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Incidence and predictors of severe infections in ANCA-associated vasculitis in a population-based cohort – preliminary results

Rathmann, Jens LU orcid ; Jayne, David R W ; Jönsson, Göran LU ; Segelmark, Mårten LU and Mohammad, Aladdin LU (2020) The 19th International Vasculitis and ANCA workshop In Rheumatology 58(Suppl 2). p.69-69
Abstract
Background: Infectious complications in ANCA associated vasculitis (AAV) are a major cause of morbidity and mortality. The aim of this study was to determine the incidence rates, predictors and outcome of severe infections in AAV. Methods: We conducted a population-based cohort study in Southern Sweden with 326 incident cases of AAV diagnosed between 1997 and 2016. Diagnosis of vasculitis was confirmed by case record review and patients were classified according to the European Medicines Agency algorithm. Demographics, clinical, andlaboratory data was collected from time of diagnosis and follow-up. All events of severe infection (required hospitalization and treated with intravenous antimicrobials) were identified. Vasculitis disease... (More)
Background: Infectious complications in ANCA associated vasculitis (AAV) are a major cause of morbidity and mortality. The aim of this study was to determine the incidence rates, predictors and outcome of severe infections in AAV. Methods: We conducted a population-based cohort study in Southern Sweden with 326 incident cases of AAV diagnosed between 1997 and 2016. Diagnosis of vasculitis was confirmed by case record review and patients were classified according to the European Medicines Agency algorithm. Demographics, clinical, andlaboratory data was collected from time of diagnosis and follow-up. All events of severe infection (required hospitalization and treated with intravenous antimicrobials) were identified. Vasculitis disease activity was evaluated using the Birmingham Vasculitis Activity Score (BVAS) and the extent of organ damage was assessed using the vasculitis damage index (VDI). Patients were followed from time of AAV-diagnosis to death or end of study, December 2017Results: Data on 262 patients (122 women) was collated and are presented in this report. Total time of follow-up was 1368 person-year. In total 104 (39.7%) patients experienced at least one severe infection during the follow-up, 33 (12.5%) suffered 2 infections and 14 (5%) suffered 3 severe infections or more. The incidence rate of severe infection was higher during the first year after diagnosis compared to that during the whole follow-up time (24.3/100 year vs. 7.6/100, p<0.001). Patients with severe infection were older at diagnosis, had higher serum creatinine, higher BVAS at diagnosis and higher VDI after 12 months (Table 1). They were also more likely to be MPO-ANCA positive. Age and BVAS at diagnosis were the only factors that independently predicted severe infection. Severe infection was associated with worse prognosis in terms of renal and patient’s survival. Conclusion: In this cohort the incidence rate of severe infection is comparable to earlier published data in AAV. The rate of severe infection is higher early in the disease course. Severe infection is still a major clinical problem and is associated with high age, increased disease activity at diagnosis, renal disease and MPO-ANCA positivity. Severe infection is associated with a worse prognosis. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Vasculitis, Comorbidities, Severe infections, Predictors
in
Rheumatology
volume
58
issue
Suppl 2
pages
69 - 69
publisher
Oxford University Press
conference name
The 19th International Vasculitis and ANCA workshop
conference location
Philadelphia, United States
conference dates
2019-04-07 - 2019-04-10
ISSN
1462-0332
DOI
10.1093/rheumatology/kez059.035
language
English
LU publication?
yes
additional info
Rheumatology, Volume 58, Issue Supplement_2, March 2019
id
a9e899da-e565-49c5-9971-9002cb637984
date added to LUP
2020-03-18 12:11:49
date last changed
2021-10-22 11:45:29
@misc{a9e899da-e565-49c5-9971-9002cb637984,
  abstract     = {{Background: Infectious complications in ANCA associated vasculitis (AAV) are a major cause of morbidity and mortality. The aim of this study was to determine the incidence rates, predictors and outcome of severe infections in AAV.  Methods: We conducted a population-based cohort study in Southern Sweden with 326 incident cases of AAV diagnosed between 1997 and 2016. Diagnosis of vasculitis was confirmed by case record review and patients were classified according to the European Medicines Agency algorithm.  Demographics, clinical, andlaboratory data was collected from time of diagnosis and follow-up. All events of severe infection (required hospitalization and treated with intravenous antimicrobials) were identified. Vasculitis disease activity was evaluated using the Birmingham Vasculitis Activity Score (BVAS) and the extent of organ damage was assessed using the vasculitis damage index (VDI). Patients were followed from time of AAV-diagnosis to death or end of study, December 2017Results: Data on 262 patients (122 women) was collated and are presented in this report. Total time of follow-up was 1368 person-year. In total 104 (39.7%) patients experienced at least one severe infection during the follow-up, 33 (12.5%) suffered 2 infections and 14 (5%) suffered 3 severe infections or more. The incidence rate of severe infection was higher during the first year after diagnosis compared to that during the whole follow-up time (24.3/100 year vs. 7.6/100, p&lt;0.001). Patients with severe infection were older at diagnosis, had higher serum creatinine, higher BVAS at diagnosis and higher VDI after 12 months (Table 1). They were also more likely to be MPO-ANCA positive. Age and BVAS at diagnosis were the only factors that independently predicted severe infection. Severe infection was associated with worse prognosis in terms of renal and patient’s survival. Conclusion: In this cohort the incidence rate of severe infection is comparable to earlier published data in AAV. The rate of severe infection is higher early in the disease course. Severe infection is still a major clinical problem and is associated with high age, increased disease activity at diagnosis, renal disease and MPO-ANCA positivity. Severe infection is associated with a worse prognosis.}},
  author       = {{Rathmann, Jens and Jayne, David R W and Jönsson, Göran and Segelmark, Mårten and Mohammad, Aladdin}},
  issn         = {{1462-0332}},
  keywords     = {{Vasculitis; Comorbidities; Severe infections; Predictors}},
  language     = {{eng}},
  note         = {{Conference Abstract}},
  number       = {{Suppl 2}},
  pages        = {{69--69}},
  publisher    = {{Oxford University Press}},
  series       = {{Rheumatology}},
  title        = {{Incidence and predictors of severe infections in ANCA-associated vasculitis in a population-based cohort – preliminary results}},
  url          = {{http://dx.doi.org/10.1093/rheumatology/kez059.035}},
  doi          = {{10.1093/rheumatology/kez059.035}},
  volume       = {{58}},
  year         = {{2020}},
}