Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “PROGNOSIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMed1975

Comparison of the prognosis of hypertension associated with chronic glomerulonephritis with that of essential hypertension.

The difference of the prognosis between essential and renal hypertension (chronic glomerulonephritis) was examined by compairing the survival rate of the patients, and the effect of lability of blood pressure and the effect of the response to hypotensive drugs on the prognosis of the two types of hypertension was observed. The prognosis of renal hypertensives was remarkedly worse when it was compaired with the prognosis of essential hypertensives. More then 80% of the latter was still alive after ten years, while the mortality rate of the former after 5 years was only 20%. Each factor of severity (diastolic pressure, optic fundi, cardiac, cerebrovascular and renal complication) in non severe patients (group O-II) did not differently affect the survival rate of both hypertensives. Diverse prognosis was observed in severe patients (group III-IV), depending on each factor of severity. In renal hypertension the survival rate was extremely low when the patients had high diastolic pressure, severe cardiac and cerebrovascular complication. It was not so low in the patients with severe ophthalmoscopic change. The prognosis of essential hypertension was poor in the order of severe cerebrovascular complication, renal complication and cardiac complication. The survival rate of the patients with high diastolic pressure or severe ophthalmoscopic change was considerably high. The patients with both renal and essential hypertension showed greater survival rate when the blood pressure was much more reduced by bed rest or antihypertensive drugs during the first hospitalization.

Blood Pressure↗
PubMed2005

A marker of oxidative stress in saliva: association with periodontally-involved teeth of a hopeless prognosis.

The aim of this study was to determine the association between levels of a marker of oxidative stress, 8-hydroxydeoxyguanosine (8-OHdG), in saliva and the presence of teeth with a hopeless prognosis as a result of advanced periodontitis. Thirty-four periodontitis patients were divided into two groups based on the presence or absence of periodontally-involved teeth of hopeless prognosis. Salivary levels of 8-OHdG in those with were significantly higher than in subjects without periodontally-involved teeth of hopeless prognosis (4.78 +/- 0.14 ng/ml and 2.35 +/- 0.18 ng/ml, respectively). We also evaluated 8-OHdG levels in gingival crevicular fluid (GCF) of teeth with advanced periodontal destruction (mean probing depth = 7.2). In this case, 8-OHdG was detected only from those periodontally-involved teeth of hopeless prognosis, and only in some cases (8 out of 18 samples). These data suggest that periodontally-involved teeth of hopeless prognosis are a major source of salivary 8-OHdG. Measurement of salivary 8-OHdG levels may prove to be useful in identifying patients with teeth of hopeless prognosis.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed2004

Relationship of hemodynamic indices and prognosis in patients with liver cirrhosis.

BACKGROUND: Hyperdynamic circulation due to reduced peripheral vascular resistance and increased cardiac output, and the development of portal hypertension are the hemodynamic changes observed in patients with liver cirrhosis. Such hemodynamic abnormalities appear in patients with late stage liver cirrhosis. Therefore, hemodynamic indices, which represent hyperdynamic circulation and portal hypertension, are significant for the prognosis of patients with liver cirrhosis. The aim of this study was to determine the hemodynamic indices associated with the prognosis of patients with liver cirrhosis. METHODS: A total of 103 patients diagnosed with liver cirrhosis between December 1999 and June 2003, with a mean follow-up period of 73 weeks, ranging from 7 to 168 weeks, were recruited. Using Child-Pugh classification, the mean arterial pressure, heart rate and hepatic venous pressure gradient (HVPG) were measured. The indices of Doppler ultrasonography, including the portal and splenic venous flows, and the resistance of the hepatic, splenic, and renal arteries were also measured using the arterial pulsatility index (PI). The prognostic values of these indices were determined by their comparison with the patient survivals. RESULTS: Significant hemodynamic indices for a bad prognosis were high HVPG (> or = 15 mmHg) and renal arterial PI (> or = 1.14)(p<0.05). A Child-Pugh score > or = 10 was important for a poor prognosis (p<0.05). CONCLUSION: Severe portal hypertension (HVPG > or = 15 mmHg) and high renal arterial resistance (PI +/- 1.14) were valuable hemodynamic indices for the prognosis of patients with liver cirrhosis. Therefore, it was concluded that the measurement of these hemodynamic indices, in addition to the Child-Pugh classification, is helpful in the prognosis of patients with liver cirrhosis.

Female↗
PubMed1992

[Prognosis of acute low-tone sensorineural hearing loss].

We studied 50 patients with acute low-tone sensorineural hearing loss (ALHL) who were examined at the Department of Otolaryngology, University of Tokyo, and followed up for 18 months or more. We investigated the prognosis of hearing loss within 3 months after onset, rate of recurrence during long-term follow-up, interval between the first and the second episodes of hearing loss or between onset and the time when the diagnosis of Meniere's disease was made, and factors affecting prognosis. The results were as follows. 1. Within the initial 3 months of follow-up, hearing loss continued to fluctuate in 5 patients. In the remaining 45, hearing returned to normal in 34, improved without returning to normal in 6, showed no marked change in 4, and became worse in one. 2. In long-term follow-up, the recurrence of hearing loss without vertigo occurred in 16 patients, and 5 others were eventually diagnosed as having Meniere's disease. The average interval between the first and second episodes of hearing loss was 9.2 months, and the diagnosis of Meniere's disease was made an average of 27 months after onset. 3. Recurrence was not significantly related to the initial prognosis of hearing loss. 4. Within the initial 3 months of follow-up, the prognosis of hearing loss was significantly better in patients whose hearing loss at 1 kHz was within 20 dB, and tended to be better in females and in patients attending within one week of onset. Long-term follow-up showed that the rate of recurrence was significantly lower in patients aged 40 years or more, and tended to be lower in patients who visited the hospital within one week of onset or whose hearing loss at 1 kHz was within 20 dB. 5. There were no significant differences between patients with single and recurrent attacks with respect to sex, subjective symptoms, and results of the glycerol test and electrocochleography. ALHL tends to recur without any relationship to the initial prognosis of hearing loss. Since it is still difficult to predict whether or not hearing loss will recur, long-term follow-up is necessary even in patients with good initial prognosis.

Acute Disease↗
PubMedDate not supplied

[Malignant reticuloendothelioses. Clinical variations influencing prognosis].

The relationship of age, sex, clinical findings and prognosis was studied among 30 children with malignant reticuloendotheliosis. A male predominance was found, but it was not possible to make any prognostic correlation regarding this parameter. A definitive worse prognosis was found in the early ages, thus 88% of less than 12 months-old children died. Although the visceral involvement degree signifies a poor prognosis, it was found that nevertheless, a solitary osteolytic lesion is in the accordance with good prognosis; all patients who did not have bone lesions died in less than three years. It is the first part of our purpose to enact the usefulness of the clinical findings toward a more precise prognosis in the malignant reticuloengotheliosis. Later on, we will report the possibility to obtain a numerical data from the clinical findings in order to establish an accurate prognosis.

Age Factors↗
PubMed1999

[Expression of metastasis suppressor gene nm23-H1 in oral squamous cell carcinoma and its relation to tumor prognosis].

OBJECTIVE: To study the relation between the expression level of nm23-H1 protein and prognosis of oral squamous cell carcinoma (OSCC). METHODS: The expression of nm23-H1 protein in 75 cases of OSCC, 27 cases of oral mucosa, 9 cases of cervical lymph-node metastases by immunohistochemical technique (SABC), and the relation between nm23-H1 protein expression level and prognosis of OSCC was evaluated by chi-test and single-factor, multi-factor Cox proportional hazards regression model analysis. RESULTS: These immunoreactivities of nm23-H1 protein were mostly in the cytoplasm of tumor and epithelial cells. There was a significant difference of nm23-H1 protein expression level between three-year survival and seven-year survival group (P < 0.05), and there was a relation between nm23-H1 protein expression level and prognosis of OSCC in single-factor Cox analysis. But no relation was found between nm23-H1 protein expression level and prognosis in multi-factor Cox analysis. CONCLUSION: nm23-H1 protein expression level was probably not a valuable predictor of OSCC patients' prognosis. It may indirectly affect OSCC prognosis through its effect on OSCC metastasis.

Carcinoma, Squamous Cell↗
PubMed2002

[Analysis of visual prognosis and correlative factors in retinal vein occlusion].

OBJECTIVE: To investigate the visual prognosis, risk factors, complications and the causes of visual deterioration in patients with various types of retinal vein occlusion (RVO). METHODS: Nine hundred and forty-four eyes of 913 patients with various types of RVO were analyzed. The age range of patients was 15 - 89 years (average 52.8 +/- 11.9), and the average follow-up was 20.7 months. The data of the patients were studied by SPSS software. RESULTS: (1) RVO was classified into central RVO (CRVO) in 406 eyes of 391 cases (43.0%), hemi-RVO (HRVO) in 60 eyes of 60 cases (6.4%) and branch RVO (BRVO) in 478 eyes of 462 cases (50.6%). (2) They were subdivided into ischemic type in 633 eyes (67.1%) and non-ischemic type in 311 eyes (32.9%). (3) The visual prognosis: the average initial visual acuity (VA) in CRVO, HRVO and BRVO was 0.36, 0.38 and 0.40 respectively. The average final VA was 0.40 in CRVO (P > 0.05), 0.50 in HRVO (P > 0.05) and 0.58 in BRVO (P < 0.05). (4) The initial VA and prognosis: there was close relationship between initial VA and visual prognosis. If the initial VA >/= 0.5, the final acuity maintained >/= 0.5 in 70.6% in CRVO, 75.0% in HRVO and 84.9% in BRVO. The patients with initial VA </= 0.l had final VA worse than 0.1 in 66.2% of CRVO, 35.7% of HRVO and 25.3% of BRVO (P < 0.01). (5) Low vision and the rate of blindness in RVO: Among the 205 eyes with low vision (21.7%), there were 27.6% with CRVO, 31.7% with HRVO and 17.2% with BRVO (P < 0.01). Among the 160 eyes with blindness (16.9%), There were 27.6% with CRVO, 11.7% with HRVO and 8.6% with BRVO (P < 0.01). (6) The visual prognostic comparison between ischemic type and non-ischemic type: there were 189 of 633 eyes with ischemic type (29.9%) and only l6 of 311 eyes with non-ischemic type (5.1%) had low vision. In the ischemic type, 157 eyes had blindness (25.1%) and 3 eyes with non-ischemic type (1.0%) had blindness (P < 0.01). (7) Risk factors of RVO were hypertension (57.8%), arteriosclerosis (67.4%), high blood viscosity (24.6%), diabetes (6.2%) and primary glaucoma (1.5%). (8) Complications of RVO: cystoid macular edema (CME) 46.7%, retinal neovascularization (RNV) 21.5%, vitreous hemorrhage 11.4% and neovascular glaucoma (NVG) 9.6% (39/406) in CRVO and 1.7% (1/60) in HRVO. (9) Low vision caused by CME was 37.9%, and RNV 29.9%; blindness in CME 19.5% and RNV 23.0%. In 40 eyes with NVG, the final VA was worse than 0.05 in 38 eyes (95.0%). CONCLUSION: The rate of blindness of RVO is high, and the visual prognosis of ischemic type is worse. There is close relationship between the level of initial VA and visual prognosis. CME, RNV and NVG are important causes of blindness.

Adolescent↗
PubMed2002

[Relationship between expressions of p53, c-erbB2 genes, proliferating cell nuclear antigen and prognosis of patients with ovarian epithelial carcinoma].

BACKGROUND & OBJECTIVE: There were a few reports about the relationship between the expressions of p53, c-erbB2 Genes, and proliferating cell nuclear antigen (PCNA) with the prognosis from the patients with ovarian epithelial carcinoma(EOC). But conclusions were difference because of various methods and samples. This study was designed to investigate the relationship between the expressions of p53, c-erbB2 Genes, and PCNA with the prognosis from the patients with EOC. MATERIALS & METHODS: A total of 84 female patients with EOC were enrolled in this study, who were hospitalized in Department of Gynecology, Cancer Center, Sun yat-sen University from March 1 1990 to March 31 1994. The expressions of p53, c-erbB-2, and PCNA from the tumor samples were detected by Labelling-streptavidin-biotin (LSAB) immunohistochemistry assay. The relationship between the expression of the above marks and the prognosis of the patients were then analyzed. Statistical analyses were performed using SPSS 8.0 softwave. RESULTS: Forty-nine tumor samples (58.3%) exhibited p53 overexpression, 65 (77.4%) exhibited c-erbB2 overexpression, and all (100%) exhibited PCNA overexpression. In univariate analysis, there was marginally significant difference in the mean survival, the 5 years survival between the patients exhibited no c-erbB2 overexpression and the patients exhibited any c-erbB2 overexpression (P = 0.05). There was significant difference in the mean survival, the 5 years survival between the patients showed lower expression of PCNA and those showed higher expression of PCNA (P < 0.01), and there was no significant difference in the mean survival, the 5 years survival between the patients with overexpression of p53 and without overexpression of p53 (P > 0.05). In multivariate analysis, only stage and histological grade were the important significant prognostic factors of the patients with EOC, and there was no statistical significance between the overexpression of c-erbB-2 and PCNA with the prognosis. CONCLUSIONS: There was no significant correlation between the overexpression of p53 gene and the prognosis of the patients with EOC. The expression of c-erbB2 or PCNA was not an independent prognostic factor for prognosis of the patients with EOC. Stage and histological grade were still the independent significant prognostic factors of EOC.

Adolescent↗
PubMed2002

[Correlation between expression of vascular endothelial growth factor and prognosis of patients with esophageal squamous cell carcinoma].

BACKGROUND & OBJECTIVES: Angiogenesis plays an essential role in tumor growth, invasion, and metastasis. Vascular endothelial growth factor(VEGF) is regarded the most important angiogenetic growth factor and it has been found in many kinds of tumors that its high expression can promote tumor progression and effect prognosis. However, there was few reports about the relationship between the VEGF expression and the progression and prognosis of the patients with esophageal carcinoma. The current study was designed to investigate the relationship between VEGF expression and the prognosis of patients with esophageal squamous cell carcinoma. METHODS: The expression of VEGF protein in 72 resected specimens from the patients with esophageal squamous cell carcinoma were examined immunohistochemically, and its effects on postoperative recurrence and survival of the patients were analyzed retrospectively. RESULTS: Fourty-five out of 72 (62.5%) samples were positive for VEGF expression. The VEGF-positive patients tend to occur postoperative recurrence than VEGF-negative patients (P < 0.001). The median survival time and 1, 3, 5-year survival rate of VEGF-positive patients was lower than those of VEGF-negative patients. And the Kaplan-Meier survival curve was worse in VEGF-positive groups than in VEGF-negtive groups(Log rank test, P = 0.021). Multivariate analysis revealed that VEGF was not an independent factor that impact on the prognosis (P > 0.05). CONCLUSIONS: The high expression of VEGF in esophageal squamous cell carcinoma may promote the tumor progression and lead to dismal prognosis. However, the value of VEGF expression for judging prognosis need further study.

Adult↗
PubMed2003

[Characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on prognosis].

BACKGROUND & OBJECTIVE: Occult cervical lymph node metastasis in squamous cell carcinoma of tongue has regularity and influence on the prognosis of patients. This study was designed to investigate the characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on the prognosis to provide clinical bases for elective supraomohyoid neck dissection. METHODS: The data of 164 patients with squamous cell carcinoma of tongue who were treated in cancer center, Sun Yat-sen University, from 1990 to 1996 were reviewed. The characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on the prognosis were analyzed. RESULTS: The rate of occult cervical lymph node metastasis of squamous cell carcinoma of tongue was 25.71%. The most common site of occult cervical lymph node metastasis was ipsilateral level II, and followed by ipsilateral level I and III. 82.98% of the lymph nodes of occult metastasis occurred in the above three levels. Most cervical lymph nodes of occult metastasis were found within two years after the first operation (33/36). There was significant difference of the prognosis between the group of dominant or occult cervical lymph node metastasis and the group of without cervical lymph node metastasis in squamous cell carcinoma of tongue (log-rank,P< 0.01); whereas there was no significant difference of the prognosis between the group of dominant cervical lymph node metastasis and the group of occult cervical lymph node metastasis according to log-rank test (P >0.05). CONCLUSION: The ipsilateral level I to level III were the common regions where occult cervical lymph node metastasis occurred. The authors suggest that elective supraomohyoid neck dissection may be applied to clinically negative neck of the patients with squamous cell carcinoma of tongue who were prone to metastasize latently. Occult cervical lymph node metastasis influences the prognosis of patients with squamous cell carcinoma of tongue significantly.

Adult↗
PubMed2003

[Significance of early diastolic notch in the prognosis of unfavorable pregnancy outcome].

OBJECTIVE: The appraisal of the sensitivity and the specificity of unilateral and bilateral or severe early diastolic notchs for prognosis of unfavorable pregnancy outcomes. PATIENTS AND METHODS: The clinical study was performed in Kaunas University of Medicine Hospital. Two hundred thirty one patients with pregnant chronic hypertension or pre-eclampsia and 229 healthy pregnant women were involved into the study. The occurrence of early diastolic notch was compared between the groups. The sensitivity and specificity of unilateral and bilateral or severe early diastolic notches for prognosis of unfavorable pregnancy outcome was evaluated. RESULTS: The sensitivity of bilateral early diastolic notch for prognosis of various unfavorable pregnancy outcomes was 64.5-70.6%, and the specificity was 71.9-79.7%. The sensitivity of unilateral early diastolic notch for prognosis of unfavorable pregnancy outcome was 78-90%, the specificity was 50-58%. The sensitivity of severe diastolic notch was 20-29.4%, and the specificity was 91-95.2%. CONCLUSIONS: The finding of bilateral early diastolic notches in the uterine artery Doppler velocimetry waveforms is a sensitive method for prognosis of unfavorable pregnancy outcomes in hypertensive women. Severe diastolic notch is more specific, but less sensitive method in comparison with bilateral early diastolic notches. The unilateral early diastolic notch has low specificity for prognosis of unfavorable pregnancy outcome.

Adult↗
PubMed1990

[Long-term follow up studies of bronchial asthma in children. II. Prognosis and complications, treatment and allergic evaluations].

A questionnaire on the prognosis of bronchial asthma was sent in 1988 to 1592 patients (1038 males, 554 females) averaging 20 years of age after 12 years' follow up. We reported on the prognosis and risk factors associated with asthmatic children in part I. The relation between prognosis and other allergic complications, treatment and laboratory data were investigated in this study. Eosinophil counts of more than 1000/mm3 and/or total serum IgE levels of more than 500 IU/ml (100 IU/ml in infants) indicated poor prognosis. However, the prognosis was not affected either by the allergens themselves or by the number of allergens determined by skin test and RAST. The prognosis was worse for patients with multiple allergic complications than for those without complications. Treatment may after the natural course of childhood asthma, but it has been difficult to evaluate the effect of each regimen over a long period. We compared the effect of hyposensitization (specific immunization) and non-bronchodilator antiasthmatic drugs (NBAAD), and found that hyposensitization alone gave better results than NBAAD and its combination. We had better results from hyposensitization over a period of 1 to 5 years than for less than 1 year or more than 5 years. We conclude that asthmatic children with risk factors should be kept under strict environmental control and given suitable therapeutic regimens to avoid the development of allergic diseases, the slow down of "allergic march", and to avoid intractable asthma.

Asthma↗
PubMed1988

Individual therapy-dependent prognosis based on data from controlled clinical trials in chronic liver disease.

In a given disease the manifestations and course of disease may vary markedly between the patients. This complicates prediction of the prognosis and treatment effect in individual patients. Most controlled clinical trials present only the "average" effect e.g. the therapy-dependent survival in the studied patient group. To estimate the therapy-dependent prognosis in individual patients it is necessary to utilize the covariation between survival time and variables characterizing each patient including the therapy given. This paper describes current methods for identification of variables which covary with survival time (prognostic variables) or the effect of therapy (therapeutic variables). Analyzing data from two large controlled clinical trials in patients with chronic liver disease: 1) the multicenter trial of prednisone versus placebo in cirrhosis conducted by the Copenhagen Study group for Liver diseases (CSL-1) and 2) the multinational trial of azathioprine versus placebo in primary biliary cirrhosis (PBC-1) we have developed indices for prediction of prognosis and therapeutic effect using Cox's multiple regression model for censored survival data. Using the indices one can estimate the therapy-dependent prognosis in new patients from their base-line data. Furthermore, a time-dependent index by which the risk of a given patient can be estimated repeatedly to update prognosis during the course of the disease is presented. To simplify application "pocket charts" have been devised by which a prognostic index for a patient can easily be obtained at the bedside. By simple graphs, a prognostic index can be translated to estimates of the probability of surviving a given time or the median survival time predicted for the patient. The indices have been validated by comparing the survival predicted by the indices with the observed survival in new patients or using data splitting. The results allow a more differentiated treatment strategy based on the characteristics of the individual patient. Even if the results apply to chronic liver disease, the general principles are valid for study of the individual therapy-dependent prognosis in other diseases.

Actuarial Analysis↗
PubMedDate not supplied

[Long-term prognosis of the status of tick-borne encephalitis foci and morbidity].

On the basis of literary data and results of the author's investigations in the Krasnoyarsk Territory a method of three-stage long-term prognosis of the state of foci and sick rate with tick-borne encephalitis was suggested. The first stage, territorial extrapolatory prognosis, is carried out in cases when long-term prognosis for unknown in epizootic and epidemiological respect territories is required. A map of epizootiological and epidemiological zonation serves as a formal materialization of territorial extrapolatory prognosis. The second stage, long-term expert extrapolatory prognosis of tendencies in natural development of foci or sick rate, is based on the retrospective evaluation of the development of foci or sick rate in the past and extrapolation of revealed regularities for the future. The third stage, expert prognosis of anthropogenic effect on the state of foci and sick rate, is carried out in the case of the forthcoming transformation of landscapes under the effect of anthropogenic factors.

Animals↗
PubMed1977

[Initial EEG findings and the prognosis of epilepsy with generalized convulsive seizures].

Correlation between the initial EEG's and the prognosis of generalized convulsive seizures without other seizures was investigated. The subjects of this study was 437 epileptics with the period of the follow-up over 3 years. They were devided into 2 groups from view point of prognosis: "good prognosis" group, in which their seizures were completely controlled, the "poor prognosis", not well controlled. Most of the EEG findings appear to be not of value in predicting the prognosis. Exceptionally, however, the localized seizure discharged in the areas of T3,4, C3, 4 and P3,4 and 14--6 Hz positive spikes related closely to good prognosis, in the group of 7 to 12 years of the age.

Adolescent↗
PubMedDate not supplied

Relationship between cytomorphologic features and prognosis in small-cell carcinoma of the lung.

Small-cell bronchial carcinoma cells obtained from 18 patients by fiberbronchoscopic brushing were examined to determine whether the cytomorphologic features could be related to the prognosis. Nuclear features such as small (less than 10 micrometer) or large (greater than 11 micrometer) size, round or aberrant shape and dark or light staining, were evaluated. In small-cell carcinoma cases with a very poor prognosis (death within four months), the incidence of small, round, darkly stained nuclei was much greater and a coarse or pyknotic chromatin pattern was more frequent in comparison with small-cell carcinoma cases with a better prognosis (survival greater than two years). In cases with a good prognosis, the incidence of large, lightly stained nuclei with aberrant shapes was much greater and a fine chromatin pattern was more frequent in comparison with cases with a very poor prognosis. Pertinent cytomorphologic features thus seem to be related to the prognosis.

Aged↗
PubMed1996

[Prognosis as a treatment frame. Considerations on schizophrenia].

Prognosis holds an ambiguous position in today clinical practice, specially in psychiatry. It is either an impossible prediction or, worse, an oracle dangerous for its predetermined effects. Hippocratic tradition follows a different path: prognosis is what is being said publicly to the patient about his or her disease. It thus allows the doctor to get the patient's trust and to start the treatment. Those two meanings of the word prognosis have been used alternatively through the history of schizophrenia. Firstly, because of medical shortcomings, diagnosis and prognosis were mingled as they both were course criteria. Today, prognosis seems to be based more on actual therapeutic actions and then we are back to the hippocratic meaning of the word: prognosis as a therapeutic frame.

Humans↗
PubMed1995

[Survival prognosis in pemphigoid. A cohort analysis of 78 patients].

INTRODUCTION: Bullous pemphigoid (BP) is the most frequent autoimmune bullous skin disease and usually affects elderly patients. Despite some conflicting data, vital prognosis is poor in BP, of which mortality rate after one year of treatment varies between 10 and 40 p. 100. To date, the factors influencing this prognosis remain to be determined. PATIENTS AND METHODS: A cohort of 78 consecutive patients with BP (mean age: 80 +- 4 years) has been prospectively selected on a six-year period (1987-1992) in Limoges. The diagnosis of BP was made on clinical criteria (using a standardized questionnaire), direct immunofluorescence (IF) findings (linear deposits of IgG and/or C3 along the basement membrane zone) and confirmed by direct immunoelectron microscopy and/or Western immunoblotting on epidermal extracts. RESULTS: The follow-up analysis (mean duration of follow-up: year of treatment (22 p. 100 in the first three months) with an actuarial survival curve inclined to be horizontal by the end of this first year of treatment. Therefore, we have studied the clinical or immunologic factors susceptible to influence the vital prognosis of BP according to this main criterion: death (or survival) at the end of the first year of treatment. None of the following factors has been found to be significantly linked to the vital prognosis in BP: age, sex, extent of skin lesions at presentation, presence of mucosal lesions, blood eosinophilia, presence of circulating basement membrane zone autoantibodies by indirect IF. The clinical factors of bad prognosis were an altered general condition and a history of coronaropathy. The presence of circulating autoantibodies against BP180 antigen (but not the one of autoantibodies against BP230) as detected by immunoblotting on epidermal extracts was found to be significantly more frequent (50 vs 22 percent) in BP patients who died within the first year of treatment (p < 0.02). DISCUSSION: Although modestly discriminating, the presence of circulating autoantibodies against BP180 represents the first vital prognosis factor demonstrated in BP. This result confirms the growing pathophysiologic importance of the anti-BP180 autoantibodies of which the pathogenic role has been recently formally demonstrated in BP using an animal model.

Aged↗