Infecciones graves en vasculitis necrosantes sistémicas

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-05-01 DOI:10.1016/j.reuma.2024.01.003

Claudia Pena, Ana Carolina Costi, Lucila García, Mercedes García

{"title":"Infecciones graves en vasculitis necrosantes sistémicas","authors":"Claudia Pena, Ana Carolina Costi, Lucila García, Mercedes García","doi":"10.1016/j.reuma.2024.01.003","DOIUrl":null,"url":null,"abstract":"<div><p>Infections in patients with systemic vasculitis represent one of the main causes of mortality. Corticosteroid use, immunosuppressive therapy, age, associated organic involvement and dialysis dependence are risk factors of infection.</p></div><div><h3>Objectives</h3><p>To determine the prevalence of severe infection and associated factors in patients diagnosed with ANCA-associated vasculitis and polyarteritis nodosa (PAN).</p></div><div><h3>Methods</h3><p>Retrospective study was conduced in a single rheumatology center (2000-2018). We included patients diagnosed with ANCA-associated vasculitis (granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis and PAN. Serious infectious events requiring hospitalization or prolonged antibiotic/antiviral treatment, recurrent infection of herpes zoster virus or opportunistic infections were evaluated. Sites of infection, isolated microorganisms and mortality related were analyzed.</p></div><div><h3>Results</h3><p>A total of 105 patients were analyzed, follow-up time median 18 months, 58.7% were women and median age was 52 years. Types of vasculitis: 41.9% microscopic polyangiitis, 16.2% eosinophilic granulomatosis with polyangiitis, 40% granulomatosis with polyangiitis, 1.9% PAN. Constitutional, pulmonary, renal and otorhinolaryngology manifestations were the most frequent.</p></div><div><h3>The prevalence of infection</h3><p>was 34,2%, with a median of 3 months from diagnosis of vasculitis to the infectious event. Low respiratory tract (42.8%), sepsis (31.4%), and urinary tract (14.3%) were the most common sites of infections. Bacterial etiology was the most prevalent (67.7%). Mortality at the first event was 14.3% and a 72.2% of patients were in the induction phase of treatment.</p><p>Infectious events were significantly associated with age> 65 years (<em>P</em>  =0.016) and renal involvement (<em>P</em>   =0.0002).</p></div><div><h3>Conclusions</h3><p>The prevalence of infection was 34.2%. Lower airway infections, septicemia and urinary tract infections were the most prevalent. Infections were associated with renal and pulmonary involvement, age older than 65 years and score BVAS>15. Severe infections were associated with mortality, especially in elderly patients.</p></div>","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1699258X24000056","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}

引用次数: 0

Abstract

Infections in patients with systemic vasculitis represent one of the main causes of mortality. Corticosteroid use, immunosuppressive therapy, age, associated organic involvement and dialysis dependence are risk factors of infection.

Objectives

To determine the prevalence of severe infection and associated factors in patients diagnosed with ANCA-associated vasculitis and polyarteritis nodosa (PAN).

Methods

Retrospective study was conduced in a single rheumatology center (2000-2018). We included patients diagnosed with ANCA-associated vasculitis (granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis and PAN. Serious infectious events requiring hospitalization or prolonged antibiotic/antiviral treatment, recurrent infection of herpes zoster virus or opportunistic infections were evaluated. Sites of infection, isolated microorganisms and mortality related were analyzed.

Results

A total of 105 patients were analyzed, follow-up time median 18 months, 58.7% were women and median age was 52 years. Types of vasculitis: 41.9% microscopic polyangiitis, 16.2% eosinophilic granulomatosis with polyangiitis, 40% granulomatosis with polyangiitis, 1.9% PAN. Constitutional, pulmonary, renal and otorhinolaryngology manifestations were the most frequent.

The prevalence of infection

was 34,2%, with a median of 3 months from diagnosis of vasculitis to the infectious event. Low respiratory tract (42.8%), sepsis (31.4%), and urinary tract (14.3%) were the most common sites of infections. Bacterial etiology was the most prevalent (67.7%). Mortality at the first event was 14.3% and a 72.2% of patients were in the induction phase of treatment.

Infectious events were significantly associated with age > 65 years (P = 0.030), presence of lung (P = 0.016) and renal involvement (P = 0.001), BVASv3 > 15 and mortality (P = 0.0002).

Conclusions

The prevalence of infection was 34.2%. Lower airway infections, septicemia and urinary tract infections were the most prevalent. Infections were associated with renal and pulmonary involvement, age older than 65 years and score BVAS >15. Severe infections were associated with mortality, especially in elderly patients.

查看原文本刊更多论文

全身坏死性血管炎的严重感染

全身性血管炎患者感染是导致死亡的主要原因之一。方法在一个风湿病学中心开展了一项回顾性研究（2000-2018 年）。我们纳入了被诊断为ANCA相关性血管炎（肉芽肿伴多血管炎、嗜酸性肉芽肿伴多血管炎、显微镜下多血管炎和结节性多动脉炎）的患者。对需要住院治疗或长期抗生素/抗病毒治疗的严重感染事件、带状疱疹病毒反复感染或机会性感染进行了评估。结果共分析了 105 名患者，随访时间中位数为 18 个月，58.7% 为女性，年龄中位数为 52 岁。血管炎类型：41.9%为显微镜下多血管炎，16.2%为嗜酸性粒细胞肉芽肿伴多血管炎，40%为肉芽肿伴多血管炎，1.9%为PAN。感染率为 34.2%，从确诊血管炎到发生感染事件的中位时间为 3 个月。低呼吸道（42.8%）、败血症（31.4%）和泌尿道（14.3%）是最常见的感染部位。细菌是最常见的病因（67.7%）。感染事件与年龄（65 岁）（P = 0.030）、肺部（P = 0.016）和肾脏受累（P = 0.001）、BVASv3（15）和死亡率（P = 0.0002）显著相关。下呼吸道感染、脓毒血症和尿路感染最为常见。感染与肾脏和肺部受累、65 岁以上和 BVAS 评分 15 分有关。严重感染与死亡率有关，尤其是在老年患者中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.