Delivering reduced dose of immunosuppression for elderly patients was associated with satisfactory outcome and favorable treatment-related complication profile. The higher mortality in the elderly could be attributed mainly to baseline cardiovascular morbidity.

BackgroundImmunosuppressive therapy has improved the outcome of ANCA-associated vasculitis (AAV), but infectious morbidity and mortality remained high. Recognizing its risk factors seems crucial for prevention, aiming to increase survival of these patients.MethodsWe investigated the incidence and types of infections and assessed predictive factors in 132 patients with severe systemic AAV.ResultsPatients with lower than median incidence of total infections/patient-year during induction had lower baseline serum creatinine, dialysis requirement and Charlson comorbidity index (CCI), compared to those with higher than median incidence (P = 0.037; P = 0.024; P = 0.001; respectively). In subgroups with below and above than median number of severe infections/patient-year during induction, differences were found in baseline creatinine (P = 0.002) and dialysis requirement (P = 0.001); comparing the same cohorts during maintenance immunosuppression, baseline dialysis requirement, diabetes, CCI, and dose of cyclophosphamide (CYC) administered as induction therapy differed significantly (P = 0.019; P = 0.015; P = 0.001; P = 0.015, respectively). Severe infections were predicted by baseline serum creatinine (OR 1.002 [CI 1.001–1.003]) and pulmonary manifestation (OR 2.153 [CI 1.017–4.560]) during induction immunosuppression. In multivariable Cox regression model all-cause mortality was independently predicted by severe infection (HR 1.998 [CI 1.214–3.287]). Among the 168 positive cultures Gram-negative bacteria were responsible for blood stream infections in 33%, and respiratory tract infections in 72%.ConclusionsAdvanced renal failure, pulmonary involvement and high degree of comorbidities increase the risk of infection in AAV. Those who suffer infection during induction immunosuppression have worse long-term survival. Our findings indicate the need for high vigilance for infections and close follow-up of comorbidities when treating AAV.

BackgroundThe early identification of patients with ANCA-associated vasculitis (AAV) who are at increased risk for inferior clinical outcome at the time of diagnosis might help to optimize the immunosuppressive therapy. In this study we wanted to determine the predictive value of simple clinical characteristics, which may be applicable for early risk-stratification of patients with AAV.MethodsWe retrospectively analyzed the outcome of 101 consecutive patients with AAV receiving a protocolized immunosuppressive therapy. Baseline Birmingham Vasculitis Activity Score (BVAS) and non-vasculitic comorbidities were computed, then predictors of early (<90 days) and late (>90 days) mortality, infectious death, relapse and end stage kidney disease (ESKD) were evaluated.ResultsThe baseline comorbidity score independently predicted early mortality (HR 1.622, CI 1.006–2.614), and showed association with infectious mortality (HR 2.056, CI 1.247–3.392). Patients with BVAS at or above median (=21) had worse early mortality in univariable analysis (HR 3.57, CI 1.039–12.243) (p = 0.031), and had more frequent relapses (p = 0.01) compared to patients with BVAS below median.ConclusionsAssessing baseline comorbidities, beside clinical indices characterizing the severity and extension of AAV, might help clinicians in risk-stratification of patients. Future prospective studies are needed to investigate whether therapies based on risk-stratification could improve both short term and long term survival.

According to these findings plasmapheresis treatment, introduced by proper indications, effectively improves the outcomes of several diseases. Early diagnosis and immediate introduction of the plasmapheresis are very important - in conjunction with the appropriate therapy of the underlying diseases.

Introduction and Aims: Infectious morbidity and mortality of ANCA-associated vasculitis (AAV) remained high in the modern era of immunosuppression. Understanding the risk factors associated with infection development is crucial in AAV to increase the life expectancy of these patients. Methods: In this single centre retrospective cohort study we assessed the cumulative incidence of infections, investigated the predictive factors of infections, and evaluated the positive microbiological cultures in patients with severe AAV. Number of infections requiring antibiotic treatment, incidence of infection/patient-year during induction immunosuppression (6 months) and in remission, routine laboratory data, ANCA serology, baseline Charlson comorbidity index (CCI, without age and renal function), leucopenia and steroid diabetes were documented. Infections were categorized as severe (sepsis, endocarditis, meningitis, pneumonia, abscess, pyelonephritis, CAPD-related peritonitis), moderate (upper respiratory tract-, joint-, enteral infections, cellulitis, zoster)