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Objectives: Penicillin V (PcV) is considered the first-line treatment for community-acquired pneumonia in Scandinavian countries, although data supporting this recommendation are scarce. Thus, this study aimed to compare PcV and amoxicillin regarding the risk of treatment failures in children aged >5 years and adults treated for pneumonia in primary care.

Methods: In this retrospective study of healthcare registry data from four regions in Sweden with 2.3 million inhabitants, we included 34 306 primary care cases of pneumonia from February 12, 2018 to December 3, 2021. Adjusted odds ratios (aORs) and 95% CIs for treatment failure days 1 to 28 (primary composite endpoint: hospitalization for lower respiratory tract infections [LRTI] or all-cause mortality; and secondary endpoint: antibiotic switch) were calculated using logistic regression analysis. A propensity score matched analysis was conducted.

Results: PcV was prescribed in 19 761 cases, amoxicillin in 2363 cases, doxycycline in 9830 cases, and other antibiotics in 2352 cases. Hospitalization for LRTI or all-cause mortality occurred in 4.9% of cases treated with amoxicillin vs. 3.8% of cases treated with PcV (aOR, 1.07; 95% CI, 0.87–1.32). Antibiotic switch occurred in 8.9% of cases treated with amoxicillin vs. 14% of cases treated with PcV (aOR, 0.58; 95% CI, 0.50–0.67). The corresponding ORs of the propensity score match analysis were 1.13 (95% CI, 0.86–1.49) for hospitalization for LRTI or all-cause mortality and 0.55 (95% CI, 0.45–0.65) for antibiotic switch.

Conclusions: This study showed no difference in risks of hospitalization for LRTI or all-cause mortality between PcV and amoxicillin for pneumonia in primary care.

Background: The ABO blood group system has shown an association with cardiovascular disease. The susceptibility to CVD is proposed to be partly mediated by dyslipidaemia in non-O individuals. Previous studies are scarce for the RhD blood group, but we recently showed that RhD − young individuals are associated with subclinical atherosclerosis. Hence, we sought to examine whether the ABO blood groups and RhD factor are associated with dyslipidaemia.

Methods: All participants were part of the VIPVIZA study, including 3532 individuals with available plasma lipid levels. Lipids were assessed as total, LDL, HDL, remnant, non-HDL cholesterol and triglycerides. Information about ABO and RhD was retrieved by linking VIPVIZA with the SCANDAT-3 database, where 85% of VIPVIZA participants were registered.

Results: For the ABO blood groups, no significant differences in lipid levels between non-O and O individuals were seen. In 40-year-old males, RhD − individuals compared to RhD + had higher levels of non-HDL cholesterol, LDL cholesterol, and remnant cholesterol, with ratios of geometric means of 1.21 (CI95% 1.03; 1.43), 1.20 (1.02; 1.41) and 1.38 (1.00; 1.92), respectively. No differences in lipid levels depending on the RhD blood group were seen in women or the older age groups.

Conclusion: Our study indicates that younger RhD − men have increased non-HDL, LDL, and remnant cholesterol levels. Thus, the RhD blood group, but not ABO, seems to be associated with dyslipidaemia and may act as a future possible risk marker of cardiovascular disease.

Guidelines on storage for samples intended for Prothrombin Time–International Normalized Ratio (PT-INR) analysis have changed over time, sometimes advising against cold storage due to presumed cold activation of the coagulation cascade. Previous studies on PT-INR storage have mainly been underpowered, performed in glass tubes, and not in a modern laboratory setting. In this study, we re-analyzed 1149 PT-INR samples, divided into low-level samples (PT-INR <1.3), and high-level samples (PT-INR 1.8–3.5) after 3 h of cold storage. We found no statistical difference for high-level samples but statistically higher PT-INR values in low-level samples. The differences were minor and not considered clinically relevant. No cold activation could be detected, as cold activation would have diminished PT-INR. These findings open the possibility of transporting and storing centrifuged PT-INR samples refrigerated. The higher PT-INR values in low-level samples after cold storage impede a mechanistic principle that needs to be further investigated.

Objectives: We examined the magnitude of transcription errors in lipid variables in the VIPVIZA study and assessed whether education among the research personnel reduced the error frequency at follow-up. We also examined how the errors affected the SCORE2 risk prediction algorithm for cardiovascular disease, which includes lipid parameters, as this could lead to an incorrect treatment decision.

Methods: The VIPVIZA study includes assessment of lipid parameters, where results for total cholesterol, triglycerides, HDL cholesterol, and calculated LDL cholesterol are transcribed into the research database by research nurses. Transcription errors were identified by recalculating LDL cholesterol, and a difference>0.15 indicated a transcription error in any of the four lipid parameters. To assess the presence of risk category misclassification, we compared the individual's SCORE2 risk category based on incorrect lipid levels to the SCORE2 categories based on the correct lipid levels.

Results: The transcription error frequency was 0.55 % in the 2019 VIPVIZA research database and halved after the educational intervention to 0.25 % in 2023. Of the 39 individuals who had a transcription error in total or HDL cholesterol (with the possibility of affecting the SCORE2 risk category based on non-HDL cholesterol), six individuals (15 %) received an incorrect risk category due to the error.

Conclusions: Transcription errors persist despite digitalisation improvements. It is essential to minimise transcriptions in fields outside the laboratory environment, as we observed that critical decisions also rely on accurate information such as the SCORE2-risk algorithm, which is dependent on lab results but not necessarily reported by the laboratory.

BACKGROUND: Elevated low-density lipoprotein (LDL) cholesterol levels represent a significant modifiable risk factor for atherosclerotic cardiovascular disease. However, a residual risk persists, possibly attributed to other atherogenic lipoproteins such as non-high-density lipoprotein (non-HDL) and remnant cholesterol. Nevertheless, few studies have explored the independent associations between these lipid biomarkers and early atherosclerotic disease.

OBJECTIVE: To evaluate the relative contributions of LDL, non-HDL, and remnant cholesterol to subclinical atherosclerosis, assessed by carotid ultrasonography.

METHOD: In this cross-sectional study, we included 1929 previously healthy individuals from the pragmatic VIPVIZA trial who had available lipid levels and carotid ultrasonography results to assess subclinical disease. Non-HDL, LDL, and remnant cholesterol were calculated from a standard lipid profile. Subclinical atherosclerosis was assessed by carotid intima-media thickness (cIMT) and the presence of carotid plaques.

RESULTS: We found that all lipid variables (LDL, non-HDL, and remnant cholesterol) were associated with subclinical atherosclerosis in univariable models (P < .01 across all models for cIMT and P < .001, P < .001, P = .003 respectively for carotid plaques). In multivariable-adjusted models, increasing LDL and non-HDL cholesterol levels were still significantly associated with increased odds of having carotid plaques (P < .001 for both) and increased cIMT (P < .001 for both). However, no independent association between remnant cholesterol and subclinical atherosclerosis was observed in the model adjusted for LDL cholesterol levels (P = .073 for cIMT and = .818 for plaque).

CONCLUSION: Increasing LDL and non-HDL cholesterol levels, but not remnant cholesterol, seem to contribute to carotid subclinical atherosclerosis.

Background: The ABO blood group system has previously been associated with cardiovascular disease (CVD), where non-O blood group individuals have shown an increased risk. Studies assessing early atherosclerotic disease while also including RhD are few. We aimed to determine whether the ABO and RhD blood groups are associated with subclinical atherosclerosis in a healthy population.

Methods: We included 3532 participants from the VIPVIZA trial with available carotid ultrasonography results to assess subclinical disease. Information about blood groups was obtained from the SCANDAT-3 database, where 85% of VIPVIZA participants were registered.

Results: RhD− individuals aged 40 years showed increased carotid intima–media thickness (B 1.09 CI 95% 1.03; 1.14) compared to RhD+ individuals. For ABO, there were no differences in ultrasonography results when assessing the whole study population. However, 60-year-old individuals with heredity for CVD and a non-O blood group had decreased odds for carotid plaques (OR 0.54 CI 95% 0.33; 0.88).

Conclusions: RhD blood group is associated with subclinical atherosclerosis in younger individuals, indicating a role as a mediator in the atherosclerotic process. In addition, a non-O blood group was associated with decreased subclinical atherosclerosis in individuals aged 60 and with heredity (corresponding to the group with the highest atherosclerotic burden).

This study aimed to describe differences in prevalence and the long-term presence of nucleocapsid antibodies (N-antibodies) elicited by SARS-CoV-2 infection in a Swedish blood donor population not subjected to lockdown. We tested 20,651 blood donor samples for nucleocapsid antibodies from the beginning of March 2020 and 27 months onwards using the Roche Elecsys Anti-SARS-CoV-2 assay. The proportion of positive SARS-CoV-2 antibody samples was determined each week. After the exclusions of one-time donors and subjects with incomplete data, 19,726 samples from 4003 donors remained. Differences in antibody prevalences stratified for age, sex, and blood groups (ABO and RhD) were determined, as well as antibody loss and recovery. Lower antibody prevalence was seen for older donors, blood group AB, and RhD-negative subjects. A significant decrease in antibody titer between the first and the second antibody-positive donation was seen for the whole study group, females, older subjects, blood group O, AB, and RhD-positive subjects. The titer waned below the detection limit in 60 (3.0%) of 1983 N-antibody-positive donors, and for 18 of these donors, a second episode with antibodies was detected. We showed that N-antibodies persist for months or years and that surprisingly few antibody-positive donors lost their antibodies. We also conclude that antibody prevalence in a Swedish population never subject to lockdown did not apparently differ from populations that were subject to stricter regulations.

Background: There has been a notable decrease in antibiotic prescribing in the last thirty years in Sweden. Little is known about factors influencing antibiotic prescribing over several years.

Objective: To compare primary care physicians who, over time, reduced their antibiotic prescribing for respiratory tract infections with those who remained either high or low prescribers regarding potentially influencing factors.

Design and setting: A register-based study including all RTI visits in primary care in Region Kronoberg, Sweden 2006-2014. The data were divided into three 3-year periods.

Subjects: The data comprised all physicians who had diagnosed at least one RTI for each of the three-year periods. The antibiotic prescribing rate adjusted for the patients' sex and age group was calculated for each physician and period, and based on the change between the first and the third period, the physicians were divided into three prescriber groups: The High Prescribing Group, the Decreasing Prescribing Group, and the Low Prescribing Group.

Main outcome measures: For the three prescriber groups, we compared factors influencing antibiotic prescribing such as the characteristics of the physicians, their use of point-of-care tests, their choice of diagnoses, and whether the patients returned and received antibiotics.

Results: The High Prescribing Group ordered more point-of-care tests, registered more potential bacterial diagnoses, prescribed antibiotics at lower C-reactive protein levels, and prescribed antibiotics more often despite negative group A Streptococci test than in the Low Prescribing Group. The Decreasing Prescribing Group was between the High Prescribing Group and the Low Prescribing Group regarding these variables. The lower prescription rate in the Low Prescribing Group did not result in more return visits or new antibiotic prescriptions within 30 days.

Conclusion: Point-of-care testing and its interpretation differed between the prescriber groups. Focus on interpreting point-of-care test results could be a way forward in antibiotic stewardship. 

Objectives: Spectrophotometric absorption curve analysis of cerebrospinal fluid (CSF) for oxyhaemoglobin and bilirubin is necessary to accurately diagnose subarachnoid haemorrhage (SAH) in patients with typical symptoms but with negative findings on X-ray examinations. In this study, we evaluated the performance of two methods for interpreting absorption curves; one method from the United Kingdom National External Quality Assessment Service (UK-NEQAS) and the other from the national quality assurance programme in Sweden (Equalis).

Methods: Consecutive absorbance curves (n=336) were interpreted with two different methods, and their performance was compared to the diagnosis as stated in the patient records.

Results: The UK-NEQAS method displayed equal sensitivity to the Equalis method, but the specificity of the UK-NEQAS method was significantly higher than the Equalis method resulting in fewer false positive results. For UK-NEQAS, a positive predictive value (PPV) of 84.6% and a negative predictive value (NPV) of 99.7% were observed, whereas the Equalis method had a PPV of 27.5% and an NPV of 99.7%.

Conclusions: The semi-automated method based on the guidelines from UK-NEQAS provides an efficient and correct interpretation of absorbance curves with short turn-around times. We propose using this method for the routine interpretation of CSF spectrophotometric curves.