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Severe Infection in Anti-Glomerular Basement Membrane Disease: A Retrospective Multicenter French Study

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 hospitalizat...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141378/
https://www.ncbi.nlm.nih.gov/pubmed/32143501
http://dx.doi.org/10.3390/jcm9030698
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author 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
author_facet 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
author_sort Caillard, Pauline
collection PubMed
description 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]; p = 0.02) and age at diagnosis (HR [95% CI] 1.10 [1.00–1.21]; p = 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]; p = 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.
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spelling pubmed-71413782020-04-10 Severe Infection in Anti-Glomerular Basement Membrane Disease: A Retrospective Multicenter French Study 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 J Clin Med Article 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]; p = 0.02) and age at diagnosis (HR [95% CI] 1.10 [1.00–1.21]; p = 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]; p = 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. MDPI 2020-03-04 /pmc/articles/PMC7141378/ /pubmed/32143501 http://dx.doi.org/10.3390/jcm9030698 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
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
Severe Infection in Anti-Glomerular Basement Membrane Disease: A Retrospective Multicenter French Study
title Severe Infection in Anti-Glomerular Basement Membrane Disease: A Retrospective Multicenter French Study
title_full Severe Infection in Anti-Glomerular Basement Membrane Disease: A Retrospective Multicenter French Study
title_fullStr Severe Infection in Anti-Glomerular Basement Membrane Disease: A Retrospective Multicenter French Study
title_full_unstemmed Severe Infection in Anti-Glomerular Basement Membrane Disease: A Retrospective Multicenter French Study
title_short Severe Infection in Anti-Glomerular Basement Membrane Disease: A Retrospective Multicenter French Study
title_sort severe infection in anti-glomerular basement membrane disease: a retrospective multicenter french study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141378/
https://www.ncbi.nlm.nih.gov/pubmed/32143501
http://dx.doi.org/10.3390/jcm9030698
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