Serious infections hospital admissions and mortality in patients with early inflammatory arthritis: results from the National Early Inflammatory Arthritis Audit (2024)

Type of publication:

Conference abstract

Author(s):

Adas M.; Bechman K.; Russell M.; Karafotias I.; Nagra D.; Patel S.; Gallagher S.; Price E.; *Garton M.; Rutherford A.; Cope A.; Norton S.; Galloway J.;

Citation:

Rheumatology. Conference: British Society for Rheumatology Annual Conference, BSR 2024. Liverpool United Kingdom. 63(Supplement 1) (pp i12), 2024. Date of Publication: 01 Apr 2024.

Abstract:

Background/Aims To identify the risk of serious infections (SI) according to initial treatment strategy, using conventional synthetic disease modifying antirheumatic drugs (csDMARD) and corticosteroids, in patients recruited to the National Early Inflammatory Arthritis Audit (NEIAA). Methods An observational cohort study design was used. The population included adults in England with a new onset rheumatoid arthritis (RA), fulfilling ACR/EULAR 2010 criteria, between April 2018-March 2021. Outcomes studied were SI, defined by infections requiring hospitalisation (primary admission diagnosis/nosocomial acquisition) or death (SI stated on death certificate), identified using NHS Digital linkage. Patients' characteristics were tabulated by treatment strategies. Hazard ratios (HR) were calculated using single failure Cox proportional-hazards models, with confounders- adjusted models (age, gender, smoking status, comorbidities, social deprivation) and fully-adjusted models including disease factors (seropositivity, DAS28). Individuals were considered at risk from the date of RA diagnosis, and censored at SI event, death, or March 2021 (whichever was earliest). Results 20,060 patients with RA were included. Initial DMARD therapy was known for 19,572 patients, of whom 11,966 were on methotrexate/ MTX based strategies (mono or combo), 5,059 on csDMARD combination strategies (other than MTX) and 2,547 on no DMARD strategy. 15,319 patients were on corticosteroids at baseline. Mean age 59.5 years (+/-15); 63% female; smoking status (20% current; 30% ex-smokers); comorbidities (21% hypertension; 10% diabetes; and 12% lung disease). Rheumatoid Factor/CCP antibodies were positive in 68%. At presentation, median disease scores were 5.1 (interquartile range [IQR]: 4.0-5.9) for DAS28, 1.1 (IQR: 0.6-1.7) for health assessment questionnaire (HAQ) and 24 (IQR: 16.0-33.0) for musculoskeletal health questionnaire (MSKHQ).There were 519 SI admissions and 17 SI deaths, corresponding to incidence rates per 100 person-years for admissions: 3.19 (95% CI: 2.93-3.48) and deaths: 0.10 (95% CI: 0.06-0.16). In fullyadjusted models, increasing age predicted both SI admissions and deaths. Being a smoker, having a comorbidity, higher disease activity (DAS28), symptom burden (MSKHQ) and disability (HAQ) at presentation associated with more SI admissions. For each 1 unit increase in DAS28, the risk of SI increased by 8% (HR 1.08 [95% CI:1.01-1.16]). Seropositivity did not associate with SI. MTX-based strategies 0.75 (95% CI:0.62-0.91) and csDMARD combination therapy 0.70 (95% CI:0.53-0.94) associated with fewer SI admissions compared to no DMARD. In unadjusted models, corticosteroid associated with more SI admissions 1.29 (95% CI:1.10 -1.62); however, in fully-adjusted models this association was no longer statistically significant. csDMARD strategies did not associated with SI deaths in any of the models. Conclusion Patient and disease factors at diagnosis appear to be important predictors of admissions and mortality for serious infections. Infection risk appears to be greatest in those with higher RA disease activity. An important limitation is that NEIAA does not capture data on treatment changes over time and steroid use beyond baseline.

Link to full-text

Description and Cross-Sectional Analyses of 25,880 Adults and Children in the UK National Registry of Rare Kidney Diseases Cohort (2024)

Type of publication:

Journal article

Author(s):

Wong K.; Pitcher D.; Braddon F.; Downward L.; Steenkamp R.; Masoud S.; Annear N.; Barratt J.; Bingham C.; Coward R.J.; Chrysochou T.; Game D.; Griffin S.; Hall M.; Johnson S.; Kanigicherla D.; Karet Frankl F.; Kavanagh D.; Kerecuk L.; Maher E.R.; Moochhala S.; Sayer J.A.; Simms R.; Sinha S.; Srivastava S.; Tam F.W.K.; Thomas K.; Turner A.N.; Walsh S.B.; Waters A.; Wilson P.; Wong E.; Sy K.T.L.; Huang K.; Ye J.; Nitsch D.; Saleem M.; Bockenhauer D.; Bramham K.; Gale D.P.; Abat S.; Adalat S.; Agbonmwandolor J.; Ahmad Z.; Alejmi A.; Almasarwah R.; Asgari E.; Ayers A.; Baharani J.; Balasubramaniam G.; Kpodo F.J.-B.; Bansal T.; Barratt A.; Bates M.; Bayne N.; Bendle J.; Benyon S.; Bergmann C.; Bhandari S.; Boddana P.; Bond S.; Branson A.; Brearey S.; Brocklebank V.; Budwal S.; Byrne C.; Cairns H.; Camilleri B.; Campbell G.; Capell A.; Carmody M.; Carson M.; Cathcart T.; Catley C.; Cesar K.; Chan M.; Chea H.; Chess J.; Cheung C.K.; Chick K.-J.; Chitalia N.; Christian M.; Clark K.; Clayton C.; Clissold R.; Cockerill H.; Coelho J.; Colby E.; Colclough V.; Conway E.; Cook H.T.; Cook W.; Cooper T.; Crosbie S.; Cserep G.; Date A.; Davidson K.; Davies A.; Dhaun N.; Dhaygude A.; Diskin L.; Dixit A.; Doctolero E.A.; Dorey S.; Downard L.; Drayson M.; Dreyer G.; Dutt T.; Etuk K.; Evans D.; Finch J.; Flinter F.; Fotheringham J.; Francis L.; Gallagher H.; Garcia E.L.; Gavrila M.; Gear S.; Geddes C.; Gilchrist M.; Gittus M.; Goggolidou P.; Goldsmith C.; Gooden P.; Goodlife A.; Goodwin P.; Grammatikopoulos T.; Gray B.; Griffith M.; Gumus S.; Gupta S.; Hamilton P.; Harper L.; Harris T.; Haskell L.; Hayward S.; Hegde S.; Hendry B.; Hewins S.; Hewitson N.; Hillman K.; Hiremath M.; Howson A.; Htet Z.; Huish S.; Hull R.; Humphries A.; Hunt D.P.J.; Hunter K.; Hunter S.; Ijeomah-Orji M.; Inston N.; Jayne D.; Jenfa G.; Jenkins A.; Jones C.A.; Jones C.; Jones A.; Jones R.; Kamesh L.; Frankl F.K.; Karim M.; Kaur A.; Kearley K.; Khwaja A.; King G.; Kislowska E.; Klata E.; Kokocinska M.; Lambie M.; Lawless L.; Ledson T.; Lennon R.; Levine A.P.; Maggie Lai L.W.; Lipkin G.; Lovitt G.; Lyons P.; Mabillard H.; Mackintosh K.; Mahdi K.; Maher E.; Marchbank K.J.; Mark P.B.; Masunda B.; Mavani Z.; Mayfair J.; McAdoo S.; Mckinnell J.; Melhem N.; Meyrick S.; Morgan P.; Morgan A.; Muhammad F.; Murray S.; Novobritskaya K.; Ong A.C.; Oni L.; Osmaston K.; Padmanabhan N.; Parkes S.; Patrick J.; Pattison J.; Paul R.; Percival R.; Perkins S.J.; Persu A.; Petchey W.G.; Pickering M.C.; Pinney J.; Plumb L.; Plummer Z.; Popoola J.; Post F.; Power A.; Pratt G.; Pusey C.; Rabara R.; Rabuya M.; Raju T.; Javier C.; Roberts I.S.; Roufosse C.; Rumjon A.; Salama A.; Sandford R.N.; *Sandu K.S.; Sarween N.; Sebire N.; Selvaskandan H.; Shah S.; Sharma A.; Sharples E.J.; Sheerin N.; Shetty H.; Shroff R.; Sinha M.; Smith K.; Smith L.; Stott I.; Stroud K.; Swift P.; Szklarzewicz J.; Tam F.; Tan K.; Taylor R.; Tischkowitz M.; Tse Y.; Turnbull A.; Tyerman K.; Usher M.; Venkat-Raman G.; Walker A.; Watt A.; Webster P.; Wechalekar A.; Welsh G.I.; West N.; Wheeler D.; Wiles K.; Willcocks L.; Williams A.; Williams E.; Williams K.; Wilson D.H.; Wilson P.D.; Winyard P.; Wood G.; Woodward E.; Woodward L.; Woolf A.; Wright D.;

Citation:

Kidney International Reports. 9(7) (pp 2067-2083), 2024. Date of Publication: 01 Jul 2024.

Abstract:

Introduction: The National Registry of Rare Kidney Diseases (RaDaR) collects data from people living with rare kidney diseases across the UK, and is the world's largest, rare kidney disease registry. We present the clinical demographics and renal function of 25,880 prevalent patients and sought evidence of bias in recruitment to RaDaR.

Method(s): RaDaR is linked with the UK Renal Registry (UKRR, with which all UK patients receiving kidney replacement therapy [KRT] are registered). We assessed ethnicity and socioeconomic status in the following: (i) prevalent RaDaR patients receiving KRT compared with patients with eligible rare disease diagnoses receiving KRT in the UKRR, (ii) patients recruited to RaDaR compared with all eligible unrecruited patients at 2 renal centers, and (iii) the age-stratified ethnicity distribution of RaDaR patients with autosomal dominant polycystic kidney disease (ADPKD) was compared to that of the English census.

Result(s): We found evidence of disparities in ethnicity and social deprivation in recruitment to RaDaR; however, these were not consistent across comparisons. Compared with either adults recruited to RaDaR or the English population, children recruited to RaDaR were more likely to be of Asian ethnicity (17.3% vs. 7.5%, P-value < 0.0001) and live in more socially deprived areas (30.3% vs. 17.3% in the most deprived Index of Multiple Deprivation (IMD) quintile, P-value < 0.0001).

Conclusion(s): We observed no evidence of systematic biases in recruitment of patients into RaDaR; however, the data provide empirical evidence of negative economic and social consequences (across all ethnicities) experienced by families with children affected by rare kidney diseases.

Link to full-text [no password required]

Each Baby Counts: Learn and Support (2024)

Type of publication:

Service improvement case study

Author(s):

*Paula Pryce

Citation:

SaTH Improvement Hub, September 2024

Abstract:

To introduce the communication tool and terminology of Each Baby Counts: Learn and Support to the team by the end of August 2024 as evidenced by observation of conversations and documentation.

Link to PDF poster

Medical Acute Take Handover (2024)

Type of publication:

Service improvement case study

Author(s):

*Navya Basavaraju, *Dr Sam Craik, *Hazel Green, *Dr Nawaid Ahmad, *Dr Shakawan Ismaeel, * Dr Thimmegowda Govindagowda

Citation:

SaTH Improvement Hub, September 2024

Abstract:

Improve how colleagues feel about the content and structure of a Medical Acute Take Handover by 1st September 2024. To improve the structure and standardization of handover at our hospital in concordance with Royal College of Physicians (RCP) recommendations for good clinical handover

Link to PDF poster

PRH ED Waiting Room Improvements (2024)

Type of publication:

Service improvement case study

Author(s):

*Laura Wild

Citation:

SaTH Improvement Hub, August 2024

Abstract:

Improve the quality of care provided to patients as measured by an increase in compliance to observations, analgesia provision, reduction in interruptions and improvement in patient feedback by 31/07/2024.

Link to PDF poster

SATH Children’s Assessment Unit Improvement Programme (2024)

Type of publication:

Service improvement case study

Author(s):

*Rachel Triggs

Citation:

SaTH Improvement Hub, October 2024

Abstract:

To facilitate a core group of Registered children's nurses who work in the Children’s Assessment Unit (CAU) to become competent in conducting a Triage on all paediatric patients referred to the unit using the Manchester Triage system.

Link to PDF poster

AMA Seated Area Test of Change (2024)

Type of publication:

Service improvement case study

Author(s):

*Rebekah Tudor

Citation:

SaTH Improvement Hub, November 2024

Abstract:

  • Improve the Length of stay (LoS) in the RSH Emergency Department (for medical patients) during the test of change weeks (by 25/10/2024)
  • Improve the LoS in the AMA Seated Area at RSH during the test of change weeks (by 25/10/2024)
  • Improve the number of discharges (all discharge destinations) from the RSH acute floor during the test of change weeks (by 25/10/2024)

Link to PDF poster