Incidence and mortality rates of varicella among end stage renal disease (ESRD) patients in Singapore General Hospital, a 12-year review

Abstract Background End stage renal disease (ESRD)/ end stage renal failure (ESRF) is on the rise globally and especially in Singapore. Varicella or chickenpox is not uncommon among adults especially ESRD/ESRF patients. It has been reported to cause complications and even death among immunocompetent adults. Methods A retrospective data collection on patients with varicella infection and ESRD in Singapore General Hospital (SGH) from the year 2005 to 2016 was performed. Continuous data and categorical data were summarized as median (range) and count (%) respectively. The association of health care utilization (total length of hospital stay, readmission related to varicella, intensive care unit admission) and mortality with complication due to varicella were tested using chi-square and Mann-Whitney test for categorical and continuous outcomes respectively. Results Sixty-six patients with ESRD developed varicella during the study period (2005–2016). The case incidence rates for varicella among ESRD ranges from 97 to 267 per 100,000 populations with ESRD yearly. There were 9 deaths (13.6%). Mortality was higher among the ESRD patients with one or more varicella complications compared to patients without complications ((25% vs 7.1%, 95% CI for difference: − 1.1%, 36.9%, p = .063). Likewise, utilisation of intensive or high dependency units were higher among patients with complications compared to those without (20.8% vs 2.4%, 95% CI for difference: 1.6%, 35.3%, p = .012). Length of stay was twice as long in the group with complications compared to patients without (median (IQR) days: 14 (8, 21) vs 7 (5, 14), p = .065), although it did not reach statistical significance. Conclusions Varicella is associated with high morbidity and significant mortality rate in ESRD patients. Varicella vaccination is recommended for seronegative ESRD patients

The effect of pre-operative methylprednisolone on the incidence of delayed graft function in renal transplantation

Introduction: This study explores the effect of different corticosteroid administration timings on the incidence of slow/delayed graft function. Methods: One hundred and twelve kidney transplants from January 2011 to March 2014 were retrospectively analysed. Thirty-six cases were excluded because they were donor-specific antibody positive ( n =16), received thymoglobulin/plasma exchange ( n =11), were ABO-incompatible ( n =6) or suffered graft loss from vascular thrombosis within the first week post-transplant ( n =3). The study period straddled three eras of corticosteroid administration, from intra-operative intravenous (IV) hydrocortisone (Era 1; n =26), to intra-operative IV methylprednisolone (Era 2; n =38) and pre-operative IV methylprednisolone (Era 3; n =12). The primary endpoint was the incidence of slow/delayed graft function. Secondary outcomes included estimated glomerular filtration rate at discharge and 120 and 365 days, rejection (acute and one-year), wound complications, post-transplant diabetes, increase in low-density lipoprotein or body mass index, and cytomegalovirus or BK viraemia within one year. Results: On univariate analysis, pre-operative methylprednisolone was associated with lower incidence of slow/delayed graft function (17%, 55%, 58% in Eras 3, 2, 1 respectively; p =0.041), superior estimated glomerular filtration rate at discharge (median 56, 37 and 43 ml/min for Eras 3, 2, 1 respectively; p =0.033) and at 120 days (median 60, 52, and 46 ml/min for Eras 3, 2, 1 respectively; p =0.017). On multivariate analysis, pre-operative IV methylprednisolone ( vs . Eras 1 and 2 combined; odds ratio 4.79 (90% confidence interval 1.16–19.80); p =0.07) and living donor type ( vs . deceased; odds ratio 5.56 (90% confidence interval 2.25–13.77); p =0.002) were associated with lower incidence of slow/delayed graft function. Conclusion: Pre-operative methylprednisolone was associated with reduced slow/delayed graft function and improved early estimated glomerular filtration

Basal serum anti-müllerian hormone and antral follicle count are predictors of ovarian response for Asian women in Singapore

Objective: To determine the basal ovarian reserve markers for prediction of poor and high responses and clinical pregnancy outcome in subfertile Asian women requiring controlled ovarian stimulation (COS) treatment in Singapore. Methods: Subfertile Asian women, aged ≤40 with basal serum follicle stimulating hormone (FSH) level of ≤12 IU/L, were enrolled prospectively during routine preliminary endocrine ovarian reserve assessment prior to COS regime for intracytoplasmic sperm insemination (ICSI) cycles. Basal serum levels of the endocrine ovarian reserve markers (anti-Müllerian hormone (AMH), estradiol, FSH, luteinizing hormone), antral follicle count (AFC) and ovarian response parameters were compared between the Poor (retrieved oocytes ≤4), Normal (retrieved oocytes, 5 to 19) and High Responder (retrieved oocytes ≥20) groups of women. Results: Basal serum AMH and AFC were significantly correlated to age (r =−0.213 and −0.243, respectively) and to the number of retrieved oocytes (r=0.570 and 0.523, respectively) (P<0.05). Both basal serum AMH and AFC were significant discriminators of poor response (cut-off levels of ≤2.0 µg/L and ≤12, respectively) and for high response (AMH ≥3.2 µg/L and AFC of ≥20, respectively) to COS. Basal AMH was the only significant predictor for clinical pregnancy outcome, ROCAUC =0.71, cut-off level of ≥3.0 µg/L and odds ratio of 1.42. Conclusion: Both basal serum AMH and AFC were reliable ovarian reserve markers for predicting poor and high ovarian response to COS in Asian women. Basal AMH was the only significant predictor for clinical pregnancy outcome