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Severe infection in antineutrophil cytoplasmic antibody-associated vasculitis

Mohammad, Aladdin J. LU ; Segelmark, Mårten LU ; Smith, Rona; Englund, Martin LU ; Nilsson, Jan-Åke LU ; Westman, Kerstin LU ; Merkel, Peter A and Jayne, David R. W. (2017) In Journal of Rheumatology 44(10). p.1468-1475
Abstract

Objective. To compare the rate of severe infections after the onset of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with the rate in the background population, and to identify predictors of severe infections among patients with AAV. Methods. The study cohort was 186 patients with AAV diagnosed from 1998 to 2010, consisting of all known cases in a defined population in southern Sweden. For each patient, 4 age- and sex-matched reference subjects were randomly chosen from the background population. Using the Skåne Healthcare Register, all International Classification of Diseases codes of infections assigned from 1998 to 2011 were identified. Severe infections were defined as infectious episodes requiring... (More)

Objective. To compare the rate of severe infections after the onset of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with the rate in the background population, and to identify predictors of severe infections among patients with AAV. Methods. The study cohort was 186 patients with AAV diagnosed from 1998 to 2010, consisting of all known cases in a defined population in southern Sweden. For each patient, 4 age- and sex-matched reference subjects were randomly chosen from the background population. Using the Skåne Healthcare Register, all International Classification of Diseases codes of infections assigned from 1998 to 2011 were identified. Severe infections were defined as infectious episodes requiring hospitalization. Rate ratios were calculated by dividing the rate in AAV by the rate among the reference subjects. Results. The rate ratio for all severe infections was 4.53 (95% CI 3.39-6.00). The highest rate ratios were found for upper respiratory tract: 8.88 (3.54-25.9), Clostridium difficile: 5.35 (1.54-23.8), nonspecific septicemia 4.55 (1.60-13.8), and skin 5.35 (1.69-19.8). Of the severe infections, 38.4% occurred within 6 months of diagnosis, 30.2% from 7-24 months, and 31.4% after 24 months. High serum creatinine and older age at diagnosis were associated with severe infection (p < 0.001). Of those with severe infection, 46.5% died during followup compared to 26% of patients without severe infection (p = 0.004). Conclusion. Patients with AAV have markedly higher rates of severe infection compared with the background population, especially patients with older age and impaired renal function. The risk of severe infection is particularly high in the first 6 months following the diagnosis of vasculitis.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ANCA-associated vasculitis, Rate population-based study, Rate ratio, Renal dysfunction, Severe infections
in
Journal of Rheumatology
volume
44
issue
10
pages
8 pages
publisher
J Rheumatol Publ Co
external identifiers
  • scopus:85030307949
  • wos:000412085100008
ISSN
0315-162X
DOI
10.3899/jrheum.160909
language
English
LU publication?
yes
id
bc380c02-e082-48b4-9f41-f3b69567ae20
date added to LUP
2017-10-24 15:31:17
date last changed
2018-01-16 13:23:54
@article{bc380c02-e082-48b4-9f41-f3b69567ae20,
  abstract     = {<p>Objective. To compare the rate of severe infections after the onset of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with the rate in the background population, and to identify predictors of severe infections among patients with AAV. Methods. The study cohort was 186 patients with AAV diagnosed from 1998 to 2010, consisting of all known cases in a defined population in southern Sweden. For each patient, 4 age- and sex-matched reference subjects were randomly chosen from the background population. Using the Skåne Healthcare Register, all International Classification of Diseases codes of infections assigned from 1998 to 2011 were identified. Severe infections were defined as infectious episodes requiring hospitalization. Rate ratios were calculated by dividing the rate in AAV by the rate among the reference subjects. Results. The rate ratio for all severe infections was 4.53 (95% CI 3.39-6.00). The highest rate ratios were found for upper respiratory tract: 8.88 (3.54-25.9), Clostridium difficile: 5.35 (1.54-23.8), nonspecific septicemia 4.55 (1.60-13.8), and skin 5.35 (1.69-19.8). Of the severe infections, 38.4% occurred within 6 months of diagnosis, 30.2% from 7-24 months, and 31.4% after 24 months. High serum creatinine and older age at diagnosis were associated with severe infection (p &lt; 0.001). Of those with severe infection, 46.5% died during followup compared to 26% of patients without severe infection (p = 0.004). Conclusion. Patients with AAV have markedly higher rates of severe infection compared with the background population, especially patients with older age and impaired renal function. The risk of severe infection is particularly high in the first 6 months following the diagnosis of vasculitis.</p>},
  author       = {Mohammad, Aladdin J. and Segelmark, Mårten and Smith, Rona and Englund, Martin and Nilsson, Jan-Åke and Westman, Kerstin and Merkel, Peter A and Jayne, David R. W.},
  issn         = {0315-162X},
  keyword      = {ANCA-associated vasculitis,Rate population-based study,Rate ratio,Renal dysfunction,Severe infections},
  language     = {eng},
  month        = {10},
  number       = {10},
  pages        = {1468--1475},
  publisher    = {J Rheumatol Publ Co},
  series       = {Journal of Rheumatology},
  title        = {Severe infection in antineutrophil cytoplasmic antibody-associated vasculitis},
  url          = {http://dx.doi.org/10.3899/jrheum.160909},
  volume       = {44},
  year         = {2017},
}