Initial functional status predicts infections during steroid therapy for renal diseases

Sakuma, Y; Katoh, Tetsuo; Owada, K; Suzuki, Hiroaki; Sakurai, Kazuo; Eiro, Masaaki; Asahi, Koichi; Watanabe, Tomonari

doi:10.5414/cnp63068

Cited by 14 publications

(10 citation statements)

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“…The importance that the alterations in immune phenotype are having on the infectious surveillance with its bidirectional conditioning with autoimmune phenomena and on the tumoral surveillance is also deemed important, given the general propensity to infections under steroid therapy [14].…”

Section: Discussionmentioning

confidence: 99%

The effect of steroids on lymphocyte profile in primary chronic glomerulonephritis. Empirical or tailored therapy?

Gluhovschi¹,

Gluhovschi²,

Herman³

et al. 2007

International Immunopharmacology

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Section: Discussionmentioning

confidence: 99%

The effect of steroids on lymphocyte profile in primary chronic glomerulonephritis. Empirical or tailored therapy?

Gluhovschi¹,

Gluhovschi²,

Herman³

et al. 2007

International Immunopharmacology

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“…The reduction in endothelial adhesion may be due to the direct effects of glucocorticoids on the expression of adhesion molecules on both leukocytes and endothelial cells, as well as indirect effects due to the inhibitory effects of glucocorticoids on the transcription of cytokines, such as interleukin-1 (IL-1) or tumor necrosis factor (TNF), that upregulate the expression of endothelial adhesion molecules. The systemic glucocorticoid therapy is associated with a dose-dependent increase in the risk of infection, especially with common bacterial, viral, and fungal pathogens (16,17). In the literature, tumor necrosis factor a is reported to play a key role in viral infections.…”

Section: N Discussion and Conclusionmentioning

confidence: 99%

Cytomegalovirus ileocolitis in a rheumatoid arthritis patient: case report and literature review

et al. 2015

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Rheumatoid arthritis (RA) is an autoimmune, systemic, chronic, inflammatory disease generally treated with various immunosuppressive drugs. Cytomegalovirus (CMV) is an opportunistic, viral infection that is commonly seen in immunosuppressed patients. A sixty-four-year old female diagnosed with RA and treated with immunosuppressive agents was admitted to our rheumatology outpatient service with complaints of diarrhea and abdominal pain, which had lasted longer than four weeks. The patient’s colonoscopy revealed inflamed and ulcerated areas in the colon and in the terminal ileum. A biopsy showed intra-nuclear inclusion particles consistent with CMV. We started an oral valganciclovir therapy in this serum-CMV-polymerase chain reaction-positive patient. The concomitant use of immunosuppressive agents and anti-viral drugs eased the patient’s complaints, and the endoscopic picture improved. Consequently, cytomegalovirus ileocolitis in immunosuppressed patients admitted with severe diarrhea must be considered in the differential diagnosis.

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“…Some of these factors (sex, increasing age, and performance status) have already been demonstrated to be risks for infection or mortality in patients treated with GCs. 11,25,28 Moderate-to high-dose GC therapy leads to an increased risk of infection. 9 The risk of infection increases with the dose and duration of treatment, and tends to remain low in patients exposed to low doses, even with a high cumulative dosage.…”

Section: Discussionmentioning

confidence: 99%

Glucocorticoid Therapy and the Risk of Infection in Patients With Newly Diagnosed Autoimmune Disease

Migita¹,

Sasaki²,

Ishizuka³

et al. 2013

Medicine

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Glucocorticoid (GC) therapy is associated with the risk of life-threatening adverse events in patients with autoimmune disease. To determine accurately the incidence and predictors of GC-related adverse events during initial GC treatment, we conducted a cohort study. Patients with autoimmune disease who were initially treated with GCs in Japan National Hospital Organization (NHO) hospitals were enrolled. Cox proportional hazard regression was used to determine the independent risks for GC-related serious adverse events and mortality. Survival was analyzed according to the Kaplan-Meier method and was assessed with the log-rank test.The 604 patients had a total follow-up of 1105.8 person-years (mean, 1.9 year per patient). One hundred thirty-six patients had at least 1 infection with objective confirmation, and 71 patients had serious infections. Twenty-two cardiovascular events, 55 cases of diabetes, 30 fractures, 23 steroid psychosis events, and 4 avascular bone necrosis events occurred during the follow-up period. The incidence of serious infections was 114.8 (95% confidence interval, 95.7Y136.6) per 1000 person-years. After adjustment for covariates, the following independent risk factors for serious infection were found: elderly age (hazard ratio EHR^, 1.25/10-yr age increment; p = 0.016), presence of interstitial lung disease (HR, 2.01; p = 0.011), high-dose GC use (Q29.9 mg/d) (HR, 1.71; p = 0.047), and low performance status (Karnofsky score, HR, 0.98/1-score increment; p = 0.002). During the follow-up period, 73 patients died, 35 of whom died of infection. Similarly, elderly age, the presence of interstitial lung disease, and high-dose GC use were found to be significant independent risk factors for mortality. The incidence of serious and life-threatening infection was higher in patients with autoimmune disease who were initially treated with GCs. Although the primary diseases are important confounding factors, elderly age, male sex, the presence of interstitial lung diseases, high-dose GCs, and low performance status were shown to be risk factors for serious infection and mortality.(Medicine 2013;92: 285Y293) Abbreviations: AE = adverse event, CI = confidence interval, CMV = cytomegalovirus, CT = computed tomography, GC = glucocorticoid, GI = gastrointestinal, HR = hazard ratio, IR = incidence rate, NHO = National Hospital Organization, RR = relative risk, SLE = systemic lupus erythematous, SOC = System Organ Class.

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Initial functional status predicts infections during steroid therapy for renal diseases

Cited by 14 publications

References 0 publications

The effect of steroids on lymphocyte profile in primary chronic glomerulonephritis. Empirical or tailored therapy?

The effect of steroids on lymphocyte profile in primary chronic glomerulonephritis. Empirical or tailored therapy?

Cytomegalovirus ileocolitis in a rheumatoid arthritis patient: case report and literature review

Glucocorticoid Therapy and the Risk of Infection in Patients With Newly Diagnosed Autoimmune Disease

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