Long-Term Risk of Comorbidity after IgA Vasculitis in Childhood: A Population-Based Cohort Study

Abstract

Introduction: Patients with IgA vasculitis (IgAV) may require aggressive treatment and are prone to disease relapses, and IgA deposition in tissues can persist. We investigated whether these factors predispose to long-term morbidity in children with IgAV. Methods: Observational cohort study comparing rates for comorbidity development by Charlson comorbidity index (CCI) and rates for hospitalization, procedures, and emergency department (ED) visits over a 20-year period for IgAV patients \ 20 years (n = 494) and matched hospital-based controls (n = 1385). Odds (OR) for events and rate ratios (RR) for event rates per 1000 person-years were derived from maximum likelihood estimates. Results: Patient survival (99.1 vs. 99.7%, p = 0.6) and overall comorbidity accrual CCI (0.21 vs. 0.23, p = 0.7) were similar for IgAV patients and hospital-based controls after 20 years. IgAV patients did not develop other rheumatic diseases, but more often were diagnosed with peptic ulcer and end-stage renal failure. Hospitalization rates were three times higher for IgAV patients (RR 3.41 CI 3.04-3.82) in the first year following diagnosis, while ED attendance rates were higher in subsequent years (RR 1.29; 1.02-1.04; p \ 0.01) for IgAV patients. Conclusions: Childhood IgAV patients have good long-term prognosis despite the occurrence of end-stage renal failure and compared to hospital-based controls are at not at increased risk for other comorbidity or rheumatic disease.

Septic Arthritis in Children: A Longitudinal Population-Based Study in Western Australia

“… CCI Charlson Comorbidity Index, ICU Intensive Care Unit, IQR interquartile range a Values in table are presented as the number with the percentage in parenthesis unless indicated otherwise b Total number of joints exceeds the number of patients as in 39 patients (4%) multiple joints were affected (see text) c Airway, skin, sepsis and urinary tract [ 20 ] …”

“…This was a population-based retrospective cohort study that used routinely collected statewide administrative health data for patients with specific rheumatic diseases recorded in the Western Australian Rheumatic Disease Epidemiological Registry between 1980 and 2015 (WARDER) [20,21]…”

“…This was a population-based retrospective cohort study that used routinely collected state-wide administrative health data for patients with specific rheumatic diseases recorded in the Western Australian Rheumatic Disease Epidemiological Registry between 1980 and 2015 (WARDER) [ 20 , 21 ]. WARDER data were extracted and linked through the Western Australian Data Linkage System (WADLS) using probabilistic matching (based on a person’s name, residential address, date of birth and gender) to link all health contacts over time for each individual registered in the Hospital Morbidity Data Collection (HMDC), WA Cancer Registry, WA Mortality Registry or the Emergency Department Data Collection (EDDC) in WA (population 2.5 million).…”

Overview of infections as an etiologic factor and complication in patients with vasculitides

“…In the small-vessel vasculitis, including ANCA-associated vasculitides (AAV) [24,25] and/or small-vessel, immune complex-mediated vasculitis [4,5,11], the possible role of infection in triggering de novo disease and relapse has been extensively investigated and a clear association has been demonstrated. On the other hand, there is only indirect evidence to support an infectious etiology for Kawasaki's disease, even though numerous organisms have been proposed but not proven [26].…”

“…Additionally, a higher rate of upper respiratory tract infections has been shown [3]. Concerning children with IgA vasculitis, specific inflammatory factors may be attributed and have a lasting effect on immune competence [4]. Another point of importance is that the incidence of IgA vasculitis exhibited seasonal increases in the spring and decreases in the winter, which may be related to a higher frequency of upper respiratory tract infections during the coldest months of the year.…”