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Severe Infection in Antineutrophil Cytoplasmic Antibody-associated Vasculitis
Addenbrookes Hospital, England; Lund University, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Nephrology.
Addenbrookes Hospital, England.
Boston University, MA 02118 USA; Lund University, Sweden.
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2017 (English)In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 44, no 10, 1468-1475 p.Article in journal (Refereed) Published
Abstract [en]

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 Skane 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 amp;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.

Place, publisher, year, edition, pages
J RHEUMATOL PUBL CO , 2017. Vol. 44, no 10, 1468-1475 p.
Keyword [en]
ANCA-ASSOCIATED VASCULITIS; SEVERE INFECTIONS; RATE; POPULATION-BASED STUDY; RATE RATIO; RENAL DYSFUNCTION
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:liu:diva-142170DOI: 10.3899/jrheum.160909ISI: 000412085100008PubMedID: 28765251OAI: oai:DiVA.org:liu-142170DiVA: diva2:1151566
Note

Funding Agencies|Faculty of Medicine, Lund University, Governmental Funding of Clinical Research within National Health Service (ALF-medel); Swedish Rheumatism Association (Reumatikerforbundet); Swedish Medical Association (Svenska Lakarsallskapet); Cambridge Biomedical Research Centre

Available from: 2017-10-23 Created: 2017-10-23 Last updated: 2017-10-23

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Segelmark, Mårten
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Division of Drug ResearchFaculty of Medicine and Health SciencesDepartment of Nephrology
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CiteExportLink to record
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