Initial high-dose corticosteroids and renal impairment are risk factors for early severe infections in elderly patients with antineutrophil cytoplasmic autoantibody-associated vasculitis: A retrospective observational study
| Autor: | Rintaro Saito, Daisuke Waki, Keiichiro Kadoba, Hiroki Mukoyama, Keisuke Nishimura, Hironobu Tokumasu, Hiroyuki Murabe, Toshihiko Yokota |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Observational Study Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis macromolecular substances Kaplan-Meier Estimate Severity of Illness Index elderly vasculitis corticosteroids 03 medical and health sciences 0302 clinical medicine Adrenal Cortex Hormones Risk Factors Internal medicine Severity of illness medicine Humans Cumulative incidence 030212 general & internal medicine Renal Insufficiency Cause of death Aged Retrospective Studies Aged 80 and over Dose-Response Relationship Drug business.industry antineutrophil cytoplasmic autoantibody Mortality rate Retrospective cohort study General Medicine Odds ratio Bacterial Infections medicine.disease mortality infection Logistic Models age 030220 oncology & carcinogenesis Creatinine Prednisolone ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Female Vasculitis business Immunosuppressive Agents medicine.drug Research Article |
| Zdroj: | Medicine |
| ISSN: | 1536-5964 |
| Popis: | Supplemental Digital Content is available in the text Recent large observational studies of antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) show that severe infection is a major cause of death and that the majority of infections occur during the early phase of initiating remission-induction therapy. Many risk factors for severe infection have been suggested, but these have been inconsistent. Nevertheless, infectious risk factors in elderly patients with AAV have not been adequately investigated in previous studies. In this retrospective observational study, we examined potential predictors of severe infection within 90 days (early severe infections) after remission-induction therapy in patients with AAV aged 65 years or older. We included 167 consecutive elderly patients with AAV admitted to our hospital. Data from medical history and remission-induction therapy were analyzed for predictive risk factors associated with early severe infections. The relationship between initial doses of corticosteroids and cumulative incidence of severe infections was also analyzed. A multivariate analysis of risk factors for early severe infections was performed using logistic regression analysis. The Kaplan–Meier method was used to estimate the overall survival, and the log-rank test was used to evaluate the differences between patients with and without early severe infections. Gray method was used to compare the cumulative incidence of severe infections in patients who did and did not receive initial high-dose corticosteroids. Logistic regression analysis showed that initial high-dose corticosteroid administration (prednisolone ≥0.8 mg/kg/d) (odds ratio [OR] 3.86, P = .030) and serum creatinine levels at diagnosis ≥1.5 mg/dL (OR 5.13, P = .003) were independent predictors of early severe infection although administration of cyclophosphamide or rituximab was not. The cumulative incidence of severe infections was also significantly higher in patients who received initial high-dose corticosteroids (P = .042), and patients with early severe infections exhibited a high mortality rate within 6 months (P |
| Databáze: | OpenAIRE |
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