UMR 1027, INSERM, Université de Toulouse III, Toulouse, France.
Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
J Thromb Haemost. 2017 Apr;15(4):785-791. doi: 10.1111/jth.13622. Epub 2017 Feb 25.
Essentials The risk factors for infection in immune thrombocytopenia are not well known. We conducted a national pharmacoepidemiological study. Pulmonary disease, corticosteroids and rituximab were the main risk factors for infections. Pneumococcal and influenza vaccines were protective against infections.
Introduction Risk factors for infection and protective effect of vaccines in immune thrombocytopenia (ITP) patients in the era of rituximab therapy are unknown. Objectives To assess the risk factors for serious and non-serious infections (respectively, SIs and NSIs) in non-splenectomized adults treated for persistent or chronic primary ITP, including the effect of pneumococcal and influenza vaccines. Patients/Methods The population was the 2009-2012 FAITH cohort (n = 1805), which is the cohort of all incident (newly diagnosed) primary ITP adults treated > 3 months in France built into the national health insurance database (SNIIRAM). SIs were hospitalizations with any infection as the primary diagnosis code. NSIs were identified using out-of-hospital antibiotic dispensing. Cox models were performed. Results Incidence rates were 6.3/100 patient-years (95% confidence interval [CI], 5.4-7.4) for SIs (lower respiratory tract in 42.8% of the cases) and 100.5/100 patient-years (95% CI, 95.0-106.3) for NSIs. In multivariate analyses, increasing age and chronic pulmonary disease were associated with both SI and NSI occurrence. The hazard ratios (HRs) for corticosteroids and rituximab were, respectively, 3.83 (95% CI, 2.76-5.31) and 2.60 (95% CI, 1.67-4.03) for SIs and 2.46 (95% CI, 2.19-2.76) and 1.49 (95% CI, 1.28-1.74) for NSIs. Pneumococcal vaccine showed a protective effect for both SIs and NSIs (0.38 [95% CI, 0.20-0.73] and 0.52 [95% CI, 0.43-0.65], respectively), as did influenza vaccine (0.42 [95% CI, 0.27-0.64] and 0.49 [95% CI, 0.41-0.59], respectively). Conclusions Chronic pulmonary disease, corticosteroids and rituximab are the main risk factors for infections, whereas pneumococcal and influenza vaccines are protective against SIs and NSIs.
目的 评估非脾切除成人持续性或慢性原发性 ITP 患者（包括肺炎球菌和流感疫苗）的严重和非严重感染（分别为 SI 和 NSI）的危险因素。
患者/方法 该人群为 2009-2012 年 FAITH 队列（n=1805），该队列为法国国家健康保险数据库（SNIIRAM）中纳入的所有新诊断原发性 ITP 成年患者（新诊断），接受 > 3 个月的治疗。SI 是指以任何感染为主要诊断代码的住院治疗。NSI 通过院外抗生素配药确定。使用 Cox 模型进行分析。
结果 SI 的发生率为 6.3/100 患者年（95%置信区间 [CI]，5.4-7.4）（42.8%的病例为下呼吸道感染），NSI 的发生率为 100.5/100 患者年（95%CI，95.0-106.3）。多变量分析显示，年龄增长和慢性肺部疾病与 SI 和 NSI 的发生均相关。皮质类固醇和利妥昔单抗的风险比（HR）分别为 3.83（95%CI，2.76-5.31）和 2.60（95%CI，1.67-4.03）对于 SI 和 2.46（95%CI，2.19-2.76）和 1.49（95%CI，1.28-1.74）对于 NSI。肺炎球菌疫苗对 SI 和 NSI 均具有保护作用（分别为 0.38 [95%CI，0.20-0.73]和 0.52 [95%CI，0.43-0.65]），流感疫苗也具有保护作用（分别为 0.42 [95%CI，0.27-0.64]和 0.49 [95%CI，0.41-0.59]）。
结论 慢性肺部疾病、皮质类固醇和利妥昔单抗是感染的主要危险因素，而肺炎球菌和流感疫苗可预防 SI 和 NSI。
