Excess Morbidity Persists in Patients With Cushing's Disease During Long-term Remission : A Swedish Nationwide Study
(2020) In The Journal of clinical endocrinology and metabolism 105(8).- Abstract
CONTEXT: Whether multisystem morbidity in Cushing's disease (CD) remains elevated during long-term remission is still undetermined. OBJECTIVE: To investigate comorbidities in patients with CD. DESIGN, SETTING, AND PATIENTS: A retrospective, nationwide study of patients with CD identified in the Swedish National Patient Register between 1987 and 2013. Individual medical records were reviewed to verify diagnosis and remission status. MAIN OUTCOMES: Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated by using the Swedish general population as reference. Comorbidities were investigated during three different time periods: (i) during the 3 years before diagnosis, (ii) from diagnosis to 1 year after... (More)
CONTEXT: Whether multisystem morbidity in Cushing's disease (CD) remains elevated during long-term remission is still undetermined. OBJECTIVE: To investigate comorbidities in patients with CD. DESIGN, SETTING, AND PATIENTS: A retrospective, nationwide study of patients with CD identified in the Swedish National Patient Register between 1987 and 2013. Individual medical records were reviewed to verify diagnosis and remission status. MAIN OUTCOMES: Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated by using the Swedish general population as reference. Comorbidities were investigated during three different time periods: (i) during the 3 years before diagnosis, (ii) from diagnosis to 1 year after remission, and (iii) during long-term remission. RESULTS: We included 502 patients with confirmed CD, of whom 419 were in remission for a median of 10 (interquartile range 4 to 21) years. SIRs (95% CI) for myocardial infarction (4.4; 1.2 to 11.4), fractures (4.9; 2.7 to 8.3), and deep vein thrombosis (13.8; 3.8 to 35.3) were increased during the 3-year period before diagnosis. From diagnosis until 1 year after remission, SIRs (95% CI were increased for thromboembolism (18.3; 7.9 to 36.0), stroke (4.9; 1.3 to 12.5), and sepsis (13.6; 3.7 to 34.8). SIRs for thromboembolism (4.9; 2.6 to 8.4), stroke (3.1; 1.8 to 4.9), and sepsis (6.0; 3.1 to 10.6) remained increased during long-term remission. CONCLUSION: Patients with CD have an increased incidence of stroke, thromboembolism, and sepsis even after remission, emphasizing the importance of early identification and management of risk factors for these comorbidities during long-term follow-up.
(Less)
- author
- organization
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- cardiovascular, comorbidity, Cushing’s disease, remission, sepsis, thromboembolism
- in
- The Journal of clinical endocrinology and metabolism
- volume
- 105
- issue
- 8
- article number
- dgaa291
- publisher
- Oxford University Press
- external identifiers
-
- scopus:85086792735
- pmid:32436951
- ISSN
- 1945-7197
- DOI
- 10.1210/clinem/dgaa291
- language
- English
- LU publication?
- yes
- id
- d68ede31-b1b3-4360-8d7a-1ff211ae88ac
- date added to LUP
- 2020-07-07 10:37:50
- date last changed
- 2024-04-03 09:36:37
@article{d68ede31-b1b3-4360-8d7a-1ff211ae88ac,
abstract = {{<p>CONTEXT: Whether multisystem morbidity in Cushing's disease (CD) remains elevated during long-term remission is still undetermined. OBJECTIVE: To investigate comorbidities in patients with CD. DESIGN, SETTING, AND PATIENTS: A retrospective, nationwide study of patients with CD identified in the Swedish National Patient Register between 1987 and 2013. Individual medical records were reviewed to verify diagnosis and remission status. MAIN OUTCOMES: Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated by using the Swedish general population as reference. Comorbidities were investigated during three different time periods: (i) during the 3 years before diagnosis, (ii) from diagnosis to 1 year after remission, and (iii) during long-term remission. RESULTS: We included 502 patients with confirmed CD, of whom 419 were in remission for a median of 10 (interquartile range 4 to 21) years. SIRs (95% CI) for myocardial infarction (4.4; 1.2 to 11.4), fractures (4.9; 2.7 to 8.3), and deep vein thrombosis (13.8; 3.8 to 35.3) were increased during the 3-year period before diagnosis. From diagnosis until 1 year after remission, SIRs (95% CI were increased for thromboembolism (18.3; 7.9 to 36.0), stroke (4.9; 1.3 to 12.5), and sepsis (13.6; 3.7 to 34.8). SIRs for thromboembolism (4.9; 2.6 to 8.4), stroke (3.1; 1.8 to 4.9), and sepsis (6.0; 3.1 to 10.6) remained increased during long-term remission. CONCLUSION: Patients with CD have an increased incidence of stroke, thromboembolism, and sepsis even after remission, emphasizing the importance of early identification and management of risk factors for these comorbidities during long-term follow-up.</p>}},
author = {{Papakokkinou, Eleni and Olsson, Daniel S. and Chantzichristos, Dimitrios and Dahlqvist, Per and Segerstedt, Elin and Olsson, Tommy and Petersson, Maria and Berinder, Katarina and Bensing, Sophie and Höybye, Charlotte and Edén-Engström, Britt and Burman, Pia and Bonelli, Lorenza and Follin, Cecilia and Petranek, David and Erfurth, Eva Marie and Wahlberg, Jeanette and Ekman, Bertil and Åkerman, Anna Karin and Schwarcz, Erik and Bryngelsson, Ing Liss and Johannsson, Gudmundur and Ragnarsson, Oskar}},
issn = {{1945-7197}},
keywords = {{cardiovascular; comorbidity; Cushing’s disease; remission; sepsis; thromboembolism}},
language = {{eng}},
number = {{8}},
publisher = {{Oxford University Press}},
series = {{The Journal of clinical endocrinology and metabolism}},
title = {{Excess Morbidity Persists in Patients With Cushing's Disease During Long-term Remission : A Swedish Nationwide Study}},
url = {{http://dx.doi.org/10.1210/clinem/dgaa291}},
doi = {{10.1210/clinem/dgaa291}},
volume = {{105}},
year = {{2020}},
}