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Risk factors for severe infections during induction therapy of patients with microscopic polyangiitis
Fangling Yao1, Yangmei Xie2, Jie Li3
1Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China.
Objectives:
Severe infections contribute to morbidity and mortality in microscopic polyangiitis (MPA). This study aims to investigate the clinical characteristics and identify risk factors for early severe infections in newly diagnosed patients with MPA.
Methods:
This retrospective cohort study included patients newly diagnosed with MPA followed up for at least 6 months at two tertiary care centres between January 2013 and December 2023. Clinical data, including demographics, laboratory findings, treatment regimens, and infection details, were collected. Multivariable logistic regression analysis was used to identify risk factors for severe infections within 6 months after the diagnosis in patients with new-onset MPA.
Results:
A total of 374 patients with MPA were included, and 25.9% (97/374) experienced severe infections. Compared to the non-infection group, the infection group had a significantly higher daily average dosage of prednisone for remission induction, a higher proportion of patients with a history of chronic lung disease, and a higher proportion receiving rituximab (RTX) therapy (p<0.05). In multivariable logistic regression analysis, a history of chronic lung disease, higher daily average dosage of prednisone therapy and RTX therapy for remission induction were associated with an increased risk of severe infections, whereby higher baseline serum IgM levels were associated with a decreased risk. The most common site of infection was the lung (75.23%), and bacteria (43.1%) was the most prevalent pathogen.
Conclusions:
MPA is associated with a high risk of severe infections, especially in patients treated with higher dosage glucocorticoid and with a history of chronic lung disease.
Insights
Microscopic polyangiitis (MPA) patients face a high risk of severe infections, particularly those on high-dose prednisone or with chronic lung disease. Early identification of risk factors is crucial for better management and outcomes in MPA.
Area of Science:
- Rheumatology and Immunology
- Infectious Diseases
- Clinical Epidemiology
Background:
- Microscopic polyangiitis (MPA) is a systemic vasculitis associated with significant morbidity and mortality, often exacerbated by severe infections.
- Understanding the specific risk factors for early severe infections in newly diagnosed MPA patients is critical for proactive management.
Purpose of the Study:
- To investigate the clinical characteristics of severe infections in new-onset microscopic polyangiitis (MPA).
- To identify independent risk factors associated with the development of early severe infections within six months of MPA diagnosis.
Main Methods:
- A retrospective cohort study involving 374 newly diagnosed MPA patients followed for at least six months.
- Data collection included demographics, laboratory results, treatment regimens, and infection details.
- Multivariable logistic regression analysis was employed to determine risk factors for severe infections.
Main Results:
- Severe infections occurred in 25.9% of MPA patients within six months of diagnosis.
- Risk factors included higher prednisone dosage for remission induction, history of chronic lung disease, and rituximab (RTX) therapy.
- Higher baseline serum IgM levels were associated with a decreased risk of severe infections. Pulmonary infections caused by bacteria were most common.
Conclusions:
- Microscopic polyangiitis (MPA) carries a substantial risk of severe infections.
- Higher glucocorticoid doses and a history of chronic lung disease are key risk factors for severe infections in MPA patients.
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