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Infectious complications of ANCA-associated vasculitis: Description and associated outcome

Jeanne Morin1, Pierre-André Jarrot2, Justine Solignac3

  • 1Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique Hôpitaux de Marseille, Marseille, France.

European Journal of Internal Medicine
|May 10, 2026
PubMed
Abstract

Insights

Infections are common in ANCA-associated vasculitis (AAV) and increase mortality risk. Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis patients with anti-PR3 positivity face higher infection risks, while methotrexate shows a protective effect.

Area of Science:

  • Nephrology
  • Internal Medicine
  • Rheumatology

Background:

  • Systemic complications, particularly infections, are significant causes of morbidity and mortality in ANCA-associated vasculitis (AAV).
  • Both the disease itself and its treatments contribute to these complications.

Purpose of the Study:

  • To evaluate the prevalence and prognosis of infectious complications in AAV.
  • To identify risk factors associated with infections in AAV patients.
  • To describe the long-term outcomes of infectious complications in AAV.

Main Methods:

  • Retrospective monocentric study including 264 patients with AAV.
  • Infection defined as requiring hospitalization or anti-infectious therapy.
  • Follow-up conducted until January 1st, 2025.

Main Results:

  • Infection incidence was 43.9%, with respiratory infections (49.1%) and bacterial infections (75.3%) being most common.
  • Risk factors included age >65, hypertension, diabetes, high Five-Factor Score, high BVAS, anti-PR3 positivity, acute kidney injury, cyclophosphamide, and intravenous corticosteroids.
  • Anti-PR3 positivity was an independent risk factor (aOR=2.0), while methotrexate was protective (aOR=0.08). Infections were linked to relapses (aOR=2.8) and cardiovascular events (aOR=3.0).
  • Mortality was significantly associated with infection (HR=2.14).

Conclusions:

  • Infections are frequent in AAV and independently impact mortality.
  • Anti-PR3 positivity is associated with increased infection risk.
  • Methotrexate demonstrates a protective effect against infections in AAV.
Keywords:
ANCAAcute kidney injuryChronic kidney diseaseInfectionMortalityVasculitis

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