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Garvik OS, Póvoa P, Vinholt PJ, Nielsen SL, Jensen TG, Frederiksen H, Chen M, Dessau RB, Coia JE, Møller JK, Gradel KO. Detection of infections by computerized capture of peaks in longitudinally measured C-reactive protein levels. Biomark Med 2023; 17:635-642. [PMID: 37962480 DOI: 10.2217/bmm-2023-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
We developed four algorithms for the automatic capture of C-reactive protein (CRP) peaks in 296 adult patients with acute myeloid leukemia who had bloodstream infection (BSI) episodes, negative blood cultures (BCs) or possible infections where no BCs were performed. The algorithms detected CRP peaks for 418-446 of the 586 documented BSI episodes (71.3-76.1%) and 2714-3118 of the 4382 negative BCs (61.9-71.2%). The four algorithms captured 382-789 CRP peaks in which there were neither BSI episodes nor negative BCs. We conclude that automatic capture of CRP peaks is a tool for the monitoring of BSI episodes and possibly other infections in patients with acute myeloid leukemia.
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Affiliation(s)
- Olav Sivertsen Garvik
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark and Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216, Ground Floor, Odense C, 5000, Denmark
| | - Pedro Póvoa
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark and Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216, Ground Floor, Odense C, 5000, Denmark
- NOVA Medical School, Comprehensive Health Research Center, New University of Lisbon, Campo Mártires da Pátria 130, Lisbon, 1169-056, Portugal
- Department of Intensive Care, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, Lisbon, 1449-005, Portugal
| | - Pernille Just Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, Entrance 40, Odense C, 5000, Denmark
| | - Stig Lønberg Nielsen
- Department of Infectious Diseases, Odense University Hospital and Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern Denmark, Kløvervænget 4, Odense C, 5000, Denmark
| | - Thøger Gorm Jensen
- Department of Clinical Microbiology, Odense University Hospital and Research Unit of Clinical Microbiology, University of Southern Denmark, JB Winsløws Vej 21, Second Floor, Odense C, 5000, Denmark
| | - Henrik Frederiksen
- Department of Hematology, Odense University Hospital and Research Unit of Hematology, Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, Entrance 112, 12th Floor, Odense C, 5000, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Kresten Philipsens Vej 15, Aabenraa, 6200, Denmark
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Ingemannsvej 46, Slagelse, 4200, Denmark
- Department of Regional Health Research, University of Southern Denmark
| | - John Eugenio Coia
- Department of Clinical Microbiology, Hospital South West Jutland and Department of Regional Health Research, University of Southern Denmark, Finsensgade 35, Esbjerg, 6700, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Hospital Lillebaelt, Beriderbakken 4, Vejle, 7100, Denmark
- Department of Regional Health Research, University of Southern Denmark
| | - Kim Oren Gradel
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark and Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216, Ground Floor, Odense C, 5000, Denmark
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Gradel KO, Larsen TS, Frederiksen H, Vinholt PJ, Iachina M, Póvoa P, Zampieri FG, Nielsen SL, Dessau RB, Møller JK, Jensen TG, Chen M, Coia JE, Jelicic J. Impact of C-reactive protein and albumin levels on short, medium, and long term mortality in patients with diffuse large B-cell lymphoma. Ann Med 2022; 54:713-722. [PMID: 35238275 PMCID: PMC8896183 DOI: 10.1080/07853890.2022.2046287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives and study design: In this population-based study of 602 patients, we amended C-reactive protein (CRP) and plasma albumin (PA) levels around the diagnosis of diffuse large B-cell lymphoma (DLBCL) to the International Prognostic Index (IPI) and assessed 0-90, 91-365, and +365-day survival.Results: The CRP did not contribute to the IPI's prognostic or discriminatory ability, regardless of time period, particularly not in models with PA. In contrast, the PA was an important contributor, especially in the 0-90 day period, but also up to one year after the diagnosis. For day 0-90, the model with the IPI only had an Area Under the Receiver Operating Characteristics (AUROC) of 0.742, whereas the IPI with PA as a continuous variable rendered an AUROC of 0.841. Especially the lower PA quartile (18-32 g/L) contributed to the worse prognosis.Conclusions: The amendment of PA to the IPI may significantly improve the short-term prognostic and discriminative ability.Key messagesThe amendment of the plasma albumin (PA) level to the International Prognostic Index significantly improved the prediction of mortality up to one year after the diagnosis of diffuse large B-cell lymphoma.It was especially the lower quartile of the PA level (18-32 g/L) that contributed to the worse prognosis.
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Affiliation(s)
- Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,OPEN - Odense Patient Data Exploratory Network, Odense University Hospital, Odense C, Denmark
| | - Thomas Stauffer Larsen
- Department of Haematology, Odense University Hospital, and Research Unit of Haematology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Henrik Frederiksen
- Department of Haematology, Odense University Hospital, and Research Unit of Haematology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Pernille Just Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark
| | - Maria Iachina
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Pedro Póvoa
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,The Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Estrada do Forte do Alto do Duque, Lisbon, and NOVA Medical School, CEDOC, New University of Lisbon, Lisbon, Portugal
| | - Fernando Godinho Zampieri
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Research Institute, dHCor-Hospital Do Coração, São Paulo, Brazil
| | - Stig Lønberg Nielsen
- Department of Infectious Diseases, Odense University Hospital, and Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Thøger Gorm Jensen
- Department of Clinical Microbiology, Odense University Hospital, and Department of Clinical Research, Research Unit of Clinical Microbiology, University of Southern Denmark, Odense C, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sønderborg, Denmark
| | - John Eugenio Coia
- Department of Clinical Microbiology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Jelena Jelicic
- Department of Haematology, Odense University Hospital, and Research Unit of Haematology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Holm MKA, Jansåker F, Gradel KO, Nielsen RT, Østergaard Andersen C, Jarløv JO, Schønheyder HC, Dahl Knudsen J. Decrease in All-Cause 30-Day Mortality after Bacteraemia over a 15-Year Period: A Population-Based Cohort Study in Denmark in 2000-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5982. [PMID: 34199587 PMCID: PMC8199663 DOI: 10.3390/ijerph18115982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Bacteraemia is a frequent infectious condition that strongly affects morbidity and mortality. The incidence is increasing worldwide. This study explores all-cause 30-day mortality after bacteraemia in two out of Denmark's five healthcare regions with approximately 2.4 million inhabitants. METHODS Clinically significant bacteraemia episodes (n = 55,257) were identified from a geographically well-defined background population between 2000 and 2014, drawing on population-based data regarding bacterial species and vital status. All-cause 30-day mortality was assessed in relation to bacteraemia episodes, number of patients with analysed blood cultures and the background population. RESULTS We observed a decreasing trend of all-cause 30-day mortality between 2000 and 2014, both in relation to the number of bacteraemia episodes and the background population. Mortality decreased from 22.7% of the bacteraemia episodes in 2000 to 17.4% in 2014 (annual IRR [95% CI]: 0.983 [0.979-0.987]). In relation to the background population, there were 41 deaths per 100,000 inhabitants in 2000, decreasing to 39 in 2014 (annual IRR [95% CI]: 0.988 [0.982-0.993]). Numbers of inhabitants, bacteraemia episodes, and analysed persons having BCs increased during the period. CONCLUSIONS All-cause 30-day mortality in patients with bacteraemia decreased significantly over a 15-year period.
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Affiliation(s)
- Mona Katrine Alberthe Holm
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark; (R.T.N.); (C.Ø.A.)
| | - Filip Jansåker
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen N, Denmark; (F.J.); (J.D.K.)
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, 214 28 Lund, Sweden
| | - Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, 5000 Odense, Denmark;
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Rikke Thoft Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark; (R.T.N.); (C.Ø.A.)
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, 2300 Copenhagen S, Denmark
| | - Christian Østergaard Andersen
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark; (R.T.N.); (C.Ø.A.)
| | - Jens Otto Jarløv
- Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark;
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark;
- Department of Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen N, Denmark; (F.J.); (J.D.K.)
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Gradel KO, Póvoa P, Garvik OS, Vinholt PJ, Nielsen SL, Jensen TG, Chen M, Dessau RB, Møller JK, Coia JE, Ljungdalh PS, Lassen AT, Frederiksen H. Longitudinal trajectory patterns of plasma albumin and C-reactive protein levels around diagnosis, relapse, bacteraemia, and death of acute myeloid leukaemia patients. BMC Cancer 2020; 20:249. [PMID: 32209087 PMCID: PMC7092519 DOI: 10.1186/s12885-020-06754-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/13/2020] [Indexed: 12/03/2022] Open
Abstract
Background No study has evaluated C-reactive protein (CRP) and plasma albumin (PA) levels longitudinally in patients with acute myeloid leukaemia (AML). Methods We studied defined events in 818 adult patients with AML in relation to 60,209 CRP and PA measures. We investigated correlations between CRP and PA levels and daily CRP and PA levels in relation to AML diagnosis, AML relapse, or bacteraemia (all ±30 days), and death (─30–0 days). Results On the AML diagnosis date (D0), CRP levels increased with higher WHO performance score (PS), e.g. patients with PS 3/4 had 68.1 mg/L higher CRP compared to patients with PS 0, adjusted for relevant covariates. On D0, the PA level declined with increasing PS, e.g. PS 3/4 had 7.54 g/L lower adjusted PA compared to PS 0. CRP and PA levels were inversely correlated for the PA interval 25–55 g/L (R = − 0.51, p < 10–5), but not for ≤24 g/L (R = 0.01, p = 0.57). CRP increases and PA decreases were seen prior to bacteraemia and death, whereas no changes occurred up to AML diagnosis or relapse. CRP increases and PA decreases were also found frequently in individuals, unrelated to a pre-specified event. Conclusions PA decrease is an important biomarker for imminent bacteraemia in adult patients with AML.
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Affiliation(s)
- Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Kløvervænget 30, Entrance 216, ground floor, 5000, Odense C, Denmark. .,OPEN - Odense Patient Data Exploratory Network, Odense University Hospital, J.B. Winsløws Vej 9 A, 5000, Odense C, Denmark.
| | - Pedro Póvoa
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Kløvervænget 30, Entrance 216, ground floor, 5000, Odense C, Denmark.,The Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Estrada do Forte do Alto do Duque, 1449-005 Lisbon, and NOVA Medical School, CEDOC, New University of Lisbon, Campo dos Mártires da Pátria, 1169-056, Lisbon, Portugal
| | - Olav Sivertsen Garvik
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Kløvervænget 30, Entrance 216, ground floor, 5000, Odense C, Denmark
| | - Pernille Just Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, entrance 40, 5000, Odense C, Denmark
| | - Stig Lønberg Nielsen
- Department of Infectious Diseases, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Thøger Gorm Jensen
- Department of Clinical Microbiology, Odense University Hospital, J.B.Winsløws Vej 21, 2nd floor, 5000, Odense C, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, 6400, Sønderborg, Denmark
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Ingemannsvej 46, 4200, Slagelse, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Hospital Lillebaelt, Beriderbakken 4, 7100, Vejle, Denmark
| | - John Eugenio Coia
- Department of Clinical Microbiology, Hospital of South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark
| | | | - Annmarie Touborg Lassen
- Department of Emergency Medicine, Odense University Hospital, Kløvervænget 25, entrance 63-65, 5000, Odense C, Denmark
| | - Henrik Frederiksen
- Department of Haematology, Odense University Hospital, and Research Unit of Haematology, Department of Clinical Research, University of Southern Denmark, Kløvervænget 6, entrance 93, 12th floor, 5000, Odense C, Denmark
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Stephens JR, Hall M, Markham JL, Zwemer EK, Cotter J, Shah SS, Brittan MS, Gay JC. Variation in Proportion of Blood Cultures Obtained for Children With Skin and Soft Tissue Infections. Hosp Pediatr 2020; 10:331-337. [PMID: 32184289 DOI: 10.1542/hpeds.2019-0317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To identify variation in the proportion of blood cultures obtained for pediatric skin and soft tissue infections (SSTIs) among children's hospitals. METHODS We conducted a retrospective cohort study using the Pediatric Health Information System database, which we queried for emergency department (ED)-only and hospital encounters between 2012 and 2017 for children aged 2 months to 18 years with diagnosis codes for SSTI. The primary outcome was proportion of SSTI encounters during which blood cultures were obtained. Encounters with and without blood cultures were compared for length of stay, costs, and 30-day ED revisit and readmission rates, adjusted for patient factors and hospital clustering. We also identified encounters with bacteremia using billing codes for septicemia and bacteremia. RESULTS We identified 239 954 ED-only and 49 291 hospital SSTI encounters among 38 hospitals. Median proportions of ED-only and hospital encounters with blood cultures were 3.2% (range: 1%- 11%) and 51.6% (range: 25%-81%), respectively. Adjusted ED-only encounters with versus without blood culture had higher costs ($1266 vs $460, P < .001), higher ED revisit rates (3.6% vs 2.9%, P < .001), and higher admission rates (2.0% vs 0.9%, P < .001). Hospital encounters with blood culture had longer length of stay (2.3 vs 2.0 days, P < .001), higher costs ($5254 vs $4425, P < .001), and higher readmission rates (0.8% vs 0.7%, P = .027). The overall proportion of encounters with bacteremia was 0.6% for ED-only encounters and 1.0% for hospital encounters. CONCLUSIONS Despite multiple studies in which low clinical value was demonstrated and current Infectious Diseases Society of America guidelines arguing against the practice, blood cultures were obtained frequently for children hospitalized with SSTIs, with substantial variation across institutions. Few bacteremic encounters were identified.
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Affiliation(s)
- John R Stephens
- Department of Pediatrics, North Carolina Children's Hospital and School of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina;
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | | | - Eric K Zwemer
- Department of Pediatrics, North Carolina Children's Hospital and School of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Jillian Cotter
- Department of Pediatrics, Children's Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado
| | - Samir S Shah
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Mark S Brittan
- Department of Pediatrics, Children's Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado
| | - James C Gay
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Søvsø MB, Christensen MB, Bech BH, Christensen HC, Christensen EF, Huibers L. Contacting out-of-hours primary care or emergency medical services for time-critical conditions - impact on patient outcomes. BMC Health Serv Res 2019; 19:813. [PMID: 31699103 PMCID: PMC6839230 DOI: 10.1186/s12913-019-4674-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Out-of-hours (OOH) healthcare services in Western countries are often differentiated into out-of-hours primary healthcare services (OOH-PC) and emergency medical services (EMS). Call waiting time, triage model and intended aims differ between these services. Consequently, the care pathway and outcome could vary based on the choice of entrance to the healthcare system. We aimed to investigate patient pathways and 1- and 1-30-day mortality, intensive care unit (ICU) stay and length of hospital stay for patients with acute myocardial infarction (AMI), stroke and sepsis in relation to the OOH service that was contacted prior to the hospital contact. METHODS Population-based observational cohort study during 2016 including adult patients from two Danish regions with an OOH service contact on the date of hospital contact. Patients <18 years were excluded. Data was retrieved from OOH service databases and national registries, linked by a unique personal identification number. Crude and adjusted logistic regression analyses were performed to assess mortality in relation to contacted OOH service with OOH-PC as the reference and cox regression analysis to assess risk of ICU stay. RESULTS We included 6826 patients. AMI and stroke patients more often contacted EMS (52.1 and 54.1%), whereas sepsis patients predominately called OOH-PC (66.9%). Less than 10% (all diagnoses) of patients contacted both OOH-PC & EMS. Stroke patients with EMS or OOH-PC & EMS contacts had higher likelihood of 1- and 1-30-day mortality, in particular 1-day (EMS: OR = 5.33, 95% CI: 2.82-10.08; OOH-PC & EMS: OR = 3.09, 95% CI: 1.06-9.01). Sepsis patients with EMS or OOH-PC & EMS contacts also had higher likelihood of 1-day mortality (EMS: OR = 2.22, 95% CI: 1.40-3.51; OOH-PC & EMS: OR = 2.86, 95% CI: 1.56-5.23) and 1-30-day mortality. Risk of ICU stay was only significantly higher for stroke patients contacting EMS (EMS: HR = 2.38, 95% CI: 1.51-3.75). Stroke and sepsis patients with EMS contact had longer hospital stays. CONCLUSIONS More patients contacted OOH-PC than EMS. Sepsis and stroke patients contacting EMS solely or OOH-PC & EMS had higher likelihood of 1- and 1-30-day mortality during the subsequent hospital contact. Our results suggest that patients contacting EMS are more severely ill, however OOH-PC is still often used for time-critical conditions.
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Affiliation(s)
- Morten Breinholt Søvsø
- Centre for Prehospital and Emergency Research, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | | | - Bodil Hammer Bech
- Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus, Denmark
| | | | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
- Emergency Medical Services, North Denmark Region, Aalborg, Denmark
| | - Linda Huibers
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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Interpreting New Evidence on Prenatal Infections and Mental Disorders. Biol Psychiatry 2019; 85:285-286. [PMID: 30665502 DOI: 10.1016/j.biopsych.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/21/2022]
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Østergaard AA, Sydenham TV, Nybo M, Andersen ÅB. Cerebrospinal fluid pleocytosis level as a diagnostic predictor? A cross-sectional study. BMC Clin Pathol 2017; 17:15. [PMID: 28855847 PMCID: PMC5571639 DOI: 10.1186/s12907-017-0053-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/17/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Lumbar puncture with quantification of leukocytes and differential count of cellular subsets in the cerebrospinal fluid is a standard procedure in cases of suspected neuroinfectious conditions. However, a number of non-infectious causes may result in a low leukocyte number (0-1000 cells/ml). We wanted to assess the diagnostic diversity of unselected adult patients with pleocytosis in the cerebrospinal fluid. METHODS The study is based on data from cerebrospinal fluid (CSF) analyses of all adult patients (15 years or older) admitted to a large university hospital in Denmark during a two-year period (2008-2009). Data from the local patient administrative system supplied with data from patient charts were combined with laboratory data. RESULTS A total of 5390 cerebrospinal fluid samples from 3290 patients were included. Pleocytosis >5 leucocytes/μl was found in samples from 262 patients of which 106 (40.5%) were caused by infection of the central nervous system (CNS), 20 (7.6%) by infection outside CNS, 79 (30.2%) due to non-infectious neurological diseases, 23 (8.8%) by malignancy, and 34 (13.0%) caused by other conditions. Significantly higher mean CSF leukocytes was found in patients suffering from CNS infection (mean 1135 cells/μl, p-value <0.0001). CONCLUSIONS CNS infection, non-infectious neurological disease, malignancy, and infection outside CNS can cause pleocytosis of the cerebrospinal fluid. Leukocyte counts above 100/μl is mainly caused by CNS infection, whereas the number of differential diagnoses is higher if the CSF leukocyte counts is below 50/μl. These conditions are most commonly caused by non-infectious neurological diseases including seizures.
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Affiliation(s)
| | | | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Åse Bengård Andersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark.,Department of Infectious Diseases 8632, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK 2100 Copenhagen OE, Denmark
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Søgaard KK, Farkas DK, Søgaard M, Schønheyder HC, Thomsen RW, Sørensen HT. Gram-negative bacteremia as a clinical marker of occult malignancy. J Infect 2016; 74:153-162. [PMID: 27838520 DOI: 10.1016/j.jinf.2016.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 09/19/2016] [Accepted: 09/28/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Gram-negative bacteremia may be a harbinger of occult cancer. We examined the risk of cancer following hospitalization with bacteremia. METHODS Using medical databases, we conducted a nationwide population-based cohort study of all Danes with a discharge diagnosis of Gram-negative bacteremia during 1994-2013. We calculated absolute risks and standardized incidence ratios (SIRs) of cancer, comparing the observed risk to that expected in the general population. RESULTS We observed 1379 cancers vs. 988 expected among 11,753 patients with Gram-negative bacteremia, corresponding to an overall SIR of 1.40 (95% confidence interval (CI): 1.32-1.47). During the first 6 months following the bacteremia diagnosis, the SIR for cancer was 3.33-fold (95% CI: 2.99-3.69) increased, corresponding to an absolute risk of 3.05%. The increased risk stemmed mainly from higher than expected occurrence of gastrointestinal cancer (3- to 13-fold higher), genitourinary cancer (4- to 10-fold higher), non-Hodgkin lymphoma (5-fold higher), non-specified metastatic cancer (5-fold higher), and breast and lung cancer (2-fold higher). The 6-12 months SIR for any cancer was 1.46 (95% CI: 1.22-1.72), and beyond 1 year of follow-up, the SIR declined to 1.13 (95% CI: 1.05-1.20). CONCLUSIONS Gram-negative bacteremia is a clinical marker of occult cancer.
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Affiliation(s)
- Kirstine K Søgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark.
| | - Dóra K Farkas
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Mette Søgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Henrik C Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
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Skov Dalgaard L, Nørgaard M, Povlsen JV, Morrissey O, Jespersen B, Jensen-Fangel S, Østergaard LJ, Schønheyder HC, Søgaard OS. Risk and prognosis of bacteremia and fungemia among first-time kidney transplant recipients: a population-based cohort study. Infect Dis (Lond) 2016; 49:286-295. [PMID: 27822975 DOI: 10.1080/23744235.2016.1248483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Bacterial infections are common complications in kidney transplant recipients (KTRs). Little is known about incidence rates of bacteremia and fungemia (BAF) in KTRs. METHODS In this population-based cohort study, we used medical and administrative registries to identify episodes of BAF among KTRs in the Central Denmark and North Denmark Regions during 1995-2010. KTRs were followed from the date of their first transplantation to the earliest of BAF, graft loss, death, emigration or 31 December 2010. We calculated incidence rates of first BAF episode overall and stratified by time from transplantation. Potential risk factors were assessed using Cox regression analysis. The Kaplan-Meier analysis was used to estimate 30- and 90-day mortality. RESULTS Among 612 KTRs, we identified 138 first episodes of bacteremia during 2397 person-years of follow-up (PYFU). The overall incidence rate (IR) was 5.8 BAF episodes per 100 PYFU (95% confidence interval [CI]: 4.9-6.8). The incidence rate declined from 84.0 per 100 PYFU (95% CI: 61.6-114.5) during post-transplant day 0-30 to 2.3 per 100 PYFU (95% CI: 1.7-3.0) from post-transplant day 365 and onwards. Hospital-onset BAF comprised 39% of the episodes of BAF. The most frequently isolated microorganisms were Escherichia coli and Klebsiella species causing 49 (35.5%) and 29 (21.0%) episodes of BAF, respectively. The 30-day mortality was 2.1% (95% CI: 0.7-6.6). CONCLUSIONS While the risk of BAF in KTRs was high, thirty-day mortality was low. After the first post-transplant year, the IR of bacteremia was substantially lower than in the immediate post-transplant period.
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Affiliation(s)
- Lars Skov Dalgaard
- a Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
| | - Mette Nørgaard
- b Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus , Denmark
| | | | - Orla Morrissey
- d Department of Infectious Diseases , Alfred Health and Monash University , Melbourne , Australia
| | - Bente Jespersen
- c Department of Nephrology , Aarhus University Hospital , Aarhus , Denmark
| | - Søren Jensen-Fangel
- a Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
| | - Lars J Østergaard
- a Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
| | - Henrik Carl Schønheyder
- e Department of Clinical Microbiology , Aalborg University Hospital , Aalborg , Denmark.,f Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
| | - Ole Schmeltz Søgaard
- a Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
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Andreasen RA, Andersen NS, Just SA, Christensen R, Hansen IMJ. Prognostic factors associated with mortality in patients with septic arthritis: a descriptive cohort study. Scand J Rheumatol 2016; 46:27-32. [DOI: 10.3109/03009742.2016.1164241] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- RA Andreasen
- Department of Medicine, Svendborg Hospital, Odense University Hospital, Svendborg, Denmark
| | - NS Andersen
- Research Department of Clinical Microbiology, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - SA Just
- Department of Medicine, Svendborg Hospital, Odense University Hospital, Svendborg, Denmark
| | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark
| | - IMJ Hansen
- Department of Medicine, Svendborg Hospital, Odense University Hospital, Svendborg, Denmark
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Schmidt M, Schmidt SAJ, Sandegaard JL, Ehrenstein V, Pedersen L, Sørensen HT. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015; 7:449-90. [PMID: 26604824 PMCID: PMC4655913 DOI: 10.2147/clep.s91125] [Citation(s) in RCA: 2957] [Impact Index Per Article: 328.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The Danish National Patient Registry (DNPR) is one of the world’s oldest nationwide hospital registries and is used extensively for research. Many studies have validated algorithms for identifying health events in the DNPR, but the reports are fragmented and no overview exists. Objectives To review the content, data quality, and research potential of the DNPR. Methods We examined the setting, history, aims, content, and classification systems of the DNPR. We searched PubMed and the Danish Medical Journal to create a bibliography of validation studies. We included also studies that were referenced in retrieved papers or known to us beforehand. Methodological considerations related to DNPR data were reviewed. Results During 1977–2012, the DNPR registered 8,085,603 persons, accounting for 7,268,857 inpatient, 5,953,405 outpatient, and 5,097,300 emergency department contacts. The DNPR provides nationwide longitudinal registration of detailed administrative and clinical data. It has recorded information on all patients discharged from Danish nonpsychiatric hospitals since 1977 and on psychiatric inpatients and emergency department and outpatient specialty clinic contacts since 1995. For each patient contact, one primary and optional secondary diagnoses are recorded according to the International Classification of Diseases. The DNPR provides a data source to identify diseases, examinations, certain in-hospital medical treatments, and surgical procedures. Long-term temporal trends in hospitalization and treatment rates can be studied. The positive predictive values of diseases and treatments vary widely (<15%–100%). The DNPR data are linkable at the patient level with data from other Danish administrative registries, clinical registries, randomized controlled trials, population surveys, and epidemiologic field studies – enabling researchers to reconstruct individual life and health trajectories for an entire population. Conclusion The DNPR is a valuable tool for epidemiological research. However, both its strengths and limitations must be considered when interpreting research results, and continuous validation of its clinical data is essential.
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Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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