Volume 18, Number 4—April 2012
Research
Identification of Risk Factors for Chronic Q Fever, the Netherlands
Linda M. Kampschreur
, 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
, 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
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
Page created: March 14, 2012
Page updated: March 14, 2012
Page reviewed: March 14, 2012
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