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Volume 18, Number 4—April 2012

Research

Identification of Risk Factors for Chronic Q Fever, the Netherlands

Linda M. KampschreurComments to Author , Sandra Dekker, Julia C.J.P. Hagenaars, Peter J. Lestrade, Nicole H.M. Renders, Monique G.L. de Jager-Leclercq, Mirjam H.A. Hermans, Cornelis A.R. Groot, Rolf H.H. Groenwold, Andy I.M. Hoepelman, Peter C. Wever, and Jan Jelrik Oosterheert
Author affiliations: University Medical Centre Utrecht, Utrecht, the Netherlands (L.M. Kampschreur, R.H.H. Groenwold, A.I.M Hoepelman, J.J. Oosterheert); VU University, Amsterdam, the Netherlands (S. Dekker); Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands (J.C.J.P. Hagenaars, P.J. Lestrade, N.H.M. Renders, M.H.A. Hermans, P.C. Wever); Bernhoven Hospital, Oss/Veghel, the Netherlands (M.G.L. de Jager-Leclercq, C.A.R. Groot)

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Table 2

Results of univariate analysis of risk factors for chronic versus acute Q fever*

Risk factor Acute Q fever, no. (%), n = 201 All chronic Q fever, n = 105

Proven and probable chronic Q fever, n = 72

Proven chronic Q fever, n = 44
No. (%) OR (95% CI) p value No. (%) OR (95% CI) p value No. (%) OR (95% CI) p value
Male 129 (64.2) 70 (66.7) 1.12 (0.68–1.84) 0.665 50 (69.4) 1.27 (0.71–2.26) 0.420 32 (72.7) 1.49 (0.72–3.07) 0.281
Mean age, y (±SD) 52.5 (±13.7) 63.9 (±13.5) 1.06 (1.04–1.09)† 0.000 67.3 (±11.8) 1.09 (1.07–1.12)† 0.000 68.4 (±10.8) 1.11 (1.07–1.15)† 0.000
Smoker 85 (42.5) 43 (44.3) 1.08 (0.66–1.76) 0.765 33 (49.3) 1.31 (0.75–2.29) 0.336 22 (55.0) 1.65 (0.84–3.27) 0.149
Medical history
Vascular history 9 (4.5) 33 (31.4) 9.78 (4.46–21.4) 0.000 29 (40.3) 14.4 (6.35–32.6) 0.000 23 (52.3) 23.4 (9.57–57.1) 0.000
Vascular prosthesis 2 (1.0) 15 (14.3) 16.5 (3.71–74.0) 0.000 15 (20.8) 26.2 (5.82–118) 0.000 14 (31.8) 46.4 (10.0–215) 0.000
Aneurysm 2 (1.0) 12 (11.4) 12.8 (2.82–58.5) 0.001 12 (16.7) 19.9 (4.33–91.4) 0.000 9 (20.5) 25.6 (5.30–123) 0.000
Other vascular surgery 3 (1.5) 7 (6.7) 4.71 (1.19–18.6) 0.027 5 (6.9) 4.93 (1.15–21.2) 0.032 4 (9.1) 6.60 (1.42–30.6) 0.016
Peripheral arterial disease 6 (3.0) 11 (10.5) 3.80 (1.37–10.6) 0.011 8 (11.1) 4.06 (1.36–12.2) 0.012 6 (13.6) 5.13 (1.57–16.8) 0.007
Cerebrovascular disease‡ 8 (4.0) 11 (10.5) 2.82 (1.10–7.25) 0.031 9 (12.5) 3.45 (1.28–9.31) 0.015 5 (11.4) 3.09 (0.96–9.96) 0.058
Valvulopathy 10 (5.0) 25 (23.8) 5.97 (2.47–13.0) 0.000 23 (31.9) 8.97 (4.00–20.1) 0.000 13 (29.5) 8.01 (3.23–19.8) 0.000
Valvular disease, NS§ 10 (5.0) 17 (16.2) 3.69 (1.62–8.39) 0.002 14 (19.4) 4.61 (1.95–10.9) 0.001 9 (20.5) 4.91 (1.86–13.0) 0.001
Valvular surgery 1 (0.5)¶ 18 (17.1) 41.4 (5.44–315) 0.000 18 (25.0) 66.7 (8.70–511) 0.000 10 (22.7) 58.8 (7.29–474) 0.000
Congenital cardiac disease 1 (0.5) 1 (1.0) 1.92 (0.12–31.1) 0.645 NA NA NA NA NA NA
Ischemic cardiac disease# 17 (8.5) 28 (26.7) 3.94 (2.04–7.61) 0.000 23 (31.9) 5.08 (2.52–10.2) 0.000 17 (38.6) 6.82 (3.11–14.9) 0.000
Pacemaker 2 (1.0) 3 (2.9) 2.93 (0.48–17.8) 0.244 3 (4.2) 4.33 (0.71–26.4) 0.113 3 (6.8) 7.28 (1.18–45.0) 0.033
Other cardiac history** 12 (6.0) 26 (24.8) 5.18 (2.49–10.8) 0.000 23 (31.9) 7.39 (3.44–15.9) 0.000 15 (34.1) 8.15 (3.47–19.1) 0.000
Hypertension 56 (27.9) 44 (41.9) 1.87 (1.14–3.07) 0.013 35 (48.6) 2.45 (1.41–4.27) 0.002 24 (54.5) 3.11 (1.59–6.06) 0.001
Dyslipidemia 39 (19.4) 32 (30.5) 1.82 (1.06–3.13) 0.031 23 (31.9) 1.95 (1.06–3.58) 0.031 16 (36.4) 2.37 (1.17–4.81) 0.017
Diabetes mellitus, type 1 or 2 13 (6.5) 15 (14.3) 2.41 (1.10–5.28) 0.028 10 (13.9) 2.33 (0.97–5.58) 0.057 7 (15.9) 2.74 (1.02–7.32) 0.045
Nonhematologic malignancy 6 (3.0) 16 (15.2) 5.84 (2.21–15.4) 0.000 10 (13.9) 5.24 (1.83–15.0) 0.002 6 (13.6) 5.13 (1.57–16.8) 0.007
Immune disorder†† 2 (1.0) 4 (3.8) 3.94 (0.71–21.9) 0.117 4 (5.6) 5.85 (1.05–32.7) 0.044 3 (6.8) 7.28 (1.18–45.0) 0.033
COPD 14 (7.0) 13 (12.4) 1.89 (0.85–4.18) 0.117 9 (12.5) 1.91 (0.79–4.62) 0.152 6 (13.6) 2.11 (0.76–5.84) 0.151
Other pulmonary disease‡‡ 6 (3.0) 3 (2.9) 0.96 (0.23–3.90) 0.950 2 (2.8) 0.93 (0.18–4.71) 0.929 NA NA NA
Liver disease 1 (0.5) 3 (2.9) 5.88 (0.60–57.3) 0.127 2 (2.8) 5.71 (0.51–64.0) 0.157 1 (2.3) 4.65 (0.29–75.8) 0.280
Renal insufficiency 2 (1.0) 12 (11.4) 12.8 (2.82–58.5) 0.001 12 (16.7) 19.9 (4.33–91.4) 0.000 9 (20.5) 25.6 (5.30–123) 0.000
Autoimmune disease§§ 2 (1.0) 1 (1.0) 0.96 (0.09–10.7) 0.971 1 (1.4) 1.40 (0.13–15.7) 0.784 NA NA NA
Pregnancy¶¶ 0 (0.0) 3 (2.9) NA 0.040 2 (2.8) NA 0.069 1 (2.3) NA 0.180
Medication at time of acute Q fever
Proton pump inhibitors¶¶ 15 (7.5) 7 (11.7) 1.63 (0.63–4.20) 0.313 5 (14.7) 2.13 (0.72–6.29) 0.173 5 (23.8) 3.85 (1.24–12.0) 0.020
Statin¶¶ 29 (14.5) 19 (31.7) 2.73 (1.40–5.35) 0.003 15 (44.1) 4.66 (2.13–10.2) 0.000 13 (61.9) 9.58 (3.65–25.1) 0.000
Carbasalate calcium¶¶ 6 (3.0) 2 (3.3) 1.12 (0.22–5.67) 0.896 2 (5.9) 2.02 (0.39–10.5) 0.401 2 (9.5) 3.40 (0.64–18.0) 0.150
Acenocoumarol¶¶ 6 (3.0) 7 (11.7) 4.27 (1.38–13.3) 0.012 5 (14.7) 5.58 (1.60–19.4) 0.007 2 (9.5) 3.40 (0.64–18.0) 0.150
Clopidogrel¶¶ 2 (1.0) 3 (5.0) 5.21 (0.85–31.9) 0.074 2 (5.9) 6.19 (0.84–45.5) 0.073 2 (9.5) 10.4 (1.39–78.2) 0.023
Acute Q fever
Adequate treatment## 157 (89.7) 37 (84.1) 0.61 (0.24–1.56) 0.298 22 (78.6) 0.42 (0.15–1.17) 0.098 12 (70.6) 0.28 (0.09–0.87) 0.028
Hospitalization 36 (18.0) 26 (35.1) 2.47 (1.36–4.49) 0.003 16 (38.1) 2.80 (1.37–5.76) 0.005 9 (34.6) 2.41 (0.99–5.84) 0.051

*No. (%) case patients. n indicates no. patients wth information available for that category. OR, odds ratio; NS, nonsurgical; NA, not applicable; COPD, chronic obstructive pulmonary disease.
†OR per year of increasing age.
‡Cerebrovascular disease and transient ischemic attack.
§Case-patients: aortic valve defects, 10 (no bicuspid valves); mitral valve defects, 9 (no prolapse); tricuspid valve defects, 4. Controls: aortic valve defects, 6 (no bicuspid valves); mitral valve defects, 3 (1 prolapse).
¶n = 0 in reality.
#Angina pectoris and myocardial infarction.
**Atrial fibrillation, congestive heart failure, pericarditis, bradycardia, ischemic cardiomyopathy, and left ventricular hypertrophy.
††Prednisone cumulative dose >750 mg; use of tumor necrosis factor α–blocker, methotrexate, mycofenolate mofetil; splenectomy.
§§Asthma, recurrent pneumonia, rheumatoid arthritis.
¶¶>25% missing in case groups.
##Defined as 10–14 d of doxycycline treatment

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