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Corticosteroids are the major contributors to the risk for serious infections in autoimmune disorders with severe renal involvement

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Abstract

Introduction

We sought to investigate the infection profile and associated risk factors in a compiled cohort of patients with autoimmune disorders with severe renal involvement treated with aggressive immunosuppressive (IS) regimens.

Methods

A total of 162 patients with aggressive glomerulonephritis [101 with lupus nephritis (LN), 24 with cryoglobulinemic vasculitis (CryoVasc), and 37 with ANCA-associated vasculitis (AAV)] were retrospectively reviewed for any infection occurrence. Infection incidence, type, site, and grade (1–5) were recorded. Multivariate Cox proportional hazard regression analysis was performed to identify independent risk factors for infections.

Results

A total of 179 infection episodes occurred during a follow-up of 468 patient-years. Eighty-two patients (50.6%) had at least one infection. The incidence rates of infections and severe infections were 38.2 and 14.3 events per 100 patient-years. Patients with AAV had more infections than those with CryoVasc and LN (100.6, 47.5, and 26.6 infections per 100-patient-years, respectively; p = 0.002). Most patients developed infections early during the initial induction therapy (62.1% in the first 6 months of follow-up). In multivariate Cox regression analysis, high-dose oral corticosteroids (≥ 0.5 mg/kg/day in the first month of induction therapy) was an independent predictor of any infection (HR 2.66; 95% CI, 1.5–4.73), severe infections (HR 2.45; 95% CI, 1.03–5.82), and pulmonary infections (HR 2.91; 95% CI, 1.05–8.01). Pulmonary involvement increased the risk for pulmonary infections (HR 3.67; 95% CI, 1.32–10.1) and severe infections (HR 2.45; 95% CI, 1.01–5.92).

Conclusion

Infections occur frequently with current IS regimens in aggressive glomerulonephritis. Pulmonary involvement and high-dose corticosteroid regimen were the most significant risk factors for infections.

Key Points

• Infections occur frequently with current immunosuppressive regimens in autoimmune aggressive glomerulonephritis.

• High-dose corticosteroids are the major contributors to the risk for serious infections.

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Data availability

The data underlying this article are available in the article and in its online supplementary material.

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Author notes

  1. Bogdan Obrișcă and Alexandra Vornicu contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania

    Bogdan Obrișcă, Alexandra Vornicu, Roxana Jurubiță, Camelia Achim, Raluca Bobeică, Andreea Andronesi, Bogdan Sorohan & Gener Ismail

  2. Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

    Bogdan Obrișcă, Camelia Achim, Andreea Andronesi, Bogdan Sorohan & Gener Ismail

  3. Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania

    Vlad Herlea & Alexandru Procop

  4. Department of Anatomy, Ovidius University, Constanța, Romania

    Constantin Dina

Authors
  1. Bogdan Obrișcă
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  10. Constantin Dina
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  11. Gener Ismail
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Bogdan Obrișcă, Alexandra Vornicu, Roxana Jurubiță, Camelia Achim, Raluca Bobeică, Andreea Andronesi, Bogdan Sorohan, Vlad Herlea, Alexandru Procop, Constantin Dina, and Gener Ismail. The first draft of the manuscript was written by Bogdan Obrișcă and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bogdan Obrișcă.

Ethics declarations

The study was conducted with the provisions of the Declaration of Helsinki and the protocol was approved by the local ethics committee (The Ethics Council of Fundeni Clinical Institute, registration number: 20639). The need for informed consent was waived due to exclusive use of deidentified information and the retrospective nature of the study.

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Obrișcă, B., Vornicu, A., Jurubiță, R. et al. Corticosteroids are the major contributors to the risk for serious infections in autoimmune disorders with severe renal involvement. Clin Rheumatol 40, 3285–3297 (2021). https://doi.org/10.1007/s10067-021-05646-2

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  • DOI: https://doi.org/10.1007/s10067-021-05646-2

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