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

Abstract

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.

Rituximab induction and reinduction in granulomatosis with polyangiitis and microscopic polyangiitis: A retrospective multicenter study in Taiwan

“…Furthermore, nearly half of the patients with MPA received cyclophosphamide, and one‐third received PLEX, revealing a disease activity requiring aggressive treatment. In previous literature, different prognostic factors of mortality, including age, disease activity, infection, organ damage, and interstitial lung disease, have been proposed 19–24 . However, high proportions of kidney involvement, higher initial creatinine levels, and PLEX treatment were noted in our patients, which suggests renal involvement is the main contributing factor of morality in this study.…”

“…In previous literature, different prognostic factors mortality, including age, disease activity, infection, organ damage, and interstitial lung disease, have been proposed. [19][20][21][22][23][24] However, high proportions of kidney involvement, higher initial creatinine levels, and PLEX treatment were noted in our patients, which suggests renal involvement is the main contributing factor of morality in this study.…”

Infections and causative microorganisms in patients with ANCA-associated vasculitis

“…In a recent study of Xu et al, infections were shown to be the most important cause of mortality in AAV patients in the first year of diagnosis. 21 This showed us that we should be more careful in terms of infection, especially in the first year of induction therapy.…”

Hydroxychloroquine as a potential therapy for ANCA-associated vasculitis

“…HCQ has previously been shown to have a beneficial effect in lowering blood sugars [166][167][168] , improving lipid profiles [167,168] , and reducing atherosclerosis/improving vascular elasticity [150,151] all of which improve CV risk profiles [169] .…”