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J Clin Immunol. 2019 Aug 1. doi: 10.1007/s10875-019-00666-9. [Epub ahead of print]

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

Author information

1
Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, Odense, Denmark. Frederik.veitland.antonsen2@rsyd.dk.
2
Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 9a, Odense, Denmark. Frederik.veitland.antonsen2@rsyd.dk.
3
Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, Odense, Denmark.
4
Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus, Denmark.
5
Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark.
6
Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Kettegaard Allé 30, Copenhagen, Denmark.
7
Department of Pulmonary and Infectious Diseases, North Zealand Hospital, Dyrehavevej 29, Hilleroed, Denmark.
8
International Center of Immunodeficiency Diseases, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus, Denmark.

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.

KEYWORDS:

CVID; PID; consultations; diagnostic delay; indicators; primary health care

PMID:
31372799
DOI:
10.1007/s10875-019-00666-9

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