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  1. Lupus organ damage: what is damaged in Asian patients?
    Kuan WP, Li EK, Tam LS
    Lupus, 2010 Oct;19(12):1436-41.
    PMID: 20947554 DOI: 10.1177/0961203310370050
    Assessment of organ damage has become the standard outcome measure for morbidity and mortality in patients with lupus. Ethnicity is thought to be a marker for genetic, environmental, behavioral, and other variables that may affect disease outcomes. Previous studies suggest that Asians residing in western countries had significantly higher prevalence of damage compared with Whites. In contrast, studies performed in Chinese, Korean and Arab patients showed that the overall prevalence of damage and the most commonly involved organs (neuropsychiatric and musculoskeletal) were similar to Whites. Compared with their Asian counterparts, Pakistani and Jewish patients appeared to have a higher prevalence of damage, most likely secondary to longer disease duration. Chinese patients had an increased prevalence of premature gonadal failure, whereas patients residing in western and southern Asia had more skin damage. When compared with Whites, Asian patients had more renal damage but less ocular and cardiovascular damage. Risk factors associated with organ damage in Asian lupus patients included older age, higher disease activity, and the use of cyclophosphamide and steroids. Further investigations into other determinants such as genetic predisposition, socioeconomic factors, prevalence and severity of disease manifestations, and treatment, is needed in order to understand the variation in damage accrual in lupus patients from different ethnicities.
    Matched MeSH terms: Multiple Organ Failure/epidemiology
  2. Differences Between Pulmonary and Extrapulmonary Pediatric Acute Respiratory Distress Syndrome: A Multicenter Analysis
    Gan CS, Wong JJ, Samransamruajkit R, Chuah SL, Chor YK, Qian S, et al.
    Pediatr Crit Care Med, 2018 10;19(10):e504-e513.
    PMID: 30036234 DOI: 10.1097/PCC.0000000000001667
    OBJECTIVES: Extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome are poorly described in the literature. We aimed to describe and compare the epidemiology, risk factors for mortality, and outcomes in extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome.

    DESIGN: This is a secondary analysis of a multicenter, retrospective, cohort study. Data on epidemiology, ventilation, therapies, and outcomes were collected and analyzed. Patients were classified into two mutually exclusive groups (extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome) based on etiologies. Primary outcome was PICU mortality. Cox proportional hazard regression was used to identify risk factors for mortality.

    SETTING: Ten multidisciplinary PICUs in Asia.

    PATIENTS: Mechanically ventilated children meeting the Pediatric Acute Lung Injury Consensus Conference criteria for pediatric acute respiratory distress syndrome between 2009 and 2015.

    INTERVENTIONS: None.

    MEASUREMENTS AND MAIN RESULTS: Forty-one of 307 patients (13.4%) and 266 of 307 patients (86.6%) were classified into extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome groups, respectively. The most common causes for extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome were sepsis (82.9%) and pneumonia (91.7%), respectively. Children with extrapulmonary pediatric acute respiratory distress syndrome were older, had higher admission severity scores, and had a greater proportion of organ dysfunction compared with pulmonary pediatric acute respiratory distress syndrome group. Patients in the extrapulmonary pediatric acute respiratory distress syndrome group had higher mortality (48.8% vs 24.8%; p = 0.002) and reduced ventilator-free days (median 2.0 d [interquartile range 0.0-18.0 d] vs 19.0 d [0.5-24.0 d]; p = 0.001) compared with the pulmonary pediatric acute respiratory distress syndrome group. After adjusting for site, severity of illness, comorbidities, multiple organ dysfunction, and severity of acute respiratory distress syndrome, extrapulmonary pediatric acute respiratory distress syndrome etiology was not associated with mortality (adjusted hazard ratio, 1.56 [95% CI, 0.90-2.71]).

    CONCLUSIONS: Patients with extrapulmonary pediatric acute respiratory distress syndrome were sicker and had poorer clinical outcomes. However, after adjusting for confounders, it was not an independent risk factor for mortality.

    Matched MeSH terms: Multiple Organ Failure/epidemiology
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