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Clustering the Clinical Course of Chronic Urticaria Using a Longitudinal Database: Effects on Urticaria Remission

Allergy, Asthma & Immunology Research : AAIR 2021년 13권 3호 p.390 ~ 403
예영민, 윤지원, Woo Seong-Dae, 장재혁, 이영수, 이현영, 신유섭, 남동호, 박해심,
소속 상세정보
예영민 ( Ye Young-Min ) - Ajou University School of Medicine Department of Allergy and Clinical Immunology
윤지원 ( Yoon Ji-Won ) - Ajou University Medical Center Clinical Trial Center
 ( Woo Seong-Dae ) - Ajou University School of Medicine Department of Allergy and Clinical Immunology
장재혁 ( Jang Jae-Hyuk ) - Ajou University School of Medicine Department of Allergy and Clinical Immunology
이영수 ( Lee Young-Soo ) - Ajou University School of Medicine Department of Allergy and Clinical Immunology
이현영 ( Lee Hyun-Young ) - Ajou University Medical Center Clinical Trial Center
신유섭 ( Shin Yoo-Seob ) - Ajou University School of Medicine Department of Allergy and Clinical Immunology
남동호 ( Nahm Dong-Ho ) - Ajou University School of Medicine Department of Allergy and Clinical Immunology
박해심 ( Park Hae-sim ) - Ajou University School of Medicine Department of Allergy and Clinical Immunology

Abstract


Purpose: Little is known about the clinical course of chronic urticaria (CU) and predictors of its prognosis. We evaluated CU patient clusters based on medication scores during the initial 3 months of treatment in an attempt to investigate time to remission and relapse rates for CU and to identify predictors for CU remission.

Methods: In total, 4,552 patients (57.9% female; mean age of 38.6 years) with CU were included in this retrospective cohort study. The K-medoids algorithm was used for clustering CU patients. Kaplan-Meier survival analysis with Cox regression was applied to identify predictors of CU remission.

Results: Four distinct clusters were identified: patients with consistently low disease activity (cluster 1, n = 1,786), with medium-to-low disease activity (cluster 2, n = 1,031), with consistently medium disease activity (cluster 3, n = 1,332), or with consistently high disease activity (cluster 4, n = 403). Mean age, treatment duration, peripheral neutrophil counts, total immunoglobulin E, and complements levels were significantly higher for cluster 4 than the other 3 clusters. Median times to remission were also different among the 4 clusters (2.1 vs. 3.3 vs. 6.4 vs. 9.4 years, respectively, P < 0.001). Sensitization to house dust mites (HDMs; at least class 3) and female sex were identified as significant predictors of CU remission. Around 20% of patients who achieved CU remission experienced relapse.

Conclusions: In this study, we identified 4 CU patient clusters by analyzing medication scores during the first 3 months of treatment and found that sensitization to HDMs and female sex can affect CU prognosis. The use of immunomodulators was implicated in the risk for CU relapse.

키워드

Chronic urticaria; cluster analysis; recurrence; database; cohort studies; survival analysis; prognosis; house dust mites

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