
Subject(s)
Leukemia, Lymphocytic, Chronic, B-Cell/complications , Sjogren's Syndrome/complications , von Willebrand Diseases/complications , Aged , Antineoplastic Agents, Alkylating/therapeutic use , Antineoplastic Agents, Immunological/therapeutic use , Bendamustine Hydrochloride/therapeutic use , Female , Hemorrhage/etiology , Hemorrhage/therapy , Humans , Immunoglobulins/therapeutic use , Leukemia, Lymphocytic, Chronic, B-Cell/therapy , Rituximab/therapeutic use , Sjogren's Syndrome/therapy , von Willebrand Diseases/therapySubject(s)
Contracture/etiology , Eosinophilia/complications , Fasciitis/complications , Fingers , Adult , Contracture/diagnostic imaging , Eosinophilia/diagnostic imaging , Fasciitis/diagnostic imaging , Female , Fingers/diagnostic imaging , Humans , Magnetic Resonance Imaging , Tendons/diagnostic imagingABSTRACT
Introduction/objectives autoantibodies to types I and IV collagen have been described in rheumatic fever and infective endocarditis. We tried to elucidate if an autoimmune response against collagens I and IV exists, associated with heart valve disease in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). A cohort of 172 patients with SLE (n = 79), primary APS (PAPS, n = 83), and secondary APS (n = 10) were assessed for valvulopathy by transthoracic echocardiograms. Autoantibodies to types I and IV collagen were assessed in patients and 50 controls, setting autoantibody positivity at two standard deviations above the mean antibody level of controls. Positive anticollagen IV antibody rate was significantly higher in SLE patients (17.7%) in respect to the rest of groups (PAPS 2.4%, controls 2%; P = 0.001). Percentage of positive autoantibodies to collagen I was similar in SLE and APS cohort of patients with and without valvular disease (48.4 vs 51.6%, respectively; P = 0.45). Percentage of positive autoantibodies to collagen IV was increased but not significantly in SLE and APS cohort of patients with respect to those without valvular disease (62.5 vs 37.5%, respectively; P = 0.08). Mean (standard deviation) levels of positive anticollagen I and IV antibodies did not differ between patients with and without valvular disease (85.6 ± 55 vs 81 ± 85 U/ml, respectively; P = 0.86 for anticollagen I) (0.05 ± 0.02 vs 0.12 ± 0.16 U/ml, respectively; P = 0.34 for anticollagen IV). Our data indicate a lack of association of autoantibodies to types I and IV collagen with heart valve disease in SLE and APS.
Subject(s)
Antiphospholipid Syndrome/complications , Collagen Type IV/immunology , Collagen Type I/immunology , Heart Valve Diseases/immunology , Lupus Erythematosus, Systemic/complications , Adult , Aged , Antiphospholipid Syndrome/immunology , Autoantibodies/blood , Case-Control Studies , Female , Humans , Lupus Erythematosus, Systemic/immunology , Male , Middle AgedABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Neutropenia/complications , Neutropenia/diagnosis , Neutropenia/therapy , IgG Deficiency/complications , IgG Deficiency/diagnosis , IgG Deficiency/immunology , IgG Deficiency/physiopathology , IgG Deficiency/therapy , Autoimmunity/immunology , Autoimmunity/physiology , Colonoscopy/methods , Colonoscopy/trendsABSTRACT
IgG4-related disease (IgG4-RD) is a rare entity consisting of inflammation and fibrosis that has been described in multiple organs. Concrete diagnostic criteria have been established recently and there is a lack of large series of patients.To describe the clinical presentation, histopathological characteristics, treatment and evolution of a series of IgG4-RD Spanish patients.A retrospective multicenter study was performed. Twelve hospitals across Spain included patients meeting the current 2012 consensus criteria on IgG4-RD diagnosis.Fifty-five patients were included in the study, 38 of whom (69.1%) were male. Median age at diagnosis was 53 years. Thirty (54.5%) patients were included in the Histologically Highly Suggestive IgG4-RD group and 25 (45.5%) in the probable IgG4-RD group. Twenty-six (47.3%) patients had more than 1 organ affected at presentation. The most frequently affected organs were: retroperitoneum, orbital pseudotumor, pancreas, salivary and lachrymal glands, and maxillary sinuses.Corticosteroids were the mainstay of treatment (46 patients, 83.6%). Eighteen patients (32.7%) required additional immunosuppressive agents. Twenty-four (43.6%) patients achieved a complete response and 26 (43.7%) presented a partial response (<50% of regression) after 22 months of follow-up. No deaths were attributed directly to IgG4-RD and malignancy was infrequent.This is the largest IgG4-RD series reported in Europe. Patients were middle-aged males, with histologically probable IgG4-RD. The systemic form of the disease was frequent, involving mainly sites of the head and abdomen. Corticosteroids were an effective first line treatment, sometimes combined with immunosuppressive agents. Neither fatalities nor malignancies were attributed to IgG4-RD.
Subject(s)
Autoimmune Diseases/diagnosis , Immunoglobulin G , Autoimmune Diseases/drug therapy , Autoimmune Diseases/epidemiology , Humans , Immunosuppressive Agents/therapeutic use , Paraproteinemias/drug therapy , Paraproteinemias/epidemiology , Paraproteinemias/pathology , Registries , Spain/epidemiologySubject(s)
Autoimmune Diseases/immunology , IgG Deficiency/complications , Immunoglobulin G/blood , Neutropenia/immunology , Autoimmune Diseases/diagnosis , Biomarkers/blood , Chronic Disease , Humans , IgG Deficiency/blood , IgG Deficiency/diagnosis , IgG Deficiency/immunology , Male , Middle Aged , Neutropenia/diagnosisABSTRACT
AIM: Non-valvular cardiac disease in the antiphospholipid syndrome (APS) has been scanty studied. We wanted to assess the prevalence and evolution of left myocardial disease, pulmonary hypertension and intracardiac thrombi in a cohort of APS patients. METHOD: A total of 53 patients with APS, either primary (n = 34, 64%) or associated to lupus (n = 19, 36%) and 20 controls were included. Initial transthoracic echocardiography assessment was performed in patients at diagnosis, with echocardiography controls performed along mean follow-up of 12 years. Prevalence of myocardial disease in APS cohort was assessed taking into account primary risk factors (hemodynamically significant valvular disease, systemic hypertension, diabetes, alcoholism, myocardial infarction or myocarditis), the same as for pulmonary hypertension (severe left ventricular dysfunction or chronic lung disease). RESULTS: Left myocardial disease had a prevalence of 3.8% (2/53 patients), not different from controls (P = 0.12). Both patients had diastolic dysfunction grade I that maintained stability throughout echocardiographic follow-up period. Pulmonary hypertension had a prevalence of 11.3% (6/53 patients), not different from controls (P = 0.12); all cases were related to pulmonary embolism. Patients diagnosed with pulmonary hypertension in baseline maintained stable pressures throughout follow-up in the absence of new thrombosis. Intracardiac thrombi had a prevalence of 1.8% (1/53 patients), not different from controls (P = 0.4), without changes along echocardiographic follow-up. CONCLUSION: Pulmonary hypertension is the most prevalent non-valvular cardiac manifestation in APS, with an evolution associated with thromboembolic disease, while left myocardial disease and intracardiac thrombi would be rare manifestations in APS.
Subject(s)
Antiphospholipid Syndrome/epidemiology , Echocardiography, Doppler , Heart Diseases/diagnostic imaging , Heart Diseases/epidemiology , Adult , Aged , Antiphospholipid Syndrome/blood , Antiphospholipid Syndrome/diagnosis , Case-Control Studies , Echocardiography, Doppler, Pulsed , Female , Follow-Up Studies , Heart Diseases/physiopathology , Humans , Hypertension, Pulmonary/diagnostic imaging , Hypertension, Pulmonary/epidemiology , Hypertrophy, Left Ventricular/diagnostic imaging , Hypertrophy, Left Ventricular/epidemiology , Male , Middle Aged , Predictive Value of Tests , Prevalence , Risk Factors , Spain/epidemiology , Thrombosis/diagnostic imaging , Thrombosis/epidemiology , Time Factors , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/epidemiology , Young AdultABSTRACT
Background: Although home intravenous antimicrobial infusion therapy (HIVAIT) has proved its safety and efficacy in a great number of common infections, there are few published studies about its role in the treatment of infections caused by multi-drug resistant microorganisms. Our objectives are to study clinical and epidemiological characteristics of patients with multi-drug resistant microorganism infections treated with HIVAIT, and its usefulness in this type of infections. Methods: We analyzed all patients diagnosed of infections requiring HIVAIT and admitted to our Hospital at Home Unit (HHU) from March 2007 to February 2010. Subjects were divided into two groups: patients with multi-drug resistant microorganism infections as a study group, and the remaining patients as a control group. Results: A total of 487 patients were included, 82 in the study group. Comorbidity and physical dependence were higher in this group than in the control group (p=0.000 and p=0.002 respectively). The majority of patients were discharged because of a satisfactory clinical evolution. However, 17 (20.7%) patients in the study group required readmission to hospital during treatment and another 22 (26.8%) were re-admitted to hospital 3 months after discharge from HHU. There were significant differences between the results from the control group in clinical readmissions. Conclusions: Patients with multi-drug resistant microorganism infections and HIVAIT have higher comorbidity, physical dependence, and frequency of hospital readmissions. However, HIVAIT is useful in this kind of infections if the patients are appropriately selected (AU)
Fundamento: La antibioticoterapia intravenosa domiciliaria (AID) ha demostrado su seguridad y eficacia en un gran número de infecciones comunes. Sin embargo, existen pocos trabajos publicados sobre su papel en el tratamiento de las infecciones causadas por bacterias multirresistentes. Los objetivos de este trabajo son definir las características clínicas y epidemiológicas de los pacientes con infecciones causadas por microorganismos multirresistentes tratados con AID, así como estudiar su utilidad en este tipo de infecciones. Material y método: Analizamos todos los pacientes que por requerir AID ingresaron en nuestra Unidad de Hospitalización a Domicilio (UHD) desde marzo de 2007 hasta febrero de 2010. Los pacientes se dividieron en dos grupos: los pacientes con infecciones causadas por microorganismos multirresistentes fueron incluidos en el grupo a estudio, mientras que el resto de pacientes formó el grupo control. Resultados: Se incluyeron 487 pacientes, de los cuales 82 formaron el grupo a estudio. La comorbilidad y la dependencia física en este grupo fueron mayores que en el grupo control (p=0,000 y p=0,002 respectivamente). La mayoría de los pacientes tuvieron una evolución clínica satisfactoria. Sin embargo, 17 (20,7%) pacientes del grupo a estudio reingresaron durante el tratamiento y otros 22 (26,8%) reingresaron 3 meses después del alta definitiva de nuestra unidad, siendo las diferencias entre ambos grupos estadísticamente significativas. Conclusiones: Los pacientes con infecciones causadas por microorganismos multirresistentes y AID tienen mayor comorbilidad, dependencia física y frecuencia de reingresos hospitalarios. Sin embargo, la AID es útil en el tratamiento de este tipo de infecciones en pacientes adecuadamente seleccionados (AU)
Subject(s)
Humans , Anti-Bacterial Agents/administration & dosage , Drug Resistance, Multiple, Bacterial , Infections/drug therapy , Injections, Intravenous , Comorbidity , Hospitalization/statistics & numerical dataABSTRACT
BACKGROUND: Although home intravenous antimicrobial infusion therapy (HIVAIT) has proved its safety and efficacy in a great number of common infections, there are few published studies about its role in the treatment of infections caused by multi-drug resistant microorganisms. Our objectives are to study clinical and epidemiological characteristics of patients with multi-drug resistant microorganism infections treated with HIVAIT, and its usefulness in this type of infections. METHODS: We analyzed all patients diagnosed of infections requiring HIVAIT and admitted to our Hospital at Home Unit (HHU) from March 2007 to February 2010. Subjects were divided into two groups: patients with multi-drug resistant microorganism infections as a study group, and the remaining patients as a control group. RESULTS: A total of 487 patients were included, 82 in the study group. Comorbidity and physical dependence were higher in this group than in the control group (p=0.000 and p=0.002 respectively). The majority of patients were discharged because of a satisfactory clinical evolution. However, 17 (20.7%) patients in the study group required readmission to hospital during treatment and another 22 (26.8%) were re-admitted to hospital 3 months after discharge from HHU. There were significant differences between the results from the control group in clinical readmissions. CONCLUSIONS: Patients with multi-drug resistant microorganism infections and HIVAIT have higher comorbidity, physical dependence, and frequency of hospital readmissions. However, HIVAIT is useful in this kind of infections if the patients are appropriately selected.
Subject(s)
Anti-Infective Agents/administration & dosage , Bacterial Infections/drug therapy , Home Care Services , Drug Resistance, Multiple, Bacterial , Female , Humans , Infusions, Intravenous , Male , Middle AgedSubject(s)
Anti-Bacterial Agents/therapeutic use , Empyema, Pleural/drug therapy , Home Infusion Therapy , Infusions, Intravenous , Lung Abscess/drug therapy , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Combined Modality Therapy , Comorbidity , Drainage , Empyema, Pleural/surgery , Female , Humans , Lung Abscess/surgery , Male , Middle Aged , Prospective Studies , Recurrence , Treatment OutcomeABSTRACT
Fundamento y objetivo: Existen pocos datos en la bibliografía sobre el tratamiento antibiótico intravenoso de abscesos hepáticos en unidades de hospitalización a domicilio (UHD). Nuestros objetivos fueron analizar las características de los pacientes con abscesos hepáticos ingresados en nuestra UHD, la eficacia y la seguridad del tratamiento antibiótico intravenoso y los factores de riesgo de reingreso hospitalario. Pacientes y método: Se incluyeron en el estudio todos los pacientes ingresados en nuestra UHD para tratamiento antibiótico intravenoso por absceso hepático desde marzo de 2006 hasta junio de 2009. Resultados: Se incluyeron 30 pacientes en el estudio. Cinco pacientes (16,6%) presentaron flebitis durante el tratamiento y no se observó ningún efecto secundario mayor. La reducción media (desviación estándar) del tamaño durante el ingreso en la UHD fue del 49,3% (36,6). El número de reingresos totales fue de 9 (30%), 6 (20%) durante el período de ingreso en la UHD y 3 (10%) el año posterior. Cuatro pacientes (13,3%) fallecieron durante el seguimiento. Los pacientes que reingresaron tuvieron un tamaño medio del absceso al alta de la UHD mayor respecto de los que no lo tuvieron (4,5 frente a 1,5cm; p=0,001), así como un menor porcentaje de disminución de su tamaño durante el ingreso en la UHD (el 19 frente al 64%; p=0,001). Las mujeres reingresaban más que los varones (el 77,8 frente al 28,6%; p=0,02), pero aquéllas presentaron una menor puntuación de Barthel (75 frente a 92; p=0,01). Conclusiones: El tratamiento antibiótico intravenoso domiciliario en el tratamiento del absceso hepático parece una alternativa segura y eficaz en la mayoría de los pacientes. El tamaño y reducción del absceso al alta, el sexo y el grado de dependencia del paciente constituyeron las principales variables de reingreso (AU)
Background and objective: Few data exists in the literature about intravenous antibiotic treatment of hepatic abscess in hospital based care units. Our objectives were to analyze the efficacy and safety of intravenous antibiotic therapy and the predictors of hospital readmission. Patients and methods: The study included all the patients admitted in our home care unit for intravenous antibiotic treatment of hepatic abscess from March 2006 to June 2009. Results: We included 30 patients in the study. Five patients (16,6%) had phlebitis during treatment and none presented a major secondary effect. Mean size reduction of abscess during admission in our home care unit was 49,3% (36,6%). Nine (30%) patients were readmitted, 6 (20%) during admission at home and 3 (10%) along the year after. Four (13.3%) patients died along follow-up. Patients readmitted had a higher mean size of abscess at discharge from our home care unit as compared to the non readmitted ones (4,5 vs 1,5cms P=0,001), besides a minor percentage of reduction of size (19% vs 64% P=0,001). Female patients were readmitted more frequently than male ones (77,8% vs 28,6% P=0,02), but they had minor scores of Barthel scale (75 vs. 92 P=0,01). Conclusions: Home intravenous antibiotic treatment of hepatic abscess seems to be a safe and effective alternative in most patients. The size and reduction of abscess at patient discharge, the female gender and dependence degree constituted the principal predictors of readmission (AU)
Subject(s)
Humans , Male , Female , Aged , Liver Abscess/drug therapy , Anti-Bacterial Agents/administration & dosage , Injections, Intravenous , Anti-Bacterial Agents/therapeutic use , Patient Readmission/statistics & numerical data , Prospective Studies , Home Care Services , Treatment Outcome , PrognosisABSTRACT
BACKGROUND AND OBJECTIVE: Few data exists in the literature about intravenous antibiotic treatment of hepatic abscess in hospital based care units. Our objectives were to analyze the efficacy and safety of intravenous antibiotic therapy and the predictors of hospital readmission. PATIENTS AND METHODS: The study included all the patients admitted in our home care unit for intravenous antibiotic treatment of hepatic abscess from March 2006 to June 2009. RESULTS: We included 30 patients in the study. Five patients (16,6%) had phlebitis during treatment and none presented a major secondary effect. Mean size reduction of abscess during admission in our home care unit was 49,3% (36,6%). Nine (30%) patients were readmitted, 6 (20%) during admission at home and 3 (10%) along the year after. Four (13.3%) patients died along follow-up. Patients readmitted had a higher mean size of abscess at discharge from our home care unit as compared to the non readmitted ones (4,5 vs 1,5 cms P=0,001), besides a minor percentage of reduction of size (19% vs 64% P=0,001). Female patients were readmitted more frequently than male ones (77,8% vs 28,6% P=0,02), but they had minor scores of Barthel scale (75 vs. 92 P=0,01). CONCLUSIONS: Home intravenous antibiotic treatment of hepatic abscess seems to be a safe and effective alternative in most patients. The size and reduction of abscess at patient discharge, the female gender and dependence degree constituted the principal predictors of readmission.