Caillard Pauline, Vigneau Cécile, Halimi Jean-Michel, Hazzan Marc, Thervet Eric, Heitz Morgane, Juillard Laurent, Audard Vincent, Rabant Marion, Hertig Alexandre, Subra Jean-François, Vuiblet Vincent, Guerrot Dominique, Tamain Mathilde, Essig Marie, Lobbedez Thierry, Quemeneur Thomas, Rebibou Jean-Michel, Ganea Alexandre, Peraldi Marie-Noëlle, Vrtovsnik François, Daroux Maïté, Lamrani Adnane, Makdassi Raïfah, Choukroun Gabriel, Titeca-Beauport Dimitri
Department of Nephrology, Dialysis, and Transplantation, University of Picardie Jules Verne, Amiens University Hospital, F-80054 Amiens, France.
Department of Nephrology, CHU Pontchaillou, University Hospital, Rennes, France and University of Rennes 1, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1085-IRSET, F-35000 Rennes, France.
J Clin Med. 2020 Mar 4;9(3):698. doi: 10.3390/jcm9030698.
In patients presenting with anti-glomerular basement membrane (GBM) disease with advanced isolated kidney involvement, the benefit of intensive therapy remains controversial due to adverse events, particularly infection. We aim to describe the burden of severe infections (SI) (requiring hospitalization or intravenous antibiotics) and identify predictive factors of SI in a large cohort of patients with anti-GBM disease. Among the 201 patients (median [IQR] age, 53 [30-71] years) included, 74 had pulmonary involvement and 127 isolated glomerulonephritis. A total of 161 SI occurred in 116 patients during the first year after diagnosis. These infections occurred during the early stage of care (median [IQR] time, 13 [8-19] days after diagnosis) with mainly pulmonary (45%), catheter-associated bacteremia (22%) and urinary tract (21%) infections. In multivariable analysis, positive ANCA (HR [95% CI] 1.62 [1.07--2.44]; = 0.02) and age at diagnosis (HR [95% CI] 1.10 [1.00-1.21]; = 0.047) remained independently associated with SI. Age-adjusted severe infection during the first three months was associated with an increased three-year mortality rate (HR [95% CI] 3.13 [1.24-7.88]; = 0.01). Thus, SI is a common early complication in anti-GBM disease, particularly in the elderly and those with positive anti-neutrophil cytoplasmic antibodies (ANCA). No significant association was observed between immunosuppressive strategy and occurrence of SI.
在患有抗肾小球基底膜（GBM）疾病且出现晚期孤立性肾脏受累的患者中，强化治疗的益处因不良事件，尤其是感染，仍存在争议。我们旨在描述严重感染（SI）（需要住院治疗或静脉使用抗生素）的负担，并在一大群抗GBM疾病患者中确定SI的预测因素。在纳入的201例患者（年龄中位数[四分位间距]为53[30 - 71]岁）中，74例有肺部受累，127例为孤立性肾小球肾炎。在诊断后的第一年，116例患者共发生了161次SI。这些感染发生在治疗早期（时间中位数[四分位间距]为诊断后13[8 - 19]天），主要为肺部感染（45%）、导管相关菌血症（22%）和尿路感染（21%）。在多变量分析中，ANCA阳性（风险比[95%置信区间]为1.62[1.07 - 2.44]；P = 0.02）和诊断时的年龄（风险比[95%置信区间]为1.10[1.00 - 1.21]；P = 0.047）仍与SI独立相关。诊断后头三个月内年龄调整后的严重感染与三年死亡率增加相关（风险比[95%置信区间]为3.13[1.24 - 7.88]；P = 0.01）。因此，SI是抗GBM疾病常见的早期并发症，尤其是在老年人和抗中性粒细胞胞浆抗体（ANCA）阳性的患者中。未观察到免疫抑制策略与SI发生之间存在显著关联。
