Causes of death in PM/DM in-patients.

<p>Causes of death in PM/DM in-patients.</p

Hospitalization mortality and associated risk factors in patients with polymyositis and dermatomyositis: A retrospective case-control study

<div><p>Background</p><p>Polymyositis and dermatomyositis (PM/DM) are systemic autoimmune diseases with multiple organ involvements that manifest as muscular and cutaneous disorders, interstitial lung disease (ILD) and malignancies. However, information concerning the outcomes and associated factors for PM/DM patients who are hospitalized is limited.</p><p>Methods</p><p>We retrospectively reviewed the medical charts of PM/DM patients admitted to a Chinese tertiary referral hospital (Peking Union Medical College Hospital, PUMCH) from 2008 to 2014. The deceased group included 63 patients who had “deceased discharge” status or were confirmed to have died within two weeks of hospital discharge. The demographic data, clinical manifestations, and direct causes of death were analyzed retrospectively. Medical records for 126 age- and sex-matched PM/DM patients were selected as controls from 982 inpatients successively admitted to the same center during the same period. In addition to the comparison of clinical manifestations between the two groups, binary logistic regression was conducted to explore the risk factors related to PM/DM mortality.</p><p>Results</p><p>Over the past 6 years at PUMCH, the in-hospital mortality rate of PM/DM patients was 4.58%. The male gender and the elder patients had a high risk of death (P = 0.031 and P = 0.001 respectively). The three most frequent causes of death for PM/DM patients were pulmonary infection (35%), ILD exacerbation (21%) or both conditions (25%). Pulmonary infection (P<0.001, OR = 5.63, 95% CI, 2.37–13.36), pneumomediastinum (P = 0.041, OR = 11.02, 95%CI, 1.10–110.54), Gottron’s papules (P = 0.010, OR = 3.24, 95%CI, 1.32–7.97), and elevated erythrocyte sedimentation rate (ESR) (P = 0.005, OR = 9.9, 95%CI 2.0–49.0) were independent risk factors for in-hospital mortality of PM/DM patients.</p><p>Conclusion</p><p>PM/DM patients continue to display high in-hospital mortality. Pulmonary infection is the strongest predictor of poor prognosis in PM/DM patients, followed by pneumomediastinum, Gottron’s papules, and elevated ESR.</p></div

Multivariate logistic regression analysis of risk factors for death of PM/DM patients.

<p>Multivariate logistic regression analysis of risk factors for death of PM/DM patients.</p

Comparison of clinical manifestations between deceased and control PM/DM patients [x ± SD or n (%)].

<p>Comparison of clinical manifestations between deceased and control PM/DM patients [x ± SD or n (%)].</p

Associations between TNF-α-308A/G Polymorphism and Susceptibility with Dermatomyositis: A Meta-Analysis

<div><p>Background</p><p>Some surveys had inspected the effects of the tumor necrosis factor-α (TNF-α)-308A/G polymorphism on susceptibility to dermatomyositis (DM), and showed mixed results. To briefly review these consequences, a comprehensive meta-analysis was carried out to estimate the relationship between them much more accurately.</p><p>Methods</p><p>Relevant documents dated to February 2014 were acquired from the PUBMED, MEDLINE, and EMBASE databases. The number of the genotypes and/or alleles for the TNF-α-308A/G in the DM and control subjects was extracted and statistical analysis was conducted using STATA 11.2 software. Summary odds ratios (ORs) with their 95% confidence intervals (95% CIs) were used to calculate the risk of DM with TNF-α-308A/G. Stratified analysis based on ethnicity and control population source was also performed.</p><p>Results</p><p>555 patients with DM and 1005 controls from eight published investigations were finally involved in this meta-analysis. Combined analysis revealed that the overall ORs for the TNF-α-308A allele were 2.041 (95% CIs 1.528–2.725, P<0.0001) in DM. Stratification by ethnicity indicated the TNF-α-308A allele polymorphism was found to be significantly associated with DM in Europeans (OR = 1.977, 95% CI 1.413–2.765, P<0.0001). The only study conducted on TNF-α-308A/G polymorphism in Asians could not be used in ethnicity-stratified meta-analysis. Meta-analysis of the AA+AG vs. GG (dominant model) and AA vs. GG (additive model) of this polymorphism revealed a significant association with DM in overall populations and Europeans.</p><p>Conclusions</p><p>Our meta-analysis demonstrated that the TNF-α-308A/G polymorphism in the TNF gene might contribute to DM susceptibility, especially in European population. However, further studies with large sample sizes and among different ethnicity populations should be required to verify the association.</p></div

Begg’s funnel plot for publication bias test (AA vs. GG).

<p>Begg’s funnel plot for publication bias test (AA vs. GG).</p

Allele and genotype distribution of the <i>TNFAIP3</i>, <i>IRF5</i>, <i>IFIH1</i> gene markers in PM/DM patients and controls.

<p>PM: polymyositis; DM: dermatomyositis; OR: odds ratio; CI: confidence interval; χ²: Chi-square test; <i>P_c</i>: <i>P</i> value corrected by Bonferroni method; NA: not available;</p><p>*: the P value of genotypic analysis was calculated under the logistic regression analysis;</p>#<p>: This research's result demonstrated that rs5029939 GG genotype in PM patients was 0. We failed to calculate its genotypic frequency.</p><p>Allele and genotype distribution of the <i>TNFAIP3</i>, <i>IRF5</i>, <i>IFIH1</i> gene markers in PM/DM patients and controls.</p

Flow diagram of included/excluded studies.

<p>Flow diagram of included/excluded studies.</p

Characteristics of the studies and populations included in the meta-analysis.

<p>Author: first author’s name, <i>Ref:</i> reference; Year: Publication year; USA: United States of America, UK: United Kingdom, E: European, A: Asian; SOC: source of control, HB: hospital-based, PB: population-based; NS no significant; P_HWE: P value of Hardy-Weinberg equilibrium, chi-square test; *Power calculations assume α = 0.05, OR = 1.5.</p

The results of sensitivity analysis from random-effects estimates. (A allele vs. G allele).

<p>The results of sensitivity analysis from random-effects estimates. (A allele vs. G allele).</p