Factors predicting development of serious infections in ANCA-associated vasculitis
DOI:
https://doi.org/10.36141/svdld.v40i2.13243Keywords:
Infection, ANCA, vasculitis, mortalityAbstract
Background: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare autoimmune disease usually involving small vessels and progressing with necrotizing inflammation. Treatment requires long-term use of immunosuppressive agents to inhibit disease activity. Serious infections (SIs) are a common complication in AAV.
Objective: The aim of this study was to identify the risk factors for serious infections which required hospitalization in patients with AAV.
Methods: In this retrospective cohort study., we included 84 patients admitted to the Ankara University Faculty of Medicine in the last 10 years with a diagnosis of AAV.
Results: In 42 (50%) of 84 patients followed up with the diagnosis of AAV, an infection requiring hospitalization was identified. The patients’ total corticosteroid dose, use of pulse steroids, induction regimen, levels of C-reactive protein (CRP) and the presence of pulmonary and renopulmonary involvement were found to be associated with the frequency of infection (respectively: p=0.015, p=0.016, p=0.010, p=0.03, p= 0.026 and p=0.029). However, after a multivariate analysis was performed due to the confounding factors, it was found that renopulmonary involvement (p=0.002, HR=4.95, 95% CI= 1.804-13.605), an age of over 65 (p=0.049, HR=3.37, 95% CI=1.004-11.369) and high CRP levels (p=0.043, HR=1.006, 95% CI=1.000-1.011) constituted independent predictors of serious infection risk.
Conclusion: The frequency of infection is known to be increasing in ANCA-associated vasculitis. Our study shows that renopulmonary involvement, age and elevated CRP levels on admission are independent risk factors of infection.
Downloads
References
Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1-11. doi:10.1002/art.37715
Ntatsaki E, Carruthers D, Chakravarty K, et al. BSR and BHPR guideline for the management of adults with ANCA-associated vasculitis. Rheumatology (Oxford). 2014;53(12):2306-2309. doi:10.1093/rheumatology/ket445
Bligny D, Mahr A, Toumelin PL, et al. Predicting mortality in systemic Wegener's granulomatosis: a survival analysis based on 93 patients. Arthritis Rheum. 2004;51(1):83-91. doi:10.1002/art.20082
Mohammad AJ, Segelmark M, Smith R, et al. Severe Infection in Antineutrophil Cytoplasmic Antibody-associated Vasculitis. J Rheumatol. 2017;44(10):1468-1475. doi:10.3899/jrheum.160909
Harper L, Savage CO. ANCA-associated renal vasculitis at the end of the twentieth century--a disease of older patients. Rheumatology (Oxford). 2005;44(4):495-501. doi:10.1093/rheumatology/keh522
McGregor JG, Hogan SL, Hu Y, et al. Glucocorticoids and relapse and infection rates in anti-neutrophil cytoplasmic antibody disease. Clin J Am Soc Nephrol. 2012;7(2):240-247. doi:10.2215/CJN.05610611
Hunder GG, Arend WP, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of vasculitis. Introduction. Arthritis Rheum. 1990;33(8):1065-1067. doi:10.1002/art.1780330802
Luqmani RA, Bacon PA, Moots RJ, et al. Birmingham Vasculitis Activity Score (BVAS) in systemic necrotizing vasculitis. QJM. 1994;87(11):671-678.
Mukhtyar C, Lee R, Brown D, et al. Modification and validation of the Birmingham Vasculitis Activity Score (version 3). Ann Rheum Dis. 2009;68(12):1827-1832. doi:10.1136/ard.2008.101279
Stone JH, Hoffman GS, Merkel PA, et al. A disease-specific activity index for Wegener's granulomatosis: modification of the Birmingham Vasculitis Activity Score. International Network for the Study of the Systemic Vasculitides (INSSYS). Arthritis Rheum. 2001;44(4):912-920.doi:10.1002/15290131(200104)44:4<912::AIDANR148>3.0.CO;2-5
Charlier C, Henegar C, Launay O, et al. Risk factors for major infections in Wegener granulomatosis: analysis of 113 patients. Ann Rheum Dis. 2009;68(5):658-663. doi:10.1136/ard.2008.088302
Reinhold-Keller E, Beuge N, Latza U, et al. An interdisciplinary approach to the care of patients with Wegener's granulomatosis: long-term outcome in 155 patients [published correction appears in Arthritis Rheum. 2000 Oct;43(10):2379]. Arthritis Rheum. 2000;43(5):1021-1032. doi:10.1002/1529-0131(200005)43:5<1021::AID-ANR10>3.0.CO;2-J
Gayraud M, Guillevin L, Le Toumelin P, et al. Long-term followup of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: analysis of four prospective trials including 278 patients. Arthritis Rheum. 2001;44(3):666-675. doi:10.1002/1529-0131(200103)44:3<666::AID-ANR116>3.0.CO;2-A
Álvarez Troncoso J, Iannaccone Z, Álvaro Valiente E, et al. Anca associated vasculitis and infections: retrospective analysis in a referral centre. Ab0673, annals of the rheumatic disease,2018: 77:1480
Yang L, Xie H, Liu Z, et al. Risk factors for infectious complications of ANCA-associated vasculitis: a cohort study. BMC Nephrol. 2018;19(1):138. Published 2018 Jun 14. doi:10.1186/s12882-018-0933-2
Yamaguchi M, Katsuno T, Iwagaitsu S, et al. Oral candidiasis is a significant predictor of subsequent severe infections during immunosuppressive therapy in anti-neutrophil cytoplasmic antibody-associated vasculitis. BMC Infect Dis. 2019;19(1):664. Published 2019 Jul 26. doi:10.1186/s12879-019-4300-0
Waki D, Nishimura K, Kadoba K, et al.Mortality and early severe infection in patients with anca-associated vasculitisAnnals of the Rheumatic Diseases 2018;77:772-773.
Huffnagle GB, Dickson RP, Lukacs NW. The respiratory tract microbiome and lung inflammation: a two-way street. Mucosal Immunol. 2017;10(2):299-306. doi:10.1038/mi.2016.108
Hauser AB, Stinghen AM, Kato S, et al. Characteristics and Causes Of Immune Dysfunction Related To Uremia And Dialysis. Peritoneal Dialysis International, Vol. 28 (2008), Supplement 3 .11/2007M
Garcia-Vives E, Segarra-Medrano A, Martinez-Valle F, et al. Prevalence and Risk Factors for Major Infections in Patients with Antineutrophil Cytoplasmic Antibody-associated Vasculitis: Influence on the Disease Outcome. J Rheumatol. 2020;47(3):407-414. Doi:10.3899/jrheum.190065
Flossmann O, Berden A, de Groot K, et al. Long-term patient survival in ANCA-associated vasculitis. Ann Rheum Dis. 2011;70(3):488-494. Doi:10.1136/ard.2010.137778
Lai QY, Ma TT, Li ZY, et al. Predictors for mortality in patients with antineutrophil cytoplasmic autoantibody-associated vasculitis: a study of 398 Chinese patients. J Rheumatol. 2014;41(9):1849-1855. Doi:10.3899/jrheum.131426
Yoo J, Jung SM, Song JJ, et al. Birmingham vasculitis activity and chest manifestation at diagnosis can predict hospitalised infection in ANCA-associated vasculitis. Clinical Rheumatology. 2018 Aug;37(8):2133-2141. DOI: 10.1007/s10067-018-4067-5.
Little MA, Nightingale P, Verburgh CA, et al. Early mortality in systemic vasculitis: relative contribution of adverse events and active vasculitis. Ann Rheum Dis. 2010;69(6):1036-1043. Doi:10.1136/ard.2009.109389
Pinti M, Appay V, Campisi J, et al. Aging of the immune system: Focus on inflammation and vaccination. Eur J Immunol. 2016;46(10):2286-2301. Doi:10.1002/eji.201546178
Morishita M, Sada K-E, Matsumoto Y, et al. Risk factors for cytomegalovirus infection in patients with antineutrophil cytoplasmic antibody-associated vasculitis. Plos ONE 2019; 14(7): e0218705.
Issue
Section
License
Copyright (c) 2023 Emine Uslu Yurteri, Serdar Sezer, Müçteba Enes Yayla, İlyas Ercan Okatan, Ayşe Bahar Keleşoğlu Dinçer, Emiine Gözde Aydemir Gülöksüz, Tahsin Murat Turgay, Aşkın Ateş, Gülay Kınıklı, Charite university

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.