PDF(Pubmed)
Abstract：
Delayed diagnosis of common variable immunodeficiency (CVID) remains a serious problem. We investigated whether some diseases diagnosed during out-patient visits or admission to hospitals could act as indicator conditions for CVID diagnosis.
In this nested case-control study, we identified 128 cases diagnosed with CVID in Denmark (1999-2013) and 640 age-, gender-, and region-matched controls. We obtained data on diseases diagnosed at hospitals in the five years before CVID diagnosis from The National Hospital Registry. We grouped hospital diagnoses in 33 major disease categories and 210 subcategories. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (CI) to estimate associations between disease exposure and subsequent CVID.
During the five years preceding a CVID diagnosis, cases had four times as many hospital contacts as the controls (p < 0.001). A diagnosis in 18 major disease categories showed a significant OR for subsequent diagnosis of CVID. The most substantial association with a subsequent CVID diagnosis was a diagnosis of lower respiratory tract infections (OR: 29.9; 95% CI: 14.2-63.2) and lung diseases (35.1; 15.0-82.5). We observed a similar association when we removed the last year before diagnosis from analysis and overall, in the years < 1, ≥ 1-3, and ≥ 3-5 before diagnosis, although the absolute number of exposures was small. Twenty-eight specific diseases displayed an at least 3-fold risk of subsequent CVID diagnosis.
Targeted screening for antibody deficiency in patients diagnosed with specific diseases associated with CVID may lead to earlier CVID diagnosis and treatment and thereby potentially reduced morbidity and mortality.
In this nested case-control study, we identified 128 cases diagnosed with CVID in Denmark (1999-2013) and 640 age-, gender-, and region-matched controls. We obtained data on diseases diagnosed at hospitals in the five years before CVID diagnosis from The National Hospital Registry. We grouped hospital diagnoses in 33 major disease categories and 210 subcategories. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (CI) to estimate associations between disease exposure and subsequent CVID.
During the five years preceding a CVID diagnosis, cases had four times as many hospital contacts as the controls (p < 0.001). A diagnosis in 18 major disease categories showed a significant OR for subsequent diagnosis of CVID. The most substantial association with a subsequent CVID diagnosis was a diagnosis of lower respiratory tract infections (OR: 29.9; 95% CI: 14.2-63.2) and lung diseases (35.1; 15.0-82.5). We observed a similar association when we removed the last year before diagnosis from analysis and overall, in the years < 1, ≥ 1-3, and ≥ 3-5 before diagnosis, although the absolute number of exposures was small. Twenty-eight specific diseases displayed an at least 3-fold risk of subsequent CVID diagnosis.
Targeted screening for antibody deficiency in patients diagnosed with specific diseases associated with CVID may lead to earlier CVID diagnosis and treatment and thereby potentially reduced morbidity and mortality.
摘要：
目的：常见可变免疫缺陷（CVID）的延迟诊断仍然是一个严重的问题。我们调查了在门诊就诊或入院期间诊断出的某些疾病是否可以作为CVID诊断的指标条件。
方法：在这项嵌套病例对照研究中，我们在丹麦（1999-2013）确定了128例诊断为CVID的病例，年龄为640，性别-,和区域匹配的控件。我们从国家医院登记处获得了CVID诊断前五年在医院诊断的疾病数据。我们将医院诊断分为33种主要疾病类别和210种子类别。我们使用条件逻辑回归来计算比值比（OR）和95％置信区间（CI），以估计疾病暴露与随后的CVID之间的关联。
结果：在CVID诊断之前的五年中，病例的医院接触人数是对照组的4倍(p<0.001).在18种主要疾病类别中的诊断显示，对于随后的CVID诊断具有显着的OR。与随后的CVID诊断最重要的关联是诊断为下呼吸道感染（OR：29.9;95％CI：14.2-63.2）和肺部疾病（35.1;15.0-82.5）。当我们从分析和总体上删除诊断前的最后一年时，我们观察到了类似的关联，在诊断前<1、≥1-3和≥3-5年，尽管暴露的绝对数量很少。28种特定疾病显示出随后的CVID诊断的至少3倍风险。
结论：在诊断为与CVID相关的特定疾病的患者中进行抗体缺乏的靶向筛查可能导致更早的CVID诊断和治疗，从而可能降低发病率和死亡率。
方法：在这项嵌套病例对照研究中，我们在丹麦（1999-2013）确定了128例诊断为CVID的病例，年龄为640，性别-,和区域匹配的控件。我们从国家医院登记处获得了CVID诊断前五年在医院诊断的疾病数据。我们将医院诊断分为33种主要疾病类别和210种子类别。我们使用条件逻辑回归来计算比值比（OR）和95％置信区间（CI），以估计疾病暴露与随后的CVID之间的关联。
结果：在CVID诊断之前的五年中，病例的医院接触人数是对照组的4倍(p<0.001).在18种主要疾病类别中的诊断显示，对于随后的CVID诊断具有显着的OR。与随后的CVID诊断最重要的关联是诊断为下呼吸道感染（OR：29.9;95％CI：14.2-63.2）和肺部疾病（35.1;15.0-82.5）。当我们从分析和总体上删除诊断前的最后一年时，我们观察到了类似的关联，在诊断前<1、≥1-3和≥3-5年，尽管暴露的绝对数量很少。28种特定疾病显示出随后的CVID诊断的至少3倍风险。
结论：在诊断为与CVID相关的特定疾病的患者中进行抗体缺乏的靶向筛查可能导致更早的CVID诊断和治疗，从而可能降低发病率和死亡率。
