The effects of age and frailty on the risks of end-stage renal disease, death, and severe infection in older adults with antineutrophil cytoplasmic antibody-associated vasculitis: a retrospective cohort study

IF 15 1区医学 Q1 RHEUMATOLOGY

Lancet Rheumatology Pub Date : 2024-09-18 DOI:10.1016/S2665-9913(24)00193-0

Sebastian E Sattui MD , Bohang Jiang MPH , Xiaoqing Fu MS , Claire Cook MPH , Shruthi Srivatsan BS , Zachary K Williams BS , Guy Katz MD , Prof Yuqing Zhang DSc , Zachary S Wallace MD

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引用次数: 0

Abstract

Background

Frailty, a measure of biological age, might predict poor outcomes in older adults better than chronological age. We aimed to compare the effect of age and frailty on end-stage renal disease, death, and severe infection within 2 years of diagnosis in older adults with incident antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis.

Methods

This retrospective cohort study included individuals aged 65 years or older from the Mass General Brigham ANCA-associated vasculitis cohort in the USA who were treated between Jan 1, 2002, and Dec 31, 2019. Individuals with a diagnosis of eosinophilic granulomatosis with polyangiitis were excluded from the analysis. Baseline frailty was measured with a claims-based frailty index using data collected in the year before the date of treatment initiation in individuals with at least one health-care encounter before baseline; individuals who did not have an encounter within the 12 months before baseline were classified as pre-frail. Incidence rates of end-stage renal disease or death and severe infections (ie, infections leading to hospital admission or death) at 2 years were estimated, and multivariable analyses were performed to compare the association of age and frailty with these outcomes. Cumulative incidence rates and an additive interaction analysis were used to assess the interaction of age and frailty groupings.

Findings

Of the 234 individuals included, 136 (58%) were women, 98 (42%) were men, 198 (85%) were White, and 198 (85%) were positive for myeloperoxidase-specific ANCA. Frailty was present in 25 (22%) of 116 individuals aged 65–74 years and 44 (37%) of 118 aged 75 years or older. In the multivariable analysis, an age of 75 years or older was associated with an increased risk of end-stage renal disease or death (hazard ratio [HR] 4·50 [95% CI 1·83–11·09]), however, frailty was not (1·08 [0·50–2·36]). Both an age of 75 years or older (HR 2·52 [95% CI 1·26–5·04]) and frailty (8·46 [3·95–18·14]) were independent risk factors for severe infections. The effect of frailty on the incidence of end-stage renal disease or death was greater in individuals aged 65–74 years (frail vs non-frail or pre-frail incidence rate 7·5 cases vs 2·0 cases per 100 person-years) than in those aged 75 years or older (13·5 cases vs 16·0 cases per 100 person-years). The effect of frailty on the incidence of serious infections varied by age, with large differences observed among both individuals aged 65–74 years (frail vs non-frail or pre-frail incidence rate 38·9 cases vs 0·8 cases per 100 person-years) and individuals aged 75 years or older (61·9 cases vs 12·3 cases per 100 person-years). Despite the observed differences between the age groups, the additive interaction terms were not statistically significant for either frailty and end-stage renal disease or death (p for interaction=0·276) or frailty and serious infections (p for interaction=0·650).

Interpretation

Adults with ANCA-associated vasculitis aged 75 years or older had a higher incidence of end-stage renal disease, death, and severe infections within 2 years of diagnosis than adults aged 65–74 years. Frailty, an approximation of biological age, was a risk factor for severe infection. Assessment beyond chronological age could better inform management decisions in older adults with ANCA-associated vasculitis.

Funding

National Institutes of Health and National Institute of Arthritis and Musculoskeletal and Skin Diseases.

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抗中性粒细胞胞浆抗体相关性血管炎老年患者的年龄和虚弱对终末期肾病、死亡和严重感染风险的影响：一项回顾性队列研究。

背景：虚弱是衡量生理年龄的一个指标，它可能比实际年龄更能预测老年人的不良预后。我们的目的是比较年龄和虚弱对患有抗中性粒细胞胞浆抗体（ANCA）相关性血管炎的老年人确诊后两年内终末期肾病、死亡和严重感染的影响：这项回顾性队列研究纳入了2002年1月1日至2019年12月31日期间接受治疗的美国马萨诸塞州布里格姆综合医院ANCA相关性血管炎队列中65岁或以上的患者。诊断为嗜酸性粒细胞肉芽肿伴多血管炎的患者不在分析范围内。基线虚弱度采用基于索赔的虚弱度指数进行测量，该指数使用在基线前至少有一次就医经历的患者开始治疗前一年收集的数据；基线前 12 个月内没有就医经历的患者被归类为前期虚弱。我们估算了2年内终末期肾病或死亡以及严重感染（即导致入院或死亡的感染）的发病率，并进行了多变量分析，以比较年龄和虚弱与这些结果的关系。累积发病率和加性交互分析用于评估年龄和虚弱分组的交互作用：在纳入的 234 人中，136 人（58%）为女性，98 人（42%）为男性，198 人（85%）为白人，198 人（85%）髓过氧化物酶特异性 ANCA 阳性。在 116 名 65-74 岁的患者中，有 25 人（22%）存在虚弱；在 118 名 75 岁或以上的患者中，有 44 人（37%）存在虚弱。在多变量分析中，75 岁或以上与终末期肾病或死亡风险增加有关（危险比 [HR] 4-50 [95% CI 1-83-11-09]），但与体弱无关（1-08 [0-50-2-36]）。75 岁或以上（HR 2-52 [95% CI 1-26-5-04]）和体弱（8-46 [3-95-18-14]）是严重感染的独立风险因素。体弱对终末期肾病或死亡发病率的影响在 65-74 岁人群中（体弱与非体弱或体弱前的发病率对比为 7-5 例 vs 2-0 例/100 人-年）大于 75 岁或以上人群（13-5 例 vs 16-0 例/100 人-年）。虚弱对严重感染发病率的影响因年龄而异，在 65-74 岁人群（虚弱与非虚弱或虚弱前的发病率为每百人年 38-9 例与 0-8 例）和 75 岁或以上人群（每百人年 61-9 例与 12-3 例）中观察到的差异都很大。尽管观察到各年龄组之间存在差异，但在虚弱与终末期肾病或死亡（交互作用的 p=0-276）或虚弱与严重感染（交互作用的 p=0-650）方面，加法交互项均无统计学意义：75岁或以上的ANCA相关性血管炎患者在确诊后2年内发生终末期肾病、死亡和严重感染的几率高于65-74岁的成年人。与生理年龄近似的虚弱是严重感染的一个风险因素。对于患有ANCA相关性血管炎的老年人，超越生理年龄的评估能更好地为管理决策提供依据：美国国立卫生研究院和美国国立关节炎、肌肉骨骼和皮肤病研究所。

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来源期刊

Lancet Rheumatology RHEUMATOLOGY-

CiteScore

34.70

自引率

3.10%

发文量

279

期刊介绍： The Lancet Rheumatology, an independent journal, is dedicated to publishing content relevant to rheumatology specialists worldwide. It focuses on studies that advance clinical practice, challenge existing norms, and advocate for changes in health policy. The journal covers clinical research, particularly clinical trials, expert reviews, and thought-provoking commentary on the diagnosis, classification, management, and prevention of rheumatic diseases, including arthritis, musculoskeletal disorders, connective tissue diseases, and immune system disorders. Additionally, it publishes high-quality translational studies supported by robust clinical data, prioritizing those that identify potential new therapeutic targets, advance precision medicine efforts, or directly contribute to future clinical trials. With its strong clinical orientation, The Lancet Rheumatology serves as an independent voice for the rheumatology community, advocating strongly for the enhancement of patients' lives affected by rheumatic diseases worldwide.