Factors associated with major infections in patients with granulomatosis with polyangiitis and systemic lupus erythematosus treated for deep organ involvement
Identifieur interne : 001560 ( Main/Exploration ); précédent : 001559; suivant : 001561Factors associated with major infections in patients with granulomatosis with polyangiitis and systemic lupus erythematosus treated for deep organ involvement
Auteurs : Muir Morton [Royaume-Uni] ; Sarah Edmonds [Royaume-Uni] ; Aislinn M. Doherty [Royaume-Uni] ; Ajay Dhaygude [Royaume-Uni] ; Matthew Helbert [Royaume-Uni] ; Mike Venning [Royaume-Uni]Source :
- Rheumatology International [ 0172-8172 ] ; 2012-11-01.
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Abstract
Abstract: This study is an audit and a comparison of major infective complications in patients with granulomatosis with polyangiitis (GPA) and systemic lupus erythematosis (SLE). Data were collected on consecutive patients attending a single treatment approach, multidisciplinary vasculitis centre who met diagnostic criteria for GPA and SLE from 01/01/2006 to 30/06/2006. Immunosuppressive treatment is used in this clinic with guidelines targeting avoidance of neutropenia. For each patient, documentation was made of disease presentation, organ involvement and therapy used. A history of major infections requiring hospital admission and intravenous antimicrobials pre- and post-diagnosis was recorded. Patients with GPA received a higher cumulative dose of cyclophosphamide, had a higher median age, shorter period of follow-up and had lower mean and nadir absolute lymphocyte counts and nadir neutrophil counts. GPA patients had more major infections per patient years (P = 0.0027) and respiratory tract infections (P = 0.0031) per patient years. Relative risk (RR) of major infection was significantly increased with methylprednisolone, RR 11.1 (P = <0.0001), cyclophosphamide, RR 2.0 (P = 0.0246) and the intensive phase of treatment, RR 13.3 (P = <0.0001). Marked lymphopenia was common in both groups during follow-up and was associated with an increased risk of major infection (P = 0.0020). Major infections, in particular respiratory tract infections, are more common in those treated for GPA than SLE. This may be due to a combination of factors including greater doses and duration of methyprednisolone and cyclophosphamide. We recommend treatment strategies that aim not only to avoid neutropenia but that also identify lymphopenia as a risk factor for major infection.
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DOI: 10.1007/s00296-011-2151-0
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Data were collected on consecutive patients attending a single treatment approach, multidisciplinary vasculitis centre who met diagnostic criteria for GPA and SLE from 01/01/2006 to 30/06/2006. Immunosuppressive treatment is used in this clinic with guidelines targeting avoidance of neutropenia. For each patient, documentation was made of disease presentation, organ involvement and therapy used. A history of major infections requiring hospital admission and intravenous antimicrobials pre- and post-diagnosis was recorded. Patients with GPA received a higher cumulative dose of cyclophosphamide, had a higher median age, shorter period of follow-up and had lower mean and nadir absolute lymphocyte counts and nadir neutrophil counts. GPA patients had more major infections per patient years (P = 0.0027) and respiratory tract infections (P = 0.0031) per patient years. Relative risk (RR) of major infection was significantly increased with methylprednisolone, RR 11.1 (P = <0.0001), cyclophosphamide, RR 2.0 (P = 0.0246) and the intensive phase of treatment, RR 13.3 (P = <0.0001). Marked lymphopenia was common in both groups during follow-up and was associated with an increased risk of major infection (P = 0.0020). Major infections, in particular respiratory tract infections, are more common in those treated for GPA than SLE. This may be due to a combination of factors including greater doses and duration of methyprednisolone and cyclophosphamide. We recommend treatment strategies that aim not only to avoid neutropenia but that also identify lymphopenia as a risk factor for major infection.</div></front></TEI><affiliations><list><country><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Manchester</li></region><settlement><li>Manchester</li></settlement></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Morton, Muir" sort="Morton, Muir" uniqKey="Morton M" first="Muir" last="Morton">Muir Morton</name></region><name sortKey="Dhaygude, Ajay" sort="Dhaygude, Ajay" uniqKey="Dhaygude A" first="Ajay" last="Dhaygude">Ajay Dhaygude</name><name sortKey="Doherty, Aislinn M" sort="Doherty, Aislinn M" uniqKey="Doherty A" first="Aislinn M." last="Doherty">Aislinn M. Doherty</name><name sortKey="Edmonds, Sarah" sort="Edmonds, Sarah" uniqKey="Edmonds S" first="Sarah" last="Edmonds">Sarah Edmonds</name><name sortKey="Helbert, Matthew" sort="Helbert, Matthew" uniqKey="Helbert M" first="Matthew" last="Helbert">Matthew Helbert</name><name sortKey="Venning, Mike" sort="Venning, Mike" uniqKey="Venning M" first="Mike" last="Venning">Mike Venning</name><name sortKey="Venning, Mike" sort="Venning, Mike" uniqKey="Venning M" first="Mike" last="Venning">Mike Venning</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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