Abstract
BackgroundSevere infections are common complications of immunosuppressive treatment for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with renal involvement. We investigated the clinical characteristics and risk factors of severe infection in Chinese patients with AAV after immunosuppressive therapy.MethodsA total of 248 patients with a new diagnosis of ANCA-associated vasculitis were included in this study. The incidence, time, site, and risk factors of severe infection by the induction therapies were analysed. Multivariate Cox proportional hazards models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CI).ResultsA total of 103 episodes of severe infection were identified in 86 (34.7%, 86/248) patients during a median follow-up of 15 months. The incidence of infection during induction therapy was 38.5% for corticosteroids (CS), 39.0% for CS+ intravenous cyclophosphamide (IV-CYC), 33.8% for CS+ mycophenolate mofetil and 22.5% for CS + tripterygium glycosides, 76 (73.8%) infection episodes occurred within 6 months, while 66 (64.1%) occurred within 3 months. Pneumonia (71.8%, 74/103) was the most frequent type of infection, and the main pathogenic spectrum included bacteria (78.6%), fungi (12.6%), and viruses (8.7%). The risk factors associated with infection were age at the time of diagnosis (HR = 1.003, 95% CI = 1.000–1.006), smoking (HR = 2.338, 95% CI = 1.236–4.424), baseline secrum creatinine (SCr) ≥5.74 mg/dl (HR = 2.153, 95% CI = 1.323–3.502), CD4+ T cell< 281 μl (HR = 1.813, 95% CI = 1.133–2.900), and intravenous cyclophosphamide regimen (HR = 1.951, 95% CI =1.520–2.740). Twelve (13.9%) patients died of severe pneumonia.ConclusionThe infection rate during induction therapy was high in patients with AAV. Bacterial pneumonia was the main type of infection encountered. Age at the time of diagnosis, smoking, baseline SCr ≥5.74 mg/dl, CD4+ T cell< 281 μl, and IV-CYC therapy were identified as risk factors for infection.
Highlights
Severe infections are common complications of immunosuppressive treatment for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with renal involvement
Patient selection A total of 248 patients newly diagnosed with AAV and renal involvement who met the criteria of the Chapel Hill Consensus Conference [7] between January 1, 1998 and December 31, 2013 at the National Clinical Research Center of Kidney Diseases Jinling Hospital were included, among whom 194 patients had renal biopsies that showed pauci-immune necrotic and crescentic glomerulonephritis
Characteristics of the cohort This study identified 248 individuals with ages ranging from 14 to 78 years, including 214 cases diagnosed as microscopic polyangiitis (MPA), 16 cases diagnosed as renal-limited vasculitis (RLV), 10 cases diagnosed as granulomatosis with polyangiitis (GPA) and 8 cases diagnosed as eosinophilic granulomatosis with polyangitis (EGPA)
Summary
Severe infections are common complications of immunosuppressive treatment for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with renal involvement. We investigated the clinical characteristics and risk factors of severe infection in Chinese patients with AAV after immunosuppressive therapy. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic vasculitis syndrome including microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangitis (EGPA) and renal-limited vasculitis (RLV). The diagnosis of AAV is based on the presence of clinical manifestations with characteristic histopathological findings and the presence of MPO-ANCA or PR3-ANCA [1,2,3,4,5,6,7]. AAV may have predominant involvement of the. Yang et al BMC Nephrology (2018) 19:138
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