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Iversen KK, Ronit A, Ahlström MG, Nordestgaard BG, Afzal S, Benfield T. Lung function trajectories in mild COVID-19 with two-year follow-up. J Infect Dis 2024:jiae037. [PMID: 38271235 DOI: 10.1093/infdis/jiae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/02/2024] [Accepted: 01/22/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE To characterize lung function dynamics in individuals with mild COVID-19 from pre-infection to two years post-infection. METHODS We re-invited participants two years after infection from our matched cohort study of the Copenhagen General Population who had initially been examined 5.4 months after infection. We repeated lung tests and questionnaires. Linear mixed models were used to estimate lung volume changes in individuals with COVID-19 patients versus uninfected controls over two intervals: from pre-infection to six months post-infection and six months post-infection to two years post-infection. RESULTS 52 individuals (48.6%) attended the two-year examination at median 1.9 years (IQR 1.8; 2.4) after COVID-19, all with mild infection. Individuals with COVID-19 had an adjusted excess decline in FEV1 of 13.0 mL per year (CI 23.5; 2.5), p=0.02 from prior infection to 6 months after infection compared to uninfected controls. From 6 to 24 months after infection, they had an excess decline of 7.5 mL per year (CI 25.6; 9.6), p=0.40. A similar pattern was observed for FVC. Participants had a mean increase in DLco of 3.33 (SD 7.97) between the 6- and 24-month examination. CONCLUSION Our results indicate that mild COVID-19 infection affects lung function at time of infection with limited recovery two years after infection.
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Affiliation(s)
- Katrine K Iversen
- Department of Infectious Diseases, Copenhagen University Hospital - Amager Hvidovre, Hvidovre, Denmark
| | - Andreas Ronit
- Department of Infectious Diseases, Copenhagen University Hospital - Amager Hvidovre, Hvidovre, Denmark
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Magnus G Ahlström
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital - Amager Hvidovre, Hvidovre, Denmark
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Ahlström MG, Antsupova VS, Pedersen M, Johansen HK, Hansen DS, Knudsen IJD. A Dedicated Mycosis Flask Increases the Likelihood of Identifying Candidemia Sepsis. J Fungi (Basel) 2023; 9:jof9040441. [PMID: 37108896 PMCID: PMC10146598 DOI: 10.3390/jof9040441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Abstract
Introduction: Candidemia is a severe condition associated with high mortality, and fungi are often not covered by empiric antimicrobial regimes for sepsis. Therefore, the shortest possible time to detection of yeast in the blood is of the essence. Materials and methods: We performed a cohort study of blood culture flasks drawn from patients aged 18 or older in the capital region of Denmark. In 2018 a blood cultures set consisted of two aerobic and two anaerobic flasks. This was changed in 2020 to two aerobic, one anaerobic, and one mycosis flask. We used time-to-event statistics to model time to positivity and compared 2018 with 2020; further, we stratified analyses on the blood culture system used (BacTAlert™ vs. BACTEC™) and high-risk vs. low-risk departments. Results: We included 175,416 blood culture sets and 107,077 unique patients. We found an absolute difference in the likelihood of identifying fungi in a blood culture set of 1.2 (95% CI: 0.72; 1.6) pr. 1.000 blood culture sets corresponding to the number needed to treat 853 (617; 1382). In high-risk departments, the absolute difference was profound, whereas it was negligible and statistically non-significant in low-risk departments 5.2 (95% CI: 3.4; 7.1) vs. 0.16 (−0.17; 0.48) pr. 1.000 blood culture sets. Conclusions: We found that including a mycosis flask in a blood culture set increases the likelihood of identifying candidemia. The effect was mainly seen in high-risk departments.
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Affiliation(s)
- Magnus G. Ahlström
- Department of Clinical Microbiology, Herlev & Gentofte Hospital, 2730 Herlev, Denmark
| | - Valeria S. Antsupova
- Department of Clinical Microbiology, Herlev & Gentofte Hospital, 2730 Herlev, Denmark
| | - Michael Pedersen
- Department of Clinical Microbiology, Amager & Hvidovre Hospital, 2650 Hvidovre, Denmark
| | - Helle Krogh Johansen
- Department of Clinical Microbiology, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
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3
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Iversen KK, Ronit A, Kristensen TS, Afzal S, Jankovic J, Kalhauge A, Ahlström MG, Nordestgaard BG, Kofoed KF, Benfield T. Lung abnormalities in SARS-CoV-2 infection: An analysis of paired computed tomography scans before and after infection. Open Forum Infect Dis 2022; 9:ofac596. [DOI: 10.1093/ofid/ofac596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Studies on the pulmonary consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are impeded by limited access to pre-SARS-CoV-2 examinations.
Methods
We invited Copenhagen General Population Study participants with a confirmed SARS-CoV-2 PCR test during the first and second COVID-19 wave in Denmark for a repeat chest CT scan. Paired CT scans were independently assessed for interstitial and non-interstitial abnormalities by two trained radiologist. A semiquantitative CT score (ranging from 0-25) was used to quantify the extent of interstitial abnormalities.
Results
Of 111 SARS-CoV-2 infected individuals, 102 (91.2%) experienced symptoms and 12 (11.2%) were hospitalized. Follow-up examination was performed at median of 5.4 (IQR 4.1; 7.8) months after a positive SARS-CoV-2 PCR-test. Of 67 individuals with paired CT scans, ground glass opacities and reticulation were present in 31 (46.3%) individuals post-SARS-CoV-2 compared to 23 (34.1%) pre-SARS-CoV-2 (mean CT score 3.0 vs 1.3, p = 0.011). Results were similar for non-hospitalized individuals. We did not detect development of bronchiectasis, emphysema or nodules.
Conclusions
SARS-CoV-2 infection in predominantly non-hospitalized individuals with mild disease was associated with a small increase in only interstitial lung abnormalities.
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Affiliation(s)
- Katrine K Iversen
- Department of Infectious Diseases 144, Copenhagen University Hospital – Amager Hvidovre , Hvidovre , Denmark
| | - Andreas Ronit
- Department of Infectious Diseases 144, Copenhagen University Hospital – Amager Hvidovre , Hvidovre , Denmark
| | - Thomas S Kristensen
- Department of Radiology and Cardiology, Copenhagen University Hospital – Rigshospitalet , Copenhagen , Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital – Herlev and Gentofte , Hvidovre , Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital – Herlev and Gentofte , Hvidovre , Denmark
| | - Jelena Jankovic
- Department of Radiology and Cardiology, Copenhagen University Hospital – Rigshospitalet , Copenhagen , Denmark
| | - Anna Kalhauge
- Department of Radiology and Cardiology, Copenhagen University Hospital – Rigshospitalet , Copenhagen , Denmark
| | - Magnus G Ahlström
- Department of Clinical Microbiology, Copenhagen University Hospital – Rigshospitalet , Copenhagen , Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital – Herlev and Gentofte , Hvidovre , Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital – Herlev and Gentofte , Hvidovre , Denmark
| | - Klaus F Kofoed
- Department of Radiology and Cardiology, Copenhagen University Hospital – Rigshospitalet , Copenhagen , Denmark
| | - Thomas Benfield
- Department of Infectious Diseases 144, Copenhagen University Hospital – Amager Hvidovre , Hvidovre , Denmark
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Hertz FB, Ahlström MG, Bestle MH, Hein L, Mohr T, Lundgren JD, Galle T, Andersen MH, Murray D, Lindhardt A, Itenov TS, Jensen JUS. Early biomarker-guided prediction of bloodstream infection in critically ill patients: C-reactive protein, procalcitonin and leukocytes. Open Forum Infect Dis 2022; 9:ofac467. [PMID: 36225739 PMCID: PMC9547526 DOI: 10.1093/ofid/ofac467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background Bloodstream infections (BSIs) often lead to critical illness and death. The primary aim of this study was to determine the diagnostic accuracy of the biomarkers C-reactive protein (CRP), procalcitonin (PCT), and leukocyte count for the diagnosis of BSI in critically ill patients. Methods This was a nested case–control study based on the Procalcitonin And Survival Study (PASS) trial (n = 1200). Patients who were admitted to the intensive care unit (ICU) <24 hours, and not expected to die within <24 hours, were recruited. For the current study, we included patients with a BSI within ±3 days of ICU admission and matched controls without a BSI in a 1:2 ratio. Diagnostic accuracy for BSI for the biomarkers on days 1, 2, and 3 of ICU admission was assessed. Sensitivity, specificity, and negative and positive predictive values were calculated for prespecified thresholds and for a data-driven cutoff. Results In total, there were 525 patients (n = 175 cases, 350 controls). The fixed low threshold for all 3 biomarkers (CRP = 20 mg/L; leucocytes = 10 × 109/L; PCT = 0.4 ng/mL) resulted in negative predictive values on day 1: CRP = 0.91; 95% CI, 0.75–1.00; leukocyte = 0.75; 95% CI, 0.68–0.81; PCT = 0.91; 95% CI, 0.84–0.96). Combining the 3 biomarkers yielded similar results as PCT alone (P = .5). Conclusions CRP and PCT could in most cases rule out BSI in critically ill patients. As almost no patients had low CRP and ∼20% had low PCT, a low PCT could be used, along with other information, to guide clinical decisions.
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Affiliation(s)
- Frederik Boetius Hertz
- Department of Clinical Microbiology, Rigshospitalet , Copenhagen , Denmark
- Department of Clinical Microbiology, Slagelse Hospital , Slagelse , Denmark
| | - Magnus G Ahlström
- Department of Clinical Microbiology, Herlev & Gentofte Hospital , Herlev , Denmark
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital – North Zealand , Copenhagen , Denmark
- Department of Clinical Medicine, University of Copenhagen , Copenhagen , Denmark
| | - Lars Hein
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital – North Zealand , Copenhagen , Denmark
| | - Thomas Mohr
- Department of Anaesthesia and Intensive Care, Gentofte University Hospital , Copenhagen , Denmark
| | - Jens D Lundgren
- CHIP & PERSIMUNE, Rigshospitalet and University of Copenhagen , Copenhagen , Denmark
| | - Tina Galle
- Department of Anaesthesia and Intensive Care, Glostrup University Hospital , Copenhagen , Denmark
| | | | - Daniel Murray
- CHIP & PERSIMUNE, Rigshospitalet and University of Copenhagen , Copenhagen , Denmark
| | - Anne Lindhardt
- Department of Anaesthesiology, Sjællands Universitets Hospital Køge , Køge , Denmark
| | - Theis Skovsgaard Itenov
- Department of Internal Medicine, Respiratory Medicine Section, Herlev-Gentofte Hospital , Denmark
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital – North Zealand , Copenhagen , Denmark
| | - Jens Ulrik Staehr Jensen
- CHIP & PERSIMUNE, Rigshospitalet and University of Copenhagen , Copenhagen , Denmark
- Department of Internal Medicine, Respiratory Medicine Section, Herlev-Gentofte Hospital , Denmark
- Department of Clinical Medicine, University of Copenhagen , Copenhagen , Denmark
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5
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Iversen KK, Afzal S, Ahlström MG, Nordestgaard BG, Schneider UV, Nielsen L, Kofoed K, Benfield T, Ronit A. Lung function decline in relation to COVID-19 in the general population: a matched cohort study with pre-pandemic assessment of lung function. J Infect Dis 2022; 225:1308-1316. [PMID: 34979029 PMCID: PMC8755346 DOI: 10.1093/infdis/jiab636] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/02/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To quantify the potential decline in dynamic lung volumes following coronavirus disease 2019 (COVID-19) in the general population. METHODS A prospective matched cohort study of adult Copenhagen General Population Study (CGPS) participants with a pre-pandemic spirometry available. CGPS individuals with a positive SARS-CoV-2 polymerase chain reaction (PCR) test performed a repeat spirometry, a questionnaire regarding respiratory symptoms and a diffusing capacity test for carbon monoxide. A matched uninfected CGPS control sample was used, and simple regression and linear mixed effect models were computed to study lung function decline. RESULTS A total of 606 were included. 92/107 (85.9%) of individuals with a positive SARS-CoV-2 PCR test experienced COVID-19 symptoms and 12 (11.2%) were hospitalized. Spirometry was performed at a median (interquartile range) of 5.6 (3.9-12.8) months after positive SARS-CoV-2 PCR test. COVID-19 was associated with an adjusted 7.3 mL (95%CI: 0.3-14.3) and 22.6 mL (95%CI: 13.1-32.0) steeper decline in annual FEV1 and FVC or a total of 113.8 and 301.3 ml lower FEV1 and FVC from baseline to follow up. Results were robust in analyses restricted to individuals not requiring hospitalization. CONCLUSION COVID-19 related decline of dynamic lung volumes in the general population not requiring hospitalization were small but measurable.
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Affiliation(s)
- Katrine K Iversen
- Department of Infectious Diseases 144, Copenhagen University Hospital - Amager Hvidovre; Hvidovre, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.,The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Magnus G Ahlström
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.,The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Uffe V Schneider
- Department of Clinical Microbiology, Copenhagen University Hospital - Amager Hvidovre, Hvidovre, Denmark
| | - Lene Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Klaus Kofoed
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases 144, Copenhagen University Hospital - Amager Hvidovre; Hvidovre, Denmark
| | - Andreas Ronit
- Department of Infectious Diseases 144, Copenhagen University Hospital - Amager Hvidovre; Hvidovre, Denmark
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6
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Ahlström MG, Knudsen JD, Hertz FB. Stenotrophomonas maltophilia bacteraemia: 61 cases in a tertiary hospital in Denmark. Infect Dis (Lond) 2021; 54:26-35. [PMID: 34392797 DOI: 10.1080/23744235.2021.1963470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Stenotrophomonas maltophilia is an opportunistic pathogen and a dreaded cause of bacteraemia with 30-day mortality rates ranging from 14 to 69%. The purpose of this cohort study was to evaluate outcomes of S. maltophilia bacteraemia, at Rigshospitalet, a tertiary hospital in Copenhagen, Denmark. METHODS We included all patients with a blood culture positive for S. maltophilia, from January 1, 2015 to April 1, 2020. We extracted data on antimicrobial susceptibility, treatment, central venous catheter intervention and severe haematological disease. RESULTS Sixty-one cases of S. maltophilia bacteraemia were identified. The overall 90-day mortality was 18%. Sixty percent of patients had a central venous catheter intervention performed. Seventy-nine percent of patients were treated with trimethoprim/sulfamethoxazole (TMP/SMX). Patients with central venous catheter intervention had significantly better survival than those without (HR: 0.16 [95% CI: 0.03-0.73]). Severe haematological disease and patients, who received intensive care unit (ICU) care, were at higher risk of death than other patients (HR: 5.93 [95% CI: 1.18 - 29.94] and HR: 8.37 [95% CI: 1.79 - 39.20], respectively). We found no evidence that any antibiotic regime was superior with regard to 90-day mortality. CONCLUSIONS We did not find evidence to support a change in the current standard-of-care regimen of TMP/SMX and CVC removal. Larger clinical trials are needed to guide such recommendations.
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Affiliation(s)
- Magnus G Ahlström
- Department of Clinical Microbiology 9301, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology 9301, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Frederik Boëtius Hertz
- Department of Clinical Microbiology 9301, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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7
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Ronit A, Omland LH, Kronborg G, Pedersen G, Nielsen L, Mohey R, Wiese L, Obel N, Ahlström MG. Incidence of chronic obstructive pulmonary disease in people with HIV, their parents and siblings in Denmark. J Infect Dis 2021; 225:492-501. [PMID: 34260725 DOI: 10.1093/infdis/jiab369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People with HIV (PWH) may be at increased risk of several respiratory syndromes including chronic obstructive pulmonary disease (COPD). In matched cohort studies, we examined risk factors for COPD in PWH, their parents and siblings compared with population controls. METHODS Using data from national registries, competing risk regression models were constructed and used to calculate adjusted hazard ratios (aHR) for COPD. We evaluated the effect of HIV characteristics, smoking and educational attainment on COPD incidence in PWH. RESULTS A total of 226 PWH and 1029 population controls were diagnosed with COPD during 63,661 and 562,171 person years of follow up. PWH had increased risk of being diagnosed with COPD compared to controls (aHR 2.02 [95%CI: 1.75-2.33]). Parents and siblings of PWH were also more likely to be diagnosed with COPD compared to controls. CD4+ T-cell counts were not associated with COPD, but both unsuppressed viral replication, smoking status and educational attainment were associated with COPD in PWH. No COPD diagnoses were registered in PWH with high educational attainment and absence of smoking. CONCLUSIONS PWH have an increased risk of being diagnosed with COPD, as have their parents and siblings. This seems to be driven primarily by smoking and low socioeconomic status.
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Affiliation(s)
- Andreas Ronit
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre,Denmark
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigsh ospitalet,Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre,Denmark
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg,Denmark
| | - Lars Nielsen
- Department of Infectious Diseases, Hillerød University Hospital, Hillerød,Denmark
| | - Rajesh Mohey
- Department of Infectious Diseases, Herning University Hospital, Herning,Denmark
| | - Lothar Wiese
- Department of Internal Medicine, Division of Infectious Diseases, Zealand University Hospital, Roskilde,Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigsh ospitalet,Denmark
| | - Magnus G Ahlström
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Denmark
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Ahlström MG, Uter W, Ahlström MG, Johansen JD. Decrease of contact allergy to hydroxyisohexyl 3-cyclohexene carboxaldehyde in Europe prior to its ban and diagnostic value. Contact Dermatitis 2021; 84:419-422. [PMID: 33453125 DOI: 10.1111/cod.13786] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) has been the most reported fragrance chemical for two decades and will be prohibited in cosmetic products from August 2021. OBJECTIVES To describe the time trend of HICC contact allergy in European patients with dermatitis in 2009 to 2019, and the added value of testing HICC separately in the baseline series. METHODS Data were reviewed for 124 472 patients with dermatitis who were patch tested with HICC 5% pet. in the baseline series in the European Surveillance System on Contact Allergy (ESSCA) network (2009 to 2018) and at the Herlev-Gentofte Hospital Department of Dermatology and Allergy (2009 to 2019). RESULTS Contact allergy to HICC was found in 1.98% of 9865 patients in Gentofte and 1.62% of 114 607 patients in the ESSCA network. Overall, the prevalence decreased annually, with 0.156 percentage points (P = .001) in Gentofte and 0.051 percentage points (P = .0002) in ESSCA. The frequency of missed contact allergy to HICC when testing only with fragrance mix II (FMII) was 0.17% (17/9865) and 0.35% (405/114607) of the whole test population in the Gentofte and ESSCA populations, respectively. CONCLUSIONS This is the first study to demonstrate a significant decline in HICC allergy in European patients with dermatitis, most likely attributed to the upcoming European ban.
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Affiliation(s)
- Malin G Ahlström
- Department of Dermatology and Allergy, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
| | - Magnus G Ahlström
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jeanne D Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Ronit A, Berg RMG, Bay JT, Haugaard AK, Ahlström MG, Burgdorf KS, Ullum H, Rørvig SB, Tjelle K, Foss NB, Benfield T, Marquart HV, Plovsing RR. Compartmental immunophenotyping in COVID-19 ARDS: A case series. J Allergy Clin Immunol 2020; 147:81-91. [PMID: 32979342 PMCID: PMC7581505 DOI: 10.1016/j.jaci.2020.09.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 12/18/2022]
Abstract
Background Severe immunopathology may drive the deleterious manifestations that are observed in the advanced stages of coronavirus disease 2019 (COVID-19) but are poorly understood. Objective Our aim was to phenotype leukocyte subpopulations and the cytokine milieu in the lungs and blood of critically ill patients with COVID-19 acute respiratory distress syndrome (ARDS). Methods We consecutively included patients less than 72 hours after intubation following informed consent from their next of kin. Bronchoalveolar lavage fluid was evaluated by microscopy; bronchoalveolar lavage fluid and blood were assessed by 10-color flow cytometry and a multiplex cytokine panel. Results Four mechanically ventilated patients (aged 40-75 years) with moderate-to-severe COVID-19 ARDS were included. Immature neutrophils dominated in both blood and lungs, whereas CD4 and CD8 T-cell lymphopenia was observed in the 2 compartments. However, regulatory T cells and TH17 cells were found in higher fractions in the lung. Lung CD4 and CD8 T cells and macrophages expressed an even higher upregulation of activation markers than in blood. A wide range of cytokines were expressed at high levels both in the blood and in the lungs, most notably, IL-1RA, IL-6, IL-8, IP-10, and monocyte chemoattactant protein-1, consistent with hyperinflammation. Conclusion COVID-19 ARDS exhibits a distinct immunologic profile in the lungs, with a depleted and exhausted CD4 and CD8 T-cell population that resides within a heavily hyperinflammatory milieu.
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Affiliation(s)
- Andreas Ronit
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ronan M G Berg
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine and PET and Centre for Physical Activity Research, University of Copenhagen, Copenhagen, Denmark; Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Jakob T Bay
- Department of Clinical Immunology, University of Copenhagen, Copenhagen, Denmark
| | - Anna K Haugaard
- Department of Clinical Immunology, University of Copenhagen, Copenhagen, Denmark
| | - Magnus G Ahlström
- Department of Clinical Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | - Henrik Ullum
- Department of Clinical Immunology, University of Copenhagen, Copenhagen, Denmark
| | - Sara B Rørvig
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Tjelle
- Department of Anesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai B Foss
- Department of Anesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Ronni R Plovsing
- Department of Anesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
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10
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Ahlström MG, Ronit A, Omland LH, Vedel S, Obel N. Algorithmic prediction of HIV status using nation-wide electronic registry data. EClinicalMedicine 2019; 17:100203. [PMID: 31891137 PMCID: PMC6933258 DOI: 10.1016/j.eclinm.2019.10.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Late HIV diagnosis is detrimental both to the individual and to society. Strategies to improve early diagnosis of HIV must be a key health care priority. We examined whether nation-wide electronic registry data could be used to predict HIV status using machine learning algorithms. METHODS We extracted individual level data from Danish registries and used algorithms to predict HIV status. We used various algorithms to train prediction models and validated these models. We calibrated the models to mimic different clinical scenarios and created confusion matrices based on the calibrated models. FINDINGS A total 4,384,178 individuals, including 4,350 with incident HIV, were included in the analyses. The full model that included all variables that included demographic variables and information on past medical history had the highest area under the receiver operating characteristics curves of 88·4% (95%CI: 87·5% - 89·4%) in the validation dataset. Performance measures did not differ substantially with regards to which machine learning algorithm was used. When we calibrated the models to a specificity of 99·9% (pre-exposure prophylaxis (PrEP) scenario), we found a positive predictive value (PPV) of 8·3% in the full model. When we calibrated the models to a sensitivity of 90% (screening scenario), 384 individuals would have to be tested to find one undiagnosed person with HIV. INTERPRETATION Machine learning algorithms can learn from electronic registry data and help to predict HIV status with a fairly high level of accuracy. Integration of prediction models into clinical software systems may complement existing strategies such as indicator condition-guided HIV testing and prove useful for identifying individuals suitable for PrEP. FUNDING The study was supported by funds from the Preben and Anne Simonsens Foundation, the Novo Nordisk Foundation, Rigshospitalet, Copenhagen University, the Danish AIDS Foundation, the Augustinus Foundation and the Danish Health Foundation.
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Ahlström MG, Knudsen A, Ullum H, Gerstoft J, Kjaer A, Lebech AM, Hasbak P, Obel N. Association between smoking status assessed with plasma-cotinine and inflammatory and endothelial biomarkers in HIV-positive and HIV-negative individuals. HIV Med 2018; 19:679-687. [DOI: 10.1111/hiv.12647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- MG Ahlström
- Department of Infectious Diseases; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - A Knudsen
- Department of Infectious Diseases; Copenhagen University Hospital; Hvidovre Denmark
| | - H Ullum
- Department of Clinical Immunology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - J Gerstoft
- Department of Infectious Diseases; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - A Kjaer
- Department of Nuclear Physiology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - A-M Lebech
- Department of Infectious Diseases; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - P Hasbak
- Department of Nuclear Physiology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - N Obel
- Department of Infectious Diseases; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
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Faurschou M, Ahlström MG, Lindhardsen J, Obel N, Baslund B. Risk of Diabetes Mellitus among Patients Diagnosed with Giant Cell Arteritis or Granulomatosis with Polyangiitis: Comparison with the General Population. J Rheumatol 2016; 44:78-83. [PMID: 27744394 DOI: 10.3899/jrheum.160797] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Patients with organ- or life-threatening vasculitis receive high cumulative glucocorticoid (GC) doses during their disease course. GC have diabetogenic effects, but the risk of diabetes mellitus (DM) related to vasculitis therapy is not well characterized. We assessed the DM risk among patients diagnosed with giant cell arteritis (GCA) or granulomatosis with polyangiitis (GPA), i.e., patients with relatively common forms of systemic vasculitis. METHODS We used Danish healthcare registries to identify 1682 patients diagnosed with GCA and 342 patients diagnosed with GPA from 1997 to 2015 and to obtain information regarding medication exposures. Each patient with vasculitis was matched with 9 population controls. Date of new-onset DM was defined as date of first claimed prescription for an antidiabetic drug. We used Cox regression analyses to calculate incidence rate ratios (IRR) for DM as a measure of the DM risk among patients relative to population controls. Logistic regression was used to study the association between prednisolone/prednisone (PRED) dose and DM. RESULTS Median duration of followup was 6.5 years [interquartile range (IQR) 2.6-10.4] in the GCA cohort and 5.8 years (IQR 1.7-10.6) in the GPA cohort. During the first year after diagnosis of vasculitis, the IRR for DM was 7.0 (95% CI 5.2-9.3) among patients with GCA and 10.4 (95% CI 4.4-24) among patients with GPA. IRR for DM were not significantly increased in either cohort during later followup periods. Within the first year, treatment with high cumulative prednisolone/PRED doses was associated with new-onset DM among the patients with vasculitis. CONCLUSION Patients diagnosed with GCA or GPA have a markedly increased risk of new-onset DM during early treatment phases.
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Affiliation(s)
- Mikkel Faurschou
- From the Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. .,M. Faurschou, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; M.G. Ahlström, MD, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet; J. Lindhardsen, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; N. Obel, Professor, MD, DMSci, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet; B. Baslund, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases.
| | - Magnus G Ahlström
- From the Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,M. Faurschou, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; M.G. Ahlström, MD, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet; J. Lindhardsen, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; N. Obel, Professor, MD, DMSci, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet; B. Baslund, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases
| | - Jesper Lindhardsen
- From the Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,M. Faurschou, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; M.G. Ahlström, MD, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet; J. Lindhardsen, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; N. Obel, Professor, MD, DMSci, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet; B. Baslund, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases
| | - Niels Obel
- From the Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,M. Faurschou, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; M.G. Ahlström, MD, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet; J. Lindhardsen, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; N. Obel, Professor, MD, DMSci, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet; B. Baslund, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases
| | - Bo Baslund
- From the Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,M. Faurschou, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; M.G. Ahlström, MD, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet; J. Lindhardsen, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; N. Obel, Professor, MD, DMSci, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet; B. Baslund, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases
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Faurschou M, Ahlström MG, Lindhardsen J, Baslund B, Obel N. Impact of pre-existing co-morbidities on mortality in granulomatosis with polyangiitis: a cohort study. Rheumatology (Oxford) 2015; 55:649-53. [PMID: 26615030 DOI: 10.1093/rheumatology/kev390] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess the impact of pre-existing co-morbidities on mortality among patients affected by granulomatosis with polyangiitis (GPA). METHODS By means of the Danish National Hospital Register, we identified a cohort of patients hospitalized for GPA during 1994-2010 (n = 308). The burden of pre-existing co-morbidities among the patients was quantified according to the Charlson Comorbidity Index (CCI). Each patient was matched with five age- and gender-matched population controls with no pre-existing co-morbidities captured by the CCI (CCI score = 0). The study subjects were followed throughout 2010. Cox regression analyses were used to calculate mortality rate ratios (MRRs). RESULTS The median duration of follow-up in the GPA cohort was 5.8 years (interquartile range 2.3-10.0). Compared with their matched population controls, the MRR for patients presenting with a CCI score of 0 (n = 246) was 3.9 (95% CI 2.0, 7.5) during years 0-2 and 1.4 (95% CI 0.9, 2.0) from the second year of follow-up onwards. The corresponding MRRs were 13.3 (95% CI 5.8, 31) and 1.9 (95% CI 1.1, 3.6) for patients with a CCI score ⩾1 (n = 62). In a direct comparison, GPA patients with a CCI score ⩾1 were found to have significantly higher mortality than GPA patients with a CCI score of 0 during years 0-2 [adjusted MRR 3.4 (95% CI 1.6, 7.0)] but not after >2 years of follow-up [adjusted MRR 1.3 (95% CI 0.7, 2.6)]. CONCLUSION During early follow-up periods, the mortality among GPA patients with pre-existing co-morbidities is markedly higher than that among GPA patients with no pre-existing illnesses. Our analyses identify an increased CCI score for pre-existing co-morbidities as an important risk factor for a fatal outcome in GPA.
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Affiliation(s)
| | - Magnus G Ahlström
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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