Acute pericarditis with pleuropulmonary involvement, fever and elevated C-reactive protein: A systemic autoinflammatory disease? A cohort study.

Autor: Pisacreta AM; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy. Electronic address: anna.pisacreta@unimi.it., Mascolo R; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy., Nivuori M; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy., Dominioni CC; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy., Gabiati C; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy., Trotta L; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy., Pancrazi M; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy., Marco GD; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy., Carollo C; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy., Pedroli A; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy., Casarin F; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy., Tombetti E; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy; Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, Università di Milano, Milan, Italy., Bizzi E; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy., Imazio M; Cardiothoracic Department, Santa Maria della Misericordia Hospital, and DAME, University of Udine, Udine, Italy., Brucato A; Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy; Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, Università di Milano, Milan, Italy.
Jazyk: angličtina
Zdroj: European journal of internal medicine [Eur J Intern Med] 2023 Jul; Vol. 113, pp. 45-48. Date of Electronic Publication: 2023 Apr 15.
DOI: 10.1016/j.ejim.2023.03.034
Abstrakt: Objectives: This cohort study describes a systemic phenotype of pericarditis, comparing this phenotype with other forms of pericarditis.
Patients and Methods: Patients in our center were enrolled in a prospectively maintained registry from 2019 to 2022. 412 patients with idiopathic recurrent pericarditis were analyzed. "Systemic inflammatory" subset was defined as the presence of all the following criteria: fever ≥38C°, CRP ≥2 times normal values, pleural effusion detected with any imaging techniques. The absence of any of the 3 criteria was defined as "isolated" subset.
Results: We found that 211 (51.2%) of 412 patients (188 female) presented the systemic subset and the variables significantly associated with this subset in univariate analysis (p<0.001) were: higher mean age: 45.5 (±SD 17.2) vs 39.9 (±SD 16.4) years, higher mean CRP values: 128.8 vs 49.9 mg/L, higher proportion of pericardiocentesis: 19% vs 1.5%, higher mean leukocyte count: 13,143.3 vs 9910.3/mm 3 , higher mean neutrophils number: 10,402.5 vs 6779.8 /mm 3 and lower mean lymphocyte count: 1693.9 vs 2079.3 /mm 3 . As results the neutrophil-to-lymphocyte ratio was higher in systemic inflammatory phenotype: 6.6 vs 3.4 (p< 0.001). Anti-IL1 therapy was started more frequently in the systemic subgroup (26%) than in the isolated subset (7.5%) (p < 0.001). On multivariate analysis neutrophil count and lymphopenia were statistically associated with the systemic subset (p < 0.001).
Conclusion: This results demonstrate the relevance of the systemic inflammatory phenotype, characterized by pleural effusions, confirming its analogy with autoinflammatory diseases, thus possibly requiring an eventual escalation of therapy to IL-1 inhibitors.
(Copyright © 2023. Published by Elsevier B.V.)
Databáze: MEDLINE
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