Severe infections in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis: a retrospective cohort study with a clinical phenotype approach

Caballero-Islas, Adrián E.; Hoyo-Ulloa, Irma; García-Castro, Annette; Hinojosa‐Azaola, Andrea

doi:10.1007/s00296-020-04661-x

Cited by 8 publications

(7 citation statements)

References 29 publications

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“…As widely acknowledged in other studies,5–7 17 20 25–27 34–36 infection is a critical complication in the management of AAV and is closely related to deteriorative outcomes, especially in the early stage of the disease. Therefore, more attention to infection-related factors needs to be addressed, and recognition of death-related infection types or causative pathogens provides clinicians with more chances to reduce mortality.…”

Section: Discussionmentioning

confidence: 82%

“…Our results suggested that respiratory infection and Gram-negative bacterial and fungal infection during the first 3 months were independently associated with 1-year mortality. Respiratory infection in AAV, as the most common infection type, is almost unanimous in all studies 4–7 10 16 18 19 25–28. Due to the fact that patients with AAV often exhibit pulmonary involvement at the onset, which presents as interalveolar haemorrhage, the function of the endothelium is possibly damaged.…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20] Respiratory infection is the most frequent infection type, regardless of age, dialysis dependence or given treatment. [21][22][23][24][25][26][27][28] Gram-negative bacteria are the leading causative pathogens, and opportunistic infections are common in patients with AAV. 18 20 25 29 Trimethoprim-sulfamethoxazole (TMP-SMX) was previously thought to protect patients with AAV from Pneumocystis jirovecii either with CYC or rituximab (RTX) treatment.…”

Section: What This Study Addsmentioning

confidence: 99%

“…Most infection episodes occurred in the first 3 months 18–20. Respiratory infection is the most frequent infection type, regardless of age, dialysis dependence or given treatment 21–28. Gram-negative bacteria are the leading causative pathogens, and opportunistic infections are common in patients with AAV 18 20 25 29.…”

Section: Introductionmentioning

confidence: 99%

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Association between different infection profiles and one-year outcomes in ANCA-associated vasculitis: a retrospective study with monthly infection screening

Chen

Jiang

et al. 2022

RMD Open

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ObjectivesThis study aimed to explore clinical features of early infection in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and to identify the association between the infection profile of patients with AAV during the first 3 months and 1-year survival.MethodsA total of 415 newly diagnosed patients with AAV in the Department of Nephrology at Shanghai Ruijin Hospital from 2000 to 2018 were included. Four Cox regression models were used to analyse the association based on demographics, comorbidities, laboratory baseline index and therapy parameter. Infection screening was carried out monthly during the first 3 months after diagnosis.ResultsIn all, 377 episodes of infection were identified among 220 patients during the first 3 months. The overall survival after 1 year was 73.0%. Respiratory infection (210 episodes/164 persons) accounted for more than half of infections. Infection was independently associated with 1-year mortality (adjusted HR 2.32, 95% CI 1.27 to 4.23, p=0.006) after adjustment. Respiratory infection (adjusted HR 4.36, 95% CI 2.86 to 8.06, p<0.001), Gram-negative bacterial infection (adjusted HR 1.71, 95% CI 1.01 to 2.91, p=0.047) and fungal infection (adjusted HR 1.77, 95% CI 1.07 to 2.94, p=0.026) was identified as a risk factor for 1-year mortality. Trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis (adjusted HR 0.55, 95% CI 0.31 to 0.97, p=0.040) was protective for 1-year mortality.ConclusionsInfections, particularly respiratory infections, are a common and important class of complication in patients with AAV and are associated with early mortality. TMP-SMX prophylaxis might be necessary to improve short-term outcome. More consideration of infectious risk and regular infection screening should be given.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association between different infection profiles and one-year outcomes in ANCA-associated vasculitis: a retrospective study with monthly infection screening

Chen

Jiang

et al. 2022

RMD Open

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“…Wichtiger Risikofaktor für das Auftreten einer oder mehrerer SAE war eine pulmonale Beteiligung. Dieser Zusammenhang wurde auch in anderen Studien beschrieben [11][12][13]. Erklärungen hierfür könnten eine intensivere Immunsuppression in dieser Gruppe sowie eine erhöhte Anfälligkeit der geschädigten Lunge gegenüber Infekten sein [12,13].…”

Section: Diskussionunclassified

Therapieansprechen und Komplikationen von älteren Patienten mit ANCA(antineutrophile cytoplasmatische Antikörper)-assoziierten Vaskulitiden

et al. 2022

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Zusammenfassung Hintergrund Von ANCA(antineutrophile cytoplasmatische Antikörper)-assoziierten Vaskulitiden (AAV) sind v. a. Menschen höheren Alters betroffen, ohne dass adaptierte Therapiekonzepte für diese Patienten existieren. Ziel der Studie Ziel der Studie war es, Unterschiede in Verlauf und Outcome von Patienten mit AAV hinsichtlich des Alters zu analysieren. Material und Methoden 62 Patienten wurden auf Therapieansprechen, 53 (85 %) davon konnten hinsichtlich unerwünschter Nebenwirkungen (AE und SAE), analysiert werden. Es wurden ältere (> 65 J.) mit jüngeren (< 65 J.) Patienten verglichen. Das Therapieansprechen wurde nach 6 Monaten, Komplikationen wurden über 18 Monaten beurteilt. Ergebnisse Das Therapieansprechen war in beiden Altersgruppen nicht unterschiedlich. In der multiplen logistischen Regression waren die pulmonale Beteiligung (OR = 6,9, KI = 1,7–27,8; p < 0,01) und die ΔGFR [ml/min] (OR = 0,93, KI = 0,89–0,97; p < 0,01) Prädiktoren für SAE. 14 Patienten hatten mehr als eine SAE; auch hier war eine pulmonale Manifestation bei Diagnose (28,2 % vs. 78,6 %, p < 0,01) Risikofaktor. Ältere Patienten (78,6 % vs. 43,6 %, p = 0,025) waren häufiger betroffen. Patienten mit mehreren SAE bekamen länger Glukokortikoiddosen über 5 mg/Tag (171 ± 65 Tage vs. 120 ± 70 Tage, p = 0,03). Diskussion Hinsichtlich des Therapieansprechens wurden keine Unterschiede zwischen älteren und jüngeren Patienten gefunden. Bei älteren Patienten traten häufiger mehrere SAE auf. Es bestand eine Korrelation zwischen pulmonaler Manifestation und Dauer einer Glukokortikoidgabe mit einem komplizierten Verlauf. Die häufigsten SAE waren Infektionen, welche einer stationären Aufnahme bedurften. Schlussfolgerung Die Therapie für ältere Patienten sollte individualisiert werden, mit dem Ziel einer raschen Reduktion von Glukokortikoiden. Ein besonderes Monitoring ist für ältere Patienten v. a. mit pulmonaler Manifestation bei Krankheitsbeginn angezeigt.

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Infecciones graves en vasculitis necrosantes sistémicas

Pena,

Costi,

García

et al. 2024

Reumatología Clínica

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Severe infections in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis: a retrospective cohort study with a clinical phenotype approach

Cited by 8 publications

References 29 publications

Association between different infection profiles and one-year outcomes in ANCA-associated vasculitis: a retrospective study with monthly infection screening

Association between different infection profiles and one-year outcomes in ANCA-associated vasculitis: a retrospective study with monthly infection screening

Therapieansprechen und Komplikationen von älteren Patienten mit ANCA(antineutrophile cytoplasmatische Antikörper)-assoziierten Vaskulitiden

Infecciones graves en vasculitis necrosantes sistémicas

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