How to Identify Common Variable Immunodeficiency Patients Earlier: General Practice Patterns

Purpose Diagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP) consultations in individuals diagnosed with CVID within 3 years before the diagnosis and whether the risk of diagnosis was associated with th...

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Veröffentlicht in:	Journal of clinical immunology Jg. 39; H. 7; S. 641 - 652
Hauptverfasser:	Ilkjær, Frederik V., Rasmussen, Line D., Martin-Iguacel, Raquel, Westh, Lena, Katzenstein, Terese L., Hansen, Ann-Brit E., Nielsen, Thyge L., Larsen, Carsten S., Johansen, Isik S.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	New York Springer US 01.10.2019 Springer Nature B.V
Schlagworte:	Adolescent Adult Age of Onset Aged Biomedical and Life Sciences Biomedicine Case-Control Studies Clinical Decision-Making Common variable immunodeficiency Common Variable Immunodeficiency - diagnosis Common Variable Immunodeficiency - epidemiology Comorbidity Delayed Diagnosis Denmark - epidemiology Differential diagnosis Disease Management Early Diagnosis Female General Practice - methods General Practice - standards Humans Immunology Infectious Diseases Internal Medicine Male Medical Microbiology Middle Aged Odds Ratio Original Article Population Surveillance Practice Patterns, Physicians Referral and Consultation Registries Respiratory function Statistical analysis Young Adult Denmark CVID primary health care PID diagnostic delay indicators consultations
ISSN:	0271-9142, 1573-2592, 1573-2592
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Abstract	Purpose Diagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP) consultations in individuals diagnosed with CVID within 3 years before the diagnosis and whether the risk of diagnosis was associated with the frequency of consultations or character of examinations. Methods We conducted a nested case-control study, identifying 132 adult CVID patients and 5940 age- and gender-matched controls from national registers during 1997–2013. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (95%CI). Results The median number of consultations among individuals with CVID was more than twice that of the controls in all 3 years (3rd, 10; 2nd, 11.5; and 1st, 15.4 vs. 4). We found a statistically significant association between the number of consultations and the risk of a subsequent CVID diagnosis, independent of age and gender, but strongest in the individuals < 40 years. In the 3rd year before diagnosis, having 9–15 consultations compared with 1–4 was associated with an OR (95%CI) of 5.0 (2.3–10.9), 2.4 (1.1–5.4), and 1.3 (0.3–5.3) for those aged 18–40, 41–60, and > 60, respectively. Several examinations (i.e., blood tests for inflammation/infection and pulmonary function test) were associated with increased odds of a subsequent CVID diagnosis. Conclusion The risk of a CVID diagnosis was highly related to both the number of consultations and the character of examinations performed by the GP. CVID should be a differential diagnosis among patients with multiple consultations, especially in patients < 40 years old.
AbstractList	PurposeDiagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP) consultations in individuals diagnosed with CVID within 3 years before the diagnosis and whether the risk of diagnosis was associated with the frequency of consultations or character of examinations.MethodsWe conducted a nested case-control study, identifying 132 adult CVID patients and 5940 age- and gender-matched controls from national registers during 1997–2013. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (95%CI).ResultsThe median number of consultations among individuals with CVID was more than twice that of the controls in all 3 years (3rd, 10; 2nd, 11.5; and 1st, 15.4 vs. 4). We found a statistically significant association between the number of consultations and the risk of a subsequent CVID diagnosis, independent of age and gender, but strongest in the individuals < 40 years. In the 3rd year before diagnosis, having 9–15 consultations compared with 1–4 was associated with an OR (95%CI) of 5.0 (2.3–10.9), 2.4 (1.1–5.4), and 1.3 (0.3–5.3) for those aged 18–40, 41–60, and > 60, respectively. Several examinations (i.e., blood tests for inflammation/infection and pulmonary function test) were associated with increased odds of a subsequent CVID diagnosis.ConclusionThe risk of a CVID diagnosis was highly related to both the number of consultations and the character of examinations performed by the GP. CVID should be a differential diagnosis among patients with multiple consultations, especially in patients < 40 years old. Diagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP) consultations in individuals diagnosed with CVID within 3 years before the diagnosis and whether the risk of diagnosis was associated with the frequency of consultations or character of examinations. We conducted a nested case-control study, identifying 132 adult CVID patients and 5940 age- and gender-matched controls from national registers during 1997-2013. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (95%CI). The median number of consultations among individuals with CVID was more than twice that of the controls in all 3 years (3rd, 10; 2nd, 11.5; and 1st, 15.4 vs. 4). We found a statistically significant association between the number of consultations and the risk of a subsequent CVID diagnosis, independent of age and gender, but strongest in the individuals < 40 years. In the 3rd year before diagnosis, having 9-15 consultations compared with 1-4 was associated with an OR (95%CI) of 5.0 (2.3-10.9), 2.4 (1.1-5.4), and 1.3 (0.3-5.3) for those aged 18-40, 41-60, and > 60, respectively. Several examinations (i.e., blood tests for inflammation/infection and pulmonary function test) were associated with increased odds of a subsequent CVID diagnosis. The risk of a CVID diagnosis was highly related to both the number of consultations and the character of examinations performed by the GP. CVID should be a differential diagnosis among patients with multiple consultations, especially in patients < 40 years old. Diagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP) consultations in individuals diagnosed with CVID within 3 years before the diagnosis and whether the risk of diagnosis was associated with the frequency of consultations or character of examinations.PURPOSEDiagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP) consultations in individuals diagnosed with CVID within 3 years before the diagnosis and whether the risk of diagnosis was associated with the frequency of consultations or character of examinations.We conducted a nested case-control study, identifying 132 adult CVID patients and 5940 age- and gender-matched controls from national registers during 1997-2013. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (95%CI).METHODSWe conducted a nested case-control study, identifying 132 adult CVID patients and 5940 age- and gender-matched controls from national registers during 1997-2013. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (95%CI).The median number of consultations among individuals with CVID was more than twice that of the controls in all 3 years (3rd, 10; 2nd, 11.5; and 1st, 15.4 vs. 4). We found a statistically significant association between the number of consultations and the risk of a subsequent CVID diagnosis, independent of age and gender, but strongest in the individuals < 40 years. In the 3rd year before diagnosis, having 9-15 consultations compared with 1-4 was associated with an OR (95%CI) of 5.0 (2.3-10.9), 2.4 (1.1-5.4), and 1.3 (0.3-5.3) for those aged 18-40, 41-60, and > 60, respectively. Several examinations (i.e., blood tests for inflammation/infection and pulmonary function test) were associated with increased odds of a subsequent CVID diagnosis.RESULTSThe median number of consultations among individuals with CVID was more than twice that of the controls in all 3 years (3rd, 10; 2nd, 11.5; and 1st, 15.4 vs. 4). We found a statistically significant association between the number of consultations and the risk of a subsequent CVID diagnosis, independent of age and gender, but strongest in the individuals < 40 years. In the 3rd year before diagnosis, having 9-15 consultations compared with 1-4 was associated with an OR (95%CI) of 5.0 (2.3-10.9), 2.4 (1.1-5.4), and 1.3 (0.3-5.3) for those aged 18-40, 41-60, and > 60, respectively. Several examinations (i.e., blood tests for inflammation/infection and pulmonary function test) were associated with increased odds of a subsequent CVID diagnosis.The risk of a CVID diagnosis was highly related to both the number of consultations and the character of examinations performed by the GP. CVID should be a differential diagnosis among patients with multiple consultations, especially in patients < 40 years old.CONCLUSIONThe risk of a CVID diagnosis was highly related to both the number of consultations and the character of examinations performed by the GP. CVID should be a differential diagnosis among patients with multiple consultations, especially in patients < 40 years old. Purpose Diagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP) consultations in individuals diagnosed with CVID within 3 years before the diagnosis and whether the risk of diagnosis was associated with the frequency of consultations or character of examinations. Methods We conducted a nested case-control study, identifying 132 adult CVID patients and 5940 age- and gender-matched controls from national registers during 1997–2013. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (95%CI). Results The median number of consultations among individuals with CVID was more than twice that of the controls in all 3 years (3rd, 10; 2nd, 11.5; and 1st, 15.4 vs. 4). We found a statistically significant association between the number of consultations and the risk of a subsequent CVID diagnosis, independent of age and gender, but strongest in the individuals < 40 years. In the 3rd year before diagnosis, having 9–15 consultations compared with 1–4 was associated with an OR (95%CI) of 5.0 (2.3–10.9), 2.4 (1.1–5.4), and 1.3 (0.3–5.3) for those aged 18–40, 41–60, and > 60, respectively. Several examinations (i.e., blood tests for inflammation/infection and pulmonary function test) were associated with increased odds of a subsequent CVID diagnosis. Conclusion The risk of a CVID diagnosis was highly related to both the number of consultations and the character of examinations performed by the GP. CVID should be a differential diagnosis among patients with multiple consultations, especially in patients < 40 years old.
Author	Johansen, Isik S. Katzenstein, Terese L. Ilkjær, Frederik V. Martin-Iguacel, Raquel Westh, Lena Nielsen, Thyge L. Rasmussen, Line D. Larsen, Carsten S. Hansen, Ann-Brit E.
Author_xml	– sequence: 1 givenname: Frederik V. orcidid: 0000-0003-3647-7209 surname: Ilkjær fullname: Ilkjær, Frederik V. email: Frederik.veitland.antonsen2@rsyd.dk organization: Department of Infectious Diseases, Odense University Hospital, Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark – sequence: 2 givenname: Line D. surname: Rasmussen fullname: Rasmussen, Line D. organization: Department of Infectious Diseases, Odense University Hospital – sequence: 3 givenname: Raquel surname: Martin-Iguacel fullname: Martin-Iguacel, Raquel organization: Department of Infectious Diseases, Odense University Hospital – sequence: 4 givenname: Lena surname: Westh fullname: Westh, Lena organization: Department of Infectious Diseases, Aarhus University Hospital – sequence: 5 givenname: Terese L. surname: Katzenstein fullname: Katzenstein, Terese L. organization: Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital – sequence: 6 givenname: Ann-Brit E. surname: Hansen fullname: Hansen, Ann-Brit E. organization: Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital – sequence: 7 givenname: Thyge L. surname: Nielsen fullname: Nielsen, Thyge L. organization: Department of Pulmonary and Infectious Diseases, North Zealand Hospital – sequence: 8 givenname: Carsten S. surname: Larsen fullname: Larsen, Carsten S. organization: Department of Infectious Diseases, Aarhus University Hospital, International Center of Immunodeficiency Diseases, Aarhus University Hospital – sequence: 9 givenname: Isik S. surname: Johansen fullname: Johansen, Isik S. organization: Department of Infectious Diseases, Odense University Hospital
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Snippet	Purpose Diagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP)... Diagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP)... PurposeDiagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP)...
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SubjectTerms	Adolescent Adult Age of Onset Aged Biomedical and Life Sciences Biomedicine Case-Control Studies Clinical Decision-Making Common variable immunodeficiency Common Variable Immunodeficiency - diagnosis Common Variable Immunodeficiency - epidemiology Comorbidity Delayed Diagnosis Denmark - epidemiology Differential diagnosis Disease Management Early Diagnosis Female General Practice - methods General Practice - standards Humans Immunology Infectious Diseases Internal Medicine Male Medical Microbiology Middle Aged Odds Ratio Original Article Population Surveillance Practice Patterns, Physicians Referral and Consultation Registries Respiratory function Statistical analysis Young Adult
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Title	How to Identify Common Variable Immunodeficiency Patients Earlier: General Practice Patterns
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