ABSTRACT
BACKGROUND AND AIMS: Autoimmune diseases (AID) share various clinical signs and symptoms and pathophysiological mechanisms including the increased risk of cardiovascular disease. The coronary artery calcium score (CACS) is potentially useful in improving the cardiovascular risk assessment. The aim of this study was to evaluate CACS in six AIDs analyzed as a group compared with controls through a systematic literature review (SLR) and meta-analysis. METHODS: A literature search (Medline/OVID, Lilacs, Embase, and Cochrane/OVID) up to January 6, 2021 was made (PROSPERO CRD42020197182). Observational studies (patients with six AIDs: rheumatoid arthritis [RA], systemic lupus erythematosus [SLE], Sjögren's syndrome, systemic sclerosis, dermatopolymyositis, and antiphospholipid syndrome) compared with controls were included. CACS, reported in Agatston units, was the primary outcome in both groups. Mean differences and a random-effects model (DerSimonian and Laird) were calculated. RESULTS: Nineteen articles were meta-analyzed (4568 subjects: 2142 AID and 2426 controls). Mean age was 48.1 and 44.2 years, respectively and 75.6% and 84.9% were women, respectively. Of cases, 52.9% had RA, 44.4% SLE and 2.7% had systemic sclerosis. The pooled analysis showed a higher CACS in patients with AIDs (7.42; 95% CI 1.79 to 13.05; chi2-p = 0.01) compared with controls. Meta-regression models showed that age in cases and controls reduced the difference in CACS between groups (p < 0.05), HDL had an inverse relationship (p = 0.04), and CRP levels had a directly proportional relationship with CACS in cases (p = 0.036). CONCLUSIONS: The quantitative results of this meta-analysis suggest that CACS is higher in patients with AID, possibly due to chronic exposure to pro-inflammatory molecules. These results have clinical implications since the finding of highly elevated CACS in patients with AID will enable physicians and researchers to develop a risk stratification model that includes CACS as one of the screening tools for detecting coronary atherosclerosis in these patients.
Subject(s)
Arthritis, Rheumatoid , Autoimmune Diseases , Coronary Artery Disease , Lupus Erythematosus, Systemic , Autoimmune Diseases/diagnosis , Autoimmune Diseases/epidemiology , Calcium , Coronary Artery Disease/diagnosis , Coronary Artery Disease/epidemiology , Female , Humans , Lupus Erythematosus, Systemic/diagnosisABSTRACT
Abstract Introduction: infective endocarditis is a disease characterized by infection of the endocardial surface of the heart, especially the valves. Given the change in causal microorganisms, a characterization of this disease is essential in order to obtain our own results. Objective: to describe the clinical, microbiological and echocardiographic characteristics, mortality and treatment guidelines of patients with infective endocarditis. Methods: a case series was performed at a quaternary care hospital in Bogotá. The medical records from 2013-2017 of patients with an ICD-10 diagnosis of endocarditis and who were in the cardiology imaging laboratory's database were reviewed. Descriptive statistics were used to report the findings, along with a multiple correspondence analysis to explore the relationship between the type of microorganism and the other variables. Results: data from 34 patients were reviewed. These patients had an average age of 59 years (standard deviation 15.3) and were predominantly males. Native valves were more frequently involved (85.2%), especially the mitral valve (55.8%). The most common clinical finding was fever (64.7%), and vegetations were seen on echocardiogram in 91.2%. The microbiological isolates were predominantly Staphylococcus aureus (32.3%); treatment with antibiotic alone was prescribed for 70.7%, the remaining 29.3% were managed surgically, and there was an 8.8% documented mortality. Discussion and conclusions: the characteristics of this series are similar to those of other series. Staphylococcus aureus is the main causal germ. The low mortality found may be explained by the lower frequency of serious complications requiring surgical management. (Acta Med Colomb 2019; 44. DOI:https://doi.org/10.36104/amc.2019.1223).
Resumen Introducción: la endocarditis infecciosa es una enfermedad caracterizada por el compromiso infeccioso de la superficie endocárdica del corazón, principalmente a nivel valvular. Dado el cambio en los microorganismos causales, se hace indispensable realizar una caracterización de esta patología para obtener resultados propios. Objetivo: describir las características clínicas, microbiológicas, ecocardiográficas, mortalidad y pautas de tratamiento de los pacientes con endocarditis infecciosa. Metodología: de realizó una serie de casos en un hospital de IV nivel, en Bogotá. Se revisaron las historias clínicas de los años 2013- 2017, de los pacientes con diagnóstico de endocarditis por código CIE 10 y en la base de datos del laboratorio de imágenes de cardiología. Se empleó estadística descriptiva para relatar los hallazgos y un análisis de correspondencias múltiples para explorar la relación entre tipo de microorganismo y demás variables. Resultados: se revisaron datos de 34 pacientes, con edad promedio de 59 años (Desviación estándar 15.3), predominio del género masculino, siendo más frecuente en válvulas nativas (85.2%) y de éstas la válvula mitral (55.8%). El hallazgo clínico más frecuente fue la fiebre 64.7%, en ecocardiografía se observó la presencia de vegetación en 91.2%. Los aislamientos microbiológicos evidenciaron predominio de Staphylococcus aureus (32.3%), se indicó manejo exclusivamente antibiótico a 70.7% y el restante 29.3% manejo quirúrgico y se documentó una mortalidad de 8.8%. Discusión y conclusiones: las características de esta serie son similares a las de otras series, Staphylococcus aureus se posiciona como el principal germen causal. La baja mortalidad encontrada puede explicarse por la menor frecuencia de complicaciones graves que requerían manejo quirúrgico. (Acta Med Colomb 2019; 44. DOI:https://doi.org/10.36104/amc.2019.1223).
