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Birmingham vasculitis activity and chest manifestation at diagnosis can predict hospitalised infection in ANCA-associated vasculitis

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Abstract

We investigated the development rate and time, risk factors, predictors, and aetiologies of hospitalised infection in Korean patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). We retrospectively reviewed the medical records of 154 patients with AAV. Hospitalised infection was considered only when patients were admitted for serious infection related to AAV or AAV treatment. The gap-time was defined as the period from diagnosis to the first hospitalised infection or to the last visit for uninfected patients. We calculated Birmingham vasculitis activity score (BVAS) or BVAS for granulomatosis with polyangiitis (GPA) and five factor score (FFS (2009)) and reviewed medications administered. We set the optimal cut-offs of BVAS and that of FFS (2009) at diagnosis at 20.5 and 1.5. Forty-four patients (28.6%) were admitted for serious infection. One-, 5- and 10-year hospitalised infection free survival rates were 85.1, 77.9 and 72.7%, respectively. In multivariable logistic regression analysis of significant variables in comparison analysis, only chest manifestation at diagnosis (OR 2.692) was remarkably associated with hospitalised infection. In multivariable Cox hazard model analysis of significant variables in Kaplan-Meier analysis, BVAS at diagnosis ≥ 20.5 (HR 2.375) and chest manifestation at diagnosis (HR 2.422) were independent predictors of hospitalised infection during the gap-time. Bacterial pneumonia was the most common infectious aetiology (N = 29), followed by fungal infection including aspergillosis (N = 6). BVAS and chest manifestation at diagnosis can predict hospitalised infection during the gap-time.

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Funding

This study was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health and Welfare, Republic of Korea (HI14C1324), and Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2017R1D1A1B03029050).

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun–gu, Seoul, 03722, Republic of Korea

    Juyoung Yoo, Seung Min Jung, Jason Jungsik Song, Yong-Beom Park & Sang-Won Lee

  2. Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea

    Yong-Beom Park & Sang-Won Lee

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  1. Juyoung Yoo
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  2. Seung Min Jung
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  5. Sang-Won Lee
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Correspondence to Sang-Won Lee.

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This study was approved by the Institutional Review Board of Severance Hospital (4-2017-0673).

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Electronic supplementary material

Supplementary Fig. 1

Aetiologies of episodes of hospitalised infections. Among bacterial infections, pneumonia was the most common infectious aetiology (N = 29), followed by biliary infection (N = 4) and urinary tract infection (N = 3). And among atypical infections, fungus including Aspergilosis was the most often infectious aetiology (N = 6), followed by P. jirovecii (N = 4) and Cytomegalovirus (N = 3). P Pneumocystis. (PNG 800 kb)

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Supplementary Fig. 2

Association between the number of admission for serious infection and chest manifestation at diagnosis. Among patients who admitted for serious infection once, 69.2% of patients had exhibited chest manifestation at diagnosis and among 5 patients who admitted for serious infection more than two times, all patients had exhibited chest manifestation at diagnosis. (PNG 534 kb)

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Supplementary Table 1

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Yoo, J., Jung, S.M., Song, J.J. et al. Birmingham vasculitis activity and chest manifestation at diagnosis can predict hospitalised infection in ANCA-associated vasculitis. Clin Rheumatol 37, 2133–2141 (2018). https://doi.org/10.1007/s10067-018-4067-5

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  • DOI: https://doi.org/10.1007/s10067-018-4067-5

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