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Risk factors associated with severity of dry eye syndrome in ocular graft-versus-host disease

      Abstract

      Objective

      The aim of this study was to identify risk factors for the development of severe dry eye syndrome (DES) in patients with ocular graft-versus-host disease (oGVHD).

      Design

      Retrospective Chart Review.

      Participants

      Patients undergoing allogeneic hematopoietic stem cell transplantation at the British Columbia Cancer Agency between 2011 and 2013.

      Methods

      A retrospective chart review of post-transplant patients with oGVHD DES followed at the British Columbia Cancer Agency Bone Marrow Transplant Unit was performed. Patient and donor data were collected. Descriptive and inferential statistics were carried out. Linear, logistic, and ordered logistic regression analyses were carried out. DES severity was graded using the National Institutes of Health criteria.

      Results

      Of the 78 patients studied, 39 (50%) were male. The median age and Schirmer score were 56 years (range 24–71 years) and 14 mm (range 0–25 mm), respectively. A lower Schirmer score (p = 0.0001), severe overall chronic graft-versus-host disease (GVHD) (p < 0.0001), and lung involvement (p = 0.04) were associated with worsening oGVHD DES. Ordered logistic regression analysis revealed characteristics predictive of oGVHD severity. Fourteen patients (17.95%) had severe DES. Compared with those with nonsevere DES, this group was more likely to be male (p = 0.02) and have a lower Schirmer score (p = 0.01), significantly worse overall chronic GVHD (p = 0.002), as well as lung (p = 0.02) and gastrointestinal tract (p = 0.02) involvement. Logistic regression analysis revealed characteristics predictive of severe oGVHD DES.

      Conclusion

      This study identified potential risk factors associated with the development of severe DES in patients with oGVHD.

      Résumé

      Objectif

      Notre étude avait pour objectif de définir les facteurs de risque d'apparition d'une sécheresse oculaire (SO) grave chez des patients qui présentaient une maladie du greffon contre l'hôte (GVHD, pour graft-versus-host disease) oculaire.

      Nature

      Examen rétrospectif de dossiers médicaux.

      Participants

      Patients ayant subi une allogreffe de cellules souches hématopoïétiques à la British Columbia Cancer Agency entre 2011 et 2013.

      Méthodes

      On a procédé à un examen rétrospectif des dossiers médicaux de patients qui ont subi une greffe et qui présentaient une SO au décours d'une GVHD oculaire à l'unité de greffe de moelle osseuse de la British Columbia Cancer Agency. Ont été recensées les données sur les patients et les donneurs, lesquelles ont servi à l’établissement de statistiques descriptives et déductives. Des analyses de régression linéaire, logistique et logistique ordonnée ont été réalisées. La gravité de la SO a été mesurée selon les critères des National Institutes of Health.

      Résultats

      Sur les 78 patients étudiés, 39 (50 %) étaient de sexe masculin. L’âge médian s’élevait à 56 ans (fourchette : 24–71 ans), tandis que le score de Schirmer médian s’établissait à 14 mm (fourchette : 0–25 mm). On a observé une association entre un faible score de Schirmer (p = 0,0001), une GVHD globale chronique importante (p < 0,0001) et une atteinte pulmonaire (p = 0,04), d'une part, et une aggravation de la SO liée à la GVHD oculaire. L'analyse de régression logistique ordonnée a mis au jour des caractéristiques qui permettent de prédire la gravité de la SO liée à la GVHD oculaire. Ainsi, 14 patients (17,95 %) présentaient une SO grave. Comparativement aux sujets chez lesquels la SO était légère, ces 14 patients étaient plus susceptibles d’être des hommes (p = 0,02), d'avoir un faible score de Schirmer (p = 0,01), de souffrir d'une GVHD globale chronique significativement plus prononcée (p = 0,002) et de présenter une atteinte pulmonaire (p = 0,02) et gastrointestinale (p = 0,02). L'analyse de régression logistique a fait ressortir des caractéristiques qui peuvent prédire l'apparition d'une SO grave liée à la GVHD oculaire.

      Conclusion

      La présente étude a fait ressortir des facteurs de risque éventuels de l'apparition d'une SO grave en présence d'une GVHD oculaire.
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