Aladdin J Mohammad1,2, Mårten Segelmark3,4, Rona Smith3,4, Martin Englund3,4, Jan-Åke Nilsson3,4, Kerstin Westman3,4, Peter A Merkel3,4, David R W Jayne3,4. 1. From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopedics, Clinical Epidemiology Unit, and Section of Nephrology, Lund; Department of Medicine and Nephrology, Linköping University, Linköping, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Aladdin.mohammad@med.lu.se. 2. A.J. Mohammad, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Segelmark, MD, PhD, Department of Medicine and Nephrology, Linköping University; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Englund, MD, PhD, Lund University, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; J.Å. Nilsson, BSc, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology; K. Westman, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Nephrology; P.A. Merkel, MD, MPH, Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital. Aladdin.mohammad@med.lu.se. 3. From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopedics, Clinical Epidemiology Unit, and Section of Nephrology, Lund; Department of Medicine and Nephrology, Linköping University, Linköping, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 4. A.J. Mohammad, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Segelmark, MD, PhD, Department of Medicine and Nephrology, Linköping University; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Englund, MD, PhD, Lund University, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; J.Å. Nilsson, BSc, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology; K. Westman, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Nephrology; P.A. Merkel, MD, MPH, Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital.
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 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.
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.
Authors: Andreas Kronbichler; Julia Kerschbaum; Seerapani Gopaluni; Joanna Tieu; Federico Alberici; Rachel Bronwen Jones; Rona M Smith; David R W Jayne Journal: Ann Rheum Dis Date: 2018-06-27 Impact factor: 19.103
Authors: Victoria Furer; Christien Rondaan; Marloes Heijstek; Sander van Assen; Marc Bijl; Nancy Agmon-Levin; Ferdinand C Breedveld; Raffaele D'Amelio; Maxime Dougados; Meliha Crnkic Kapetanovic; Jacob M van Laar; Annette Ladefoged de Thurah; Robert Landewé; Anna Molto; Ulf Müller-Ladner; Karen Schreiber; Leo Smolar; Jim Walker; Klaus Warnatz; Nico M Wulffraat; Ori Elkayam Journal: RMD Open Date: 2019-09-19