Crowson Cynthia S, Hoganson Deana D, Fitz-Gibbon Patrick D, Matteson Eric L
Mayo Clinic, Rochester, Minnesota 55905, USA.
Arthritis Rheum. 2012 Sep;64(9):2847-55. doi: 10.1002/art.34530.
Infection risk is increased in patients with rheumatoid arthritis (RA), and accurate assessment of the risk of infection could inform clinical decision-making. This study was undertaken to develop and validate a score to predict the 1-year risk of serious infection in patients with RA.
We studied a population-based cohort of Olmsted County, Minnesota residents with incident RA ascertained in 1955-1994 whose members were followed up longitudinally, via complete medical records, until January 2000. The validation cohort included residents with incident RA ascertained in 1995-2007. The outcome measure included all serious infections (requiring hospitalization or intravenous antibiotics). Potential predictors were examined using multivariable Cox models. The risk score was estimated directly from the multivariable model, and performance was assessed in the validation cohort using Harrell's C statistic.
Among the 584 RA patients in the original cohort (72% female; mean age 57.5 years), who were followed up for a median of 9.9 years, 252 had ≥ 1 serious infection (646 total infections). Components of the risk score included age, previous serious infection, corticosteroid use, elevated erythrocyte sedimentation rate, extraarticular manifestations of RA, and comorbidities (coronary heart disease, heart failure, peripheral vascular disease, chronic lung disease, diabetes mellitus, alcoholism). Validation analysis revealed good discrimination (C statistic 0.80).
RA disease characteristics and comorbidities can be used to accurately assess the risk of serious infection in patients with RA. Knowledge of risk of serious infection in RA patients can influence clinical decision making and inform strategies to reduce and prevent the occurrence of these infections.
类风湿关节炎（RA）患者的感染风险增加，准确评估感染风险可为临床决策提供依据。本研究旨在开发并验证一个用于预测RA患者1年严重感染风险的评分系统。
我们研究了明尼苏达州奥姆斯特德县基于人群的队列，这些居民在1955 - 1994年确诊为新发RA，通过完整的医疗记录对其进行纵向随访，直至2000年1月。验证队列包括在1995 - 2007年确诊为新发RA的居民。结局指标包括所有严重感染（需要住院或静脉使用抗生素）。使用多变量Cox模型检查潜在预测因素。风险评分直接从多变量模型中估计，并在验证队列中使用Harrell's C统计量评估其性能。
在原始队列的584例RA患者中（72%为女性；平均年龄57.5岁），随访时间中位数为9.9年，252例发生了≥1次严重感染（共646次感染）。风险评分的组成部分包括年龄、既往严重感染、使用皮质类固醇、红细胞沉降率升高、RA的关节外表现以及合并症（冠心病、心力衰竭、外周血管疾病、慢性肺病、糖尿病、酗酒）。验证分析显示具有良好的区分度（C统计量为0.80）。
RA的疾病特征和合并症可用于准确评估RA患者发生严重感染的风险。了解RA患者严重感染的风险可影响临床决策，并为减少和预防这些感染的发生提供策略依据。
