Ali, Akbar Shoukat

Allana, Raheel

Jandani, Rahim

English

eCommons@AKU

eCommons@AKU Department of Medicine Department of Medicine 3-2020 Remarks about the study on infection-associated relapses in children with nephrotic syndrome: A short-term outcome study Akbar Shoukat Ali Aga Khan University, akbar.shoukatali@aku.edu Raheel Allana Dow University of Health Sciences, Karachi, Pakistan Rahim Jandani Institute of Nursing, Dow University of Health Sciences, Karachi, Pakistan Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_med_med  Part of the Nephrology Commons, and the Pediatrics Commons Recommended Citation Ali, A. S., Allana, R., Jandani, R. (2020). Remarks about the study on infection-associated relapses in children with nephrotic syndrome: A short-term outcome study. Saudi Journal of Kidney Diseases and Transplantation, 31(2), 561-562. Available at: https://ecommons.aku.edu/pakistan_fhs_mc_med_med/617 Saudi J Kidney Dis Transpl 2020;31(2):561-562© 2020 Saudi Center for Organ TransplantationLetter to the EditorRemarks about the Study on Infection-Associated Relapses in Childrenwith Nephrotic Syndrome: A Short-term Outcome StudyTo the Editor,  Lately, we had the privilege to read theoriginal article entitled, “Infection associatedRelapses in Children with Nephrotic Syndrome:A Short-term Outcome Study” published inthe Saudi Journal of Kidney Diseases andTransplantation [Saudi J Kidney Dis Transpl.2019;30(6):1245-53] by Mukta Mantan andSrijan Singh.1 Here, we would draw the oppor-tunity to extend the felicitation to the authorsfor their publication and scientific contribution.  The main objective of the study was toascertain the proportion of infection-triggerednephrotic syndromes in children that resolveon therapeutic management of acute infection.Indeed, authors have touched on an area wherescientific literature is still gray and needsblack-and-white certainties. However, we hadconcern regarding the statistical interpretationof the published article. Although authorsaptly used the concept of odds ratio (OR)based on prospective observational nature ofthe study, interpretation in results, discussionand conclusion is not complementing thefindings observed through OR and corres-ponding 95% confidence interval (CI). Wewould address our query with the help ofscientific evidence on how to interpret ORkeeping in mind the 95% CI.  In the results section (page 1249) under theheading of “Remission achieved,” 3rd para-graph and discussion section (page 1251, 4thparagraph); authors mention that “The childrenwith upper respiratory tract infections (URTIs)were less likely to achieve remission (OR1.14)” and “URTIs had lower odds of achievingspontaneous remission,” respectively. This wasperhaps reported by authors in the context ofvery first finding of Table 5 (page 1250)where OR of acute respiratory tract infectionsis 1.14 with 95%CI of 0.41–3.22. The interpre-tation in results and discussion is perhapsmisleading.  If the CI for the OR contains 1 then thecalculated OR would not be regarded asstatistically significant. An OR >1 suggestshigher odds of spontaneous remission; an OR<1 indicates lower odds of spontaneous remis-sion; and an OR = 1 implies either (higher orlower) odds of spontaneous remission.2 Hence,if the CI possesses 1 [e.g., acute respiratorytract infection (0.41–3.22), includes 1 in theCI], then, the estimated OR of the true popu-lation might be higher or lower than 1. Hence,it is not certain whether the children with acuterespiratory tract infections are more or lesslikely to achieve spontaneous remission basedon 95% CI.  Finally, the conclusion of the study (page1252, last paragraph) also remarks, withreference to 4th finding of Table 5 (page 1250)and discussion (page 1251, 4th paragraph), that“pneumonia is more likely to achieve remis-sion with treatment of the underlying infec-tion.” The OR of pneumonia is 3 with 95% CIof 0.21–42.62. Yet again, there is overlapping1 in the 95% CI (concept explained above withSaudi Journalof Kidney Diseasesand Transplantation[Downloaded free from http://www.sjkdt.org on Sunday, July 19, 2020, IP: 39.44.176.226]reference); therefore, even high OR of 3 is notstatistically significant to conclude thatchildren with pneumonia are more likely toachieve remission with treatment of theunderlying infection.  We emphasize that the interpretation of ORmust be cautiously done by simultaneouslyconsidering the value of 95% CI. We would bemore than happy to receive the reply on ourcomments from the respected authors.Conflict of interest: None declared.Mr. Akbar Shoukat Ali1,2,Dr. Raheel Allana1,2,Mr. Rahim Jandani31School of Public Health, Dow University ofHealth Sciences, 2Department of Medicine,Aga Khan University,3,Institute of Nursing,Dow University of Health Sciences, Karachi,PakistanE-mail: akber.shoukat.ali@gmail.comReferences1. Manta M, Singh S. Infection associated relapsesin children with nephrotic syndrome: A short-term outcome study. Saudi J Kidney DisTranspl 2019;30:1245-53.2. Tenny S, Hoffman MR. Odds ratio (OR). In:StatPearlsTreasure Island (FL): StatPearlsPublishing; 2019.Date of manuscript receipt: 2 February 2020.Date of final acceptance: 2 February 2020.Author’s ReplyTo the Editor,  We thank Mr. Akbar Ali, Dr. Raheel Allanaand Mr. Rahim Jandani for their comments onour article entitled “Infection associatedRelapses in Children with Nephrotic Syndrome:A Short-term Outcome Study.”1 We agreewith their comments that OR should be inter-preted with caution when the 95% confidenceinterval (CI) tends to include 1. This usuallyoccurs when the sample size is small.2As thesample size calculation was for all infectionscombined and not for individual infections inour study this variation occurred.  The odds of attaining remission with pneu-monia, spontaneous bacterial peritonitis, anddiarrhea were much higher than those withacute respiratory tract infections despite the95% CI being wide. As larger proportion ofchildren with bacterial infections attainedspontaneous remission in the study comparedto upper respiratory tract infections the oddsratios appeared to have a clinical significancethough not statistically significant.  In single-center studies with small samplesize of uncommon conditions these observa-tions often provide suggestions for futurestudies on the topic with larger sample sizeand possibly multicentric study design. Hence,we too conclude that while the odds ratioswere not statistically significant the clinicalsignificance of attainment of remission afterbacterial infections needs further evaluation inlarger studies.Dr. Mukta Mantan,Department of Pediatrics, Maulana AzadMedical College and Associated Lok NayakHospital, University of Delhi, New Delhi,India.E-mail: muktamantan@hotmail.comReferences1. Manta M, Singh S. Infection associatedrelapses in children with nephrotic syndrome:A short-term outcome study. Saudi J KidneyDis Transpl 2019;30:1245-53.2. Hazra A. Using the confidence intervalconfidently. J Thorac Dis 2017;9:4125-30.562 Letter to the Editor[Downloaded free from http://www.sjkdt.org on Sunday, July 19, 2020, IP: 39.44.176.226]

Remarks about the study on infection-associated relapses in children with nephrotic syndrome: A short-term outcome study

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Remarks about the study on infection-associated relapses in children with nephrotic syndrome: A short-term outcome study

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