Background:No previous correlation between phenotype at diagnosis of Crohn’ disease(CD)and mortality has been performed.We assessed the predictive value of phenotype at diagnosis on overall and disease related mortal...Background:No previous correlation between phenotype at diagnosis of Crohn’ disease(CD)and mortality has been performed.We assessed the predictive value of phenotype at diagnosis on overall and disease related mortality in a European cohort of CD patients.Methods:Overall and disease related mortality were recorded 10 years after diagnosis in a prospectively assembled,uniformly diagnosed European population based inception cohort of 380 CD patients diagnosed between 1991 and 1993.Standardised mortality ratios(SMRs)were calculated for geographic and phenotypic subgroups at diagnosis.Results:Thirty seven deaths were observed in the entire cohort whereas 21.5 deaths were expected(SMR 1.85(95%Cl 1.30-2.55)).Mortality risk was significantly increased in both females(SMR 1.93(95%Cl 1.10-3.14))and males(SMR 1.79(95%Cl 1.11-2.73)).Patients from northern European centres had a significant overall increased mortality risk(SMR 2.04(95%Cl 1.32-3.01))whereas a tendency towards increased overall mortality risk was also observed in the south(SMR 1.55(95%Cl 0.80-2.70)).Mortality risk was increased in patients with colonic disease location and with inflammatory disease behaviour at diagnosis.Mortality risk was also increased in the age group above 40 years at diagnosis for both total and CD related causes.Excess mortality was mainly due to gastrointestinal causes that were related to CD.Conclusions:This European multinational population based study revealed an increased overall mortality risk in CD patients 10 years after diagnosis,and age above 40 years at diagnosis was found to be the sole factor associated with increased mortality risk.展开更多
Toxic epidermal necrolysis (TEN) is a rare, life-threaten-ing, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In a...Toxic epidermal necrolysis (TEN) is a rare, life-threaten-ing, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In addition,we used the SCORTEN, a severity-of-illness score for TEN, to compare the predicted and actual mortality rates, and to evaluate the efficacy of treatment modalities. A retrospective study of 38 patients with TEN during a 13- year period (1990- 2003) at the Asan Medical Center was performed. The mean involved body surface area was 49± 17% . All except three cases were associated with medications, most commonly antibiotics, followed by non-steroidal anti-inflammatory drugs, acetaminophen and herbal remedies. Fourteen patients had a history of current infection, including upper respiratory infection, pneumonia and herpes simplex infection. The mean time from initial drug administration to the onset of TEN was 9.8± 5.7 days. Twenty-one patients were treated with systemic corticosteroids. Fourteen received high dose intravenous immunoglobulin therapy. The actual mortality rate was 23.7% (9/38), not significantly different from the SCORTEN-predicted rate (25.5% , 9.699/38). Also based on SCORTEN, treatment with high dose intravenous immunoglobulin showed a trend to lower actual mortality than predicted mortality (standardized mortality ratio (SMR)=0.425; 95% CI, 0.011- 2.368), whereas corticosteroid therapy showed no such difference (SMR=1.004; 95% CI, 0.369- 2.187).展开更多
Deaths in temporal association with vaccination of hexavalent vaccines have been recently reported.The objective of this paper is to assess whether these temporal associations can be attributed to chance.Standardised ...Deaths in temporal association with vaccination of hexavalent vaccines have been recently reported.The objective of this paper is to assess whether these temporal associations can be attributed to chance.Standardised mortality ratios (SMR) for deaths within 1 to 28 days after administration of either of the two hexavalent vaccines in the 1st and 2nd year of life were determined using the respective annual rates for sudden unexpected deaths (SUDs) from the national vital statistics.The distribution of SUD cases and the vaccination uptake by month were estimated from surveys and sales figures for the individual vaccines.Sensitivity analyses were performed to account for limitations in the data sources.For one of the vaccines, Vaccine B, all SMRs were well below one.For the other, Vaccine A, SMRs exceeded one insignificantly on the 1st day after vaccination in the 1st year of life.In the 2nd year of life, however, the SMRs for SUD cases within 1 day of vaccination with vaccine A were 31.3 (95%CI 3.8-113.1; two cases observed; 0.06 cases expected) and 23.5 (95%CI 4.8-68,6) for within 2 days after vaccination (three cases observed; 0.13 cases expected).Extensive sensitivity analyses could not attribute these findings to limitations of the data sources.Conclusion: These findings based on spontaneous reporting do not prove a causal relationship between vaccination and sudden unexpected deaths.However, they constitute a signal for one of the two hexavalent vaccines which should prompt intensi-fied surveillance for unexpected deaths after vaccination.展开更多
文摘Background:No previous correlation between phenotype at diagnosis of Crohn’ disease(CD)and mortality has been performed.We assessed the predictive value of phenotype at diagnosis on overall and disease related mortality in a European cohort of CD patients.Methods:Overall and disease related mortality were recorded 10 years after diagnosis in a prospectively assembled,uniformly diagnosed European population based inception cohort of 380 CD patients diagnosed between 1991 and 1993.Standardised mortality ratios(SMRs)were calculated for geographic and phenotypic subgroups at diagnosis.Results:Thirty seven deaths were observed in the entire cohort whereas 21.5 deaths were expected(SMR 1.85(95%Cl 1.30-2.55)).Mortality risk was significantly increased in both females(SMR 1.93(95%Cl 1.10-3.14))and males(SMR 1.79(95%Cl 1.11-2.73)).Patients from northern European centres had a significant overall increased mortality risk(SMR 2.04(95%Cl 1.32-3.01))whereas a tendency towards increased overall mortality risk was also observed in the south(SMR 1.55(95%Cl 0.80-2.70)).Mortality risk was increased in patients with colonic disease location and with inflammatory disease behaviour at diagnosis.Mortality risk was also increased in the age group above 40 years at diagnosis for both total and CD related causes.Excess mortality was mainly due to gastrointestinal causes that were related to CD.Conclusions:This European multinational population based study revealed an increased overall mortality risk in CD patients 10 years after diagnosis,and age above 40 years at diagnosis was found to be the sole factor associated with increased mortality risk.
文摘Toxic epidermal necrolysis (TEN) is a rare, life-threaten-ing, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In addition,we used the SCORTEN, a severity-of-illness score for TEN, to compare the predicted and actual mortality rates, and to evaluate the efficacy of treatment modalities. A retrospective study of 38 patients with TEN during a 13- year period (1990- 2003) at the Asan Medical Center was performed. The mean involved body surface area was 49± 17% . All except three cases were associated with medications, most commonly antibiotics, followed by non-steroidal anti-inflammatory drugs, acetaminophen and herbal remedies. Fourteen patients had a history of current infection, including upper respiratory infection, pneumonia and herpes simplex infection. The mean time from initial drug administration to the onset of TEN was 9.8± 5.7 days. Twenty-one patients were treated with systemic corticosteroids. Fourteen received high dose intravenous immunoglobulin therapy. The actual mortality rate was 23.7% (9/38), not significantly different from the SCORTEN-predicted rate (25.5% , 9.699/38). Also based on SCORTEN, treatment with high dose intravenous immunoglobulin showed a trend to lower actual mortality than predicted mortality (standardized mortality ratio (SMR)=0.425; 95% CI, 0.011- 2.368), whereas corticosteroid therapy showed no such difference (SMR=1.004; 95% CI, 0.369- 2.187).
文摘Deaths in temporal association with vaccination of hexavalent vaccines have been recently reported.The objective of this paper is to assess whether these temporal associations can be attributed to chance.Standardised mortality ratios (SMR) for deaths within 1 to 28 days after administration of either of the two hexavalent vaccines in the 1st and 2nd year of life were determined using the respective annual rates for sudden unexpected deaths (SUDs) from the national vital statistics.The distribution of SUD cases and the vaccination uptake by month were estimated from surveys and sales figures for the individual vaccines.Sensitivity analyses were performed to account for limitations in the data sources.For one of the vaccines, Vaccine B, all SMRs were well below one.For the other, Vaccine A, SMRs exceeded one insignificantly on the 1st day after vaccination in the 1st year of life.In the 2nd year of life, however, the SMRs for SUD cases within 1 day of vaccination with vaccine A were 31.3 (95%CI 3.8-113.1; two cases observed; 0.06 cases expected) and 23.5 (95%CI 4.8-68,6) for within 2 days after vaccination (three cases observed; 0.13 cases expected).Extensive sensitivity analyses could not attribute these findings to limitations of the data sources.Conclusion: These findings based on spontaneous reporting do not prove a causal relationship between vaccination and sudden unexpected deaths.However, they constitute a signal for one of the two hexavalent vaccines which should prompt intensi-fied surveillance for unexpected deaths after vaccination.
