Among individuals with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), exploring and executing preventive measures against infection, paying particular attention to certain patient populations, is of key importance, according to findings from a retrospective cohort study published in the journal Sarcoidosis, Vasculitis and Diffuse Lung Diseases.
There are 3 distinct clinicopathologic types of AAV that have been identified: granulomatosis polyangiitis (GPA), eosinophilic granuloma polyangiitis (EGPA), and microscopic polyangiitis (MPA).
The treatment of patients with AAV involves the long-term use of immunosuppressive agents for inhibiting disease activity, with the rate of developing serious infections on the rise because of these therapies. Several factors have been linked to an elevated risk for infection in patients with AAV, including advanced age, long-term use of glucocorticoids, impaired renal function, and leukopenia.
In the current study, which was conducted in Turkey, the researchers sought to identify the risk factors for serious infections that necessitated hospitalization in patients with AAV in an effort to raise awareness for the early recognition of these factors so that needed interventions can be used in appropriate individuals.
Read more about AAV diagnosis
The analysis screened data from 200 patients 18 years of age or older who had been admitted to the Ankara University Faculty of Medicine Rheumatology Clinic from 2009 through 2019. Following exclusions, 84 patients with AAV were enrolled in the study.
Overall, 40 of the 84 study participants were male. The median participant age at diagnosis of AAV was 45.6 years (range, 18.1-71.3 years). The mean duration of follow-up was 49.1 months (range, 0.6-307.5 months). The subtypes of AAV were grouped as follows:
- 75.0% (63 of 84) of participants had GPA
- 15.4% (13 of 84) of participants had MPA
- 9.5% (8 of 84) of participants had EGPA
Results of the study showed that serious infections were reported in 50% (42 of 84) of the 84 participants with AAV. The following were statistically significantly associated with frequency of serious infections:
- Total corticosteroid dose: P =.015
- Use of pulse steroids: P =.016
- Treatment with an induction regimen: P =.010
- C-reactive protein (CRP) levels: P =.03
- Pulmonary involvement: P =.026
- Renopulmonary involvement: P =.029
According to multivariable analysis, the following factors were independent predictors of risk for serious infection:
- Renopulmonary involvement: hazard ratio (HR), 4.95; 95% CI, 1.804 to 13.605; P =.002
- Age more than 65 years: HR, 3.37; 95% CI, 1.004 to 11.369; P =.049
- High CRP levels: HR, 1.006; 95% CI, 1.000 to 1.011; P =.043
“Investigating and implementing preventive measures against infection, with emphasized attention to special patient groups, are of vital importance in patients with AAV,” the researchers emphasized. “Our study showed that renopulmonary involvement, age and elevated CRP levels on admission are independent risk factors for infection in patients with AAV,” they concluded.
Reference
Uslu Yurteri E, Sezer S, Torgutalp M, et al. The factors predicting development of serious infections in ANCA-associated vasculitis. Sarcoidosis Vasc Diffuse Lung Dis. Published online June 29, 2023. doi:10.36141/svdld.v40i2.13243
