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Risk factors for serious infections and infection-related mortality in patients with microscopic polyangiitis:
Atsushi Manabe1, Keiichiro Kadoba1, Ryosuke Hiwa1
1Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Objective:
Infections are a critical concern for patients with microscopic polyangiitis (MPA). This study aimed to identify the risk factors associated with serious infections (SIs) and infection-related mortality in patients with MPA, as well as the effect of glucocorticoid (GC) dose tapering on these outcomes.
Methods:
This multicentre, retrospective, and observational study utilised data from a cohort of patients with MPA in Japan [Registry of Vasculitis Patients to Establish REAL World Evidence (REVEAL) cohort]. Patients were categorised based on the occurrence of SIs or infection-related deaths, and various characteristics were compared among the groups.
Results:
Among 182 patients, 66 (36.2%) experienced 129 SIs and 27 (14.8%) developed infection-related deaths. Advanced age, elevated C-reactive protein (CRP) levels, and higher ratio of the GC dose at 3 months to the initial dose were identified as independent risk factors for SIs. Older age was also associated with infection-related deaths. Furthermore, the cumulative incidence of infection-related deaths was significantly higher in patients with a higher ratio of the GC dose at 24 months to the initial dose.
Conclusion:
Older age, elevated CRP levels, and slower GC dose tapering predispose patients to SIs and infection-related deaths. Strategies, such as rapid GC dose tapering, are anticipated to mitigate the risk of infections.
Insights
Older age, elevated CRP, and slow glucocorticoid (GC) tapering increase serious infection (SI) and mortality risks in microscopic polyangiitis (MPA). Rapid GC dose reduction may lower these risks.
Area of Science:
- Rheumatology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Serious infections (SIs) and infection-related mortality are significant concerns for patients with microscopic polyangiitis (MPA).
- Understanding risk factors and the impact of treatment on infection outcomes is crucial for patient management.
Purpose of the Study:
- To identify risk factors for SIs and infection-related mortality in MPA patients.
- To evaluate the effect of glucocorticoid (GC) dose tapering on these outcomes.
Main Methods:
- A multicentre, retrospective, observational study using data from the REVEAL cohort in Japan.
- Patients were categorized by the occurrence of SIs or infection-related deaths.
- Comparison of patient characteristics across different outcome groups.
Main Results:
- 66 out of 182 (36.2%) patients experienced 129 SIs; 27 (14.8%) had infection-related deaths.
- Independent risk factors for SIs included older age, elevated C-reactive protein (CRP), and a higher GC dose ratio at 3 months.
- Older age was linked to infection-related deaths, with higher GC dose ratios at 24 months associated with increased mortality.
Conclusions:
- Older age, elevated CRP, and slower GC dose tapering are risk factors for SIs and infection-related deaths in MPA.
- Rapid GC dose tapering strategies are suggested to mitigate infection risks.
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