Background Asthma exacerbations are triggered by a variety of clinical and environmental factors, but their relative impacts on exacerbation risk are unclear. There is a critical need to develop methods to identify children at high-risk for future exacerbation to allow targeted prevention measures. We sought to evaluate the utility of models using spatiotemporally resolved climatic data and individual electronic health records (EHR) in predicting pediatric asthma exacerbations. Methods We extracted retrospective EHR data for 5982 children with asthma who had an encounter within the Duke University Health System between January 1, 2014 and December 31, 2019. EHR data were linked to spatially resolved environmental data, and temporally resolved climate, pollution, allergen, and influenza case data. We used xgBoost to build predictive models of asthma exacerbation over 30–180 day time horizons, and evaluated the contributions of different data types to model performance. Results Models using readily available EHR data performed moderately well, as measured by the area under the receiver operating characteristic curve (AUC 0.730–0.742) over all three time horizons. Inclusion of spatial and temporal data did not significantly improve model performance. Generating a decision rule with a sensitivity of 70% produced a positive predictive value of 13.8% for 180 day outcomes but only 2.9% for 30 day outcomes. Conclusions EHR data-based models perform moderately wellover a 30–180 day time horizon to identify children who would benefit from asthma exacerbation prevention measures. Due to the low rate of exacerbations, longer-term models are likely to be most clinically useful. Trial Registration: Not applicable.
Vaccine‐preventable viral infections are associated with increased risk of morbidity and mortality in post‐transplant patients on immunosuppression regimens. Therefore, we studied rates of immunity against vaccine‐preventable viruses in lung transplantation (LTx) candidates and their associations with underlying lung disease and clinical characteristics. We retrospectively studied 1025 consecutive adult patients who underwent first‐time evaluation for LTx at a single center between January 2016 and October 2018. Viruses studied included varicella zoster (VZV), measles, and mumps. Young age (17–48 years old) was negatively associated with immunity for VZV (OR 4.54, p < .001), measles (OR 15.45, p < .001) and mumps (OR 3.1, p < .001), as compared to those 65+. Many LTx candidates with cystic fibrosis (CF) had undetectable virus‐specific antibody titers including: 13.5% for VZV, 19.1% for measles, and 15.7% for mumps with significant odds of undetectable titers for VZV (OR 4.54, p < .001) and measles (OR 2.32, p = .010) as compared to those without CF. Therefore, a substantial number of patients undergoing LTx evaluation had undetectable virus‐specific antibody titers. Our results emphasize the importance of screening for immunity to vaccine‐preventable infections in this population and the need for revaccination in selected patients to boost their humoral immunity prior to transplantation.
Acquired angioedema due to C1‐inhibitor (C1‐INH) deficiency (AAE‐C1‐INH) is rare and is associated with underlying lymphoproliferative diseases. C1‐INH deficiency may be due to neoplastic over‐consumption of C1‐INH and the generation of anti‐C1‐INH autoantibodies. Uncovering an occult malignancy can lead to earlier oncology referral and improvement of angioedema after treatment of the underlying lymphoproliferative disorder. We characterized seven patients with C1‐INH‐AAE that highlights the importance of recognizing the association between C1‐INH‐AAE and underlying malignancy. In acute attacks, patients may be resistant to C1‐INH therapy due to the presence of anti‐C1‐INH autoantibodies or rapid complement consumption, and may respond better to icatibant or ecallantide, which directly affect bradykinin. Treatment of the underlying malignancy also improves AAE‐C1‐INH symptoms and supports the role of lymphoproliferative B cells in AAE‐C1‐INH pathophysiology. Monitoring levels of C4, C1‐INH function and level, and C1q may be predictive of AAE‐C1‐INH control and be used as surrogates for treatment efficacy. With close monitoring, low‐dose danazol can be effective for long‐term prophylaxis. Annual evaluation in AAE‐C1‐INH is recommended if an underlying malignancy is not found, as angioedema may precede the development of malignancy by several years. Our single‐center study has aided in standardization of comprehensive AAE‐C1‐INH diagnosis, treatment, and monitoring strategies towards future therapeutic clinical trials.
Vaccine-preventable viral infections are associated with increased risk of morbidity and mortality in posttransplant patients on intensive immunosuppression regimens. Of particular concern, is the 2019 CDC data indicating the largest number of cases of measles reported in the United States since 1992. Current guidelines recommend routine screening and vaccination of all patients prior to solid organ transplantation. We studied rates of immunity against vaccine-preventable viruses in a large single center cohort of patients undergoing evaluation for lung transplantation (LT) and sought to determine if impaired immunity was associated with native disease or other demographic factors. METHODS: We retrospectively studied consecutive adult patients who underwent evaluation for lung transplantation at Duke University Medical Center between January 2016 and October 2018. Viral titers measured in the evaluation were: measles, mumps and varicella zoster virus (VZV). Clinical and demographic information were extracted from the electronic medical record. Association modeling was performed using logistic and Poisson regression. An absent IgG level for each viral infection of interest was regarded as an undetectable titer. RESULTS: 703 patients underwent LT evaluation (58.7% male, median (Q1, Q3) age 62 (53, 68) years). 235 (33.4%) patients received a lung transplant, while 468 (66.6%) patients did not undergo transplantation during the study period. Percentages of patients who lacked immunity to vaccine-preventable infections at evaluation were: measles (10.8%), mumps (14.2%) and VZV (3.6%). Strikingly, many Cystic Fibrosis (CF) patients had undetectable titers to measles (17.9%), mumps (13.4%), and VZV (13.4%). When compared to other native diseases, CF was associated with a higher odds of undetectable titers for VZV (P<0.05) with a trend towards undetectable titers for measles (p=0.053). Patients born after 1970 had the highest odds of absent titers for all (P<0.05) with 25.9%, 21.4%, and 10.7% of these patients having undetectable measles, mumps, and VZV titers, respectively. CONCLUSION: A substantial number of patients undergoing LT evaluation are not immune to vaccine-preventable viruses at the time of initial assessment. In particular, young patients with chronic disease may have a blunted immunologic response to their childhood vaccines or an accelerated rate of vaccination titer losses. Our results emphasize the importance of screening for vaccine-preventable infections particularly in younger patients with CF and the opportunity for revaccination in selected patients in order to boost their humoral immunity prior to receiving transplant immunosuppression.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.