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Incidence and predictors of severe infections in ANCA-associated vasculitis: a population-based cohort study.

Rathmann, Jens LU orcid ; Jayne, David Rw ; Segelmark, Mårten LU ; Jönsson, Göran LU and Mohammad, Aladdin LU (2021) In Rheumatology (Oxford, England) 60(6). p.2745-2754
Abstract
Objective. To determine the incidence rate, predictors and outcome of severe infections in a population-based
cohort of ANCA-associated vasculitis (AAV).
Methods. The study included 325 cases of AAV (152 female) diagnosed from 1997 through 2016 from a defined
geographic area in Sweden. All severe infection events (requiring hospitalization and treatment with intravenous
antimicrobials) were identified. The Birmingham vasculitis activity score (BVAS) was used to evaluate disease activity,
and organ damage was assessed using the vasculitis damage index (VDI). Patients were followed from time of
AAV diagnosis to death or December 2017.
Results. A total of 129 (40%) patients suffered at least one severe infection.... (More)
Objective. To determine the incidence rate, predictors and outcome of severe infections in a population-based
cohort of ANCA-associated vasculitis (AAV).
Methods. The study included 325 cases of AAV (152 female) diagnosed from 1997 through 2016 from a defined
geographic area in Sweden. All severe infection events (requiring hospitalization and treatment with intravenous
antimicrobials) were identified. The Birmingham vasculitis activity score (BVAS) was used to evaluate disease activity,
and organ damage was assessed using the vasculitis damage index (VDI). Patients were followed from time of
AAV diagnosis to death or December 2017.
Results. A total of 129 (40%) patients suffered at least one severe infection. In 2307 person-years (PY) of followup,
210 severe infections were diagnosed. The incidence rate of severe infections was 9.1/100 PY and was highest
during the first year following AAV diagnosis at 22.1/100 PY (P<0.001). Pneumonia, sepsis and urinary tract infection
were the most common infections. Opportunistic infections constituted only 6% of all severe infections. In Cox
regression analysis age and BVAS at diagnosis were the only factors independently predicting severe infection
[hazard ratio: 1.54 (P<0.001) and 1.27 (P¼0.001), respectively]. Severe infection was associated with poorer prognosis
with respect to median VDI score 12 months post-AAV diagnosis, renal survival and mortality. Severe infections
were the cause of death in 32 patients (22% of all deaths).
Conclusion. Severe infection is a common problem in AAV, with the most important prognostic factors being
older age and high disease activity at diagnosis. Severe infections are associated with permanent organ damage
and high mortality. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ANCA-vasculitis, vere infection, immunosuppression, predictors of severe infection, epidemiology vasculitis
in
Rheumatology (Oxford, England)
volume
60
issue
6
article number
keaa699
pages
10 pages
publisher
Oxford University Press
external identifiers
  • pmid:33253372
  • scopus:85106975821
ISSN
1462-0324
DOI
10.1093/rheumatology/keaa699
language
English
LU publication?
yes
id
b0bbe9ed-5025-4045-b0a8-6af919534d12
date added to LUP
2021-05-30 22:25:51
date last changed
2023-11-08 14:44:41
@article{b0bbe9ed-5025-4045-b0a8-6af919534d12,
  abstract     = {{Objective. To determine the incidence rate, predictors and outcome of severe infections in a population-based<br>
cohort of ANCA-associated vasculitis (AAV).<br>
Methods. The study included 325 cases of AAV (152 female) diagnosed from 1997 through 2016 from a defined<br>
geographic area in Sweden. All severe infection events (requiring hospitalization and treatment with intravenous<br>
antimicrobials) were identified. The Birmingham vasculitis activity score (BVAS) was used to evaluate disease activity,<br>
and organ damage was assessed using the vasculitis damage index (VDI). Patients were followed from time of<br>
AAV diagnosis to death or December 2017.<br>
Results. A total of 129 (40%) patients suffered at least one severe infection. In 2307 person-years (PY) of followup,<br>
210 severe infections were diagnosed. The incidence rate of severe infections was 9.1/100 PY and was highest<br>
during the first year following AAV diagnosis at 22.1/100 PY (P&lt;0.001). Pneumonia, sepsis and urinary tract infection<br>
were the most common infections. Opportunistic infections constituted only 6% of all severe infections. In Cox<br>
regression analysis age and BVAS at diagnosis were the only factors independently predicting severe infection<br>
[hazard ratio: 1.54 (P&lt;0.001) and 1.27 (P¼0.001), respectively]. Severe infection was associated with poorer prognosis<br>
with respect to median VDI score 12 months post-AAV diagnosis, renal survival and mortality. Severe infections<br>
were the cause of death in 32 patients (22% of all deaths).<br>
Conclusion. Severe infection is a common problem in AAV, with the most important prognostic factors being<br>
older age and high disease activity at diagnosis. Severe infections are associated with permanent organ damage<br>
and high mortality.}},
  author       = {{Rathmann, Jens and Jayne, David Rw and Segelmark, Mårten and Jönsson, Göran and Mohammad, Aladdin}},
  issn         = {{1462-0324}},
  keywords     = {{ANCA-vasculitis; vere infection; immunosuppression; predictors of severe infection; epidemiology vasculitis}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{6}},
  pages        = {{2745--2754}},
  publisher    = {{Oxford University Press}},
  series       = {{Rheumatology (Oxford, England)}},
  title        = {{Incidence and predictors of severe infections in ANCA-associated vasculitis: a population-based cohort study.}},
  url          = {{http://dx.doi.org/10.1093/rheumatology/keaa699}},
  doi          = {{10.1093/rheumatology/keaa699}},
  volume       = {{60}},
  year         = {{2021}},
}