Incidence of infections in patients with giant cell arteritis: A cohort study
Incidence of infections in patients with giant cell arteritis: A cohort study
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DOI：
10.1002/acr.21569
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发表时间：
2012-04-01
影响因子：
4.7
通讯作者：
Thomas, Sara L.
中科院分区：
文献类型：
--
作者：
Durand, Madeleine;Thomas, Sara L.
Objective.巨细胞动脉炎（GCA）是成人最常见的血管炎。我们试图估计与GCA及其治疗相关的感染风险。我们使用健康改善研究网络的数据进行了一项匹配的历史队列研究。新诊断的GCA患者与最多6名非GCA患者按年龄、性别、一般实践和进入队列的日期进行匹配。使用随机效应泊松回归模型获得下呼吸道感染（LRTI）、尿路感染（UTI）和脓毒症以及严重感染（肺炎、上尿路感染和脓毒症）的发生率和率比。根据年龄、性别和诊断GCA后的时间评估影响。共有1，664例GCA患者与8，078例无GCA患者相匹配。总体而言，805例（48%）GCA患者和3,007例（37%）非GCA患者在随访期间经历了≥ 1次全身感染，LRTI、UTI和严重感染的校正率比为1.48（95%置信区间[95% CI] 1.34-1.65）、1.27（95% CI 1.10-1.46）和1.55（95% CI 1.22-1.96）（所有P < 0.001）。脓毒症的率比为1.63（95% CI 0.78-3.40，P = 0.20）。感染的比率在GCA诊断后的前6个月和年龄< 75岁的患者中最高，但不因性别而异。这是第一项表明GCA患者全身感染风险增加的研究，特别是在诊断后的前几个月。新的GCA药物，允许类固醇节省需要治疗这种情况。
Objective. Giant cell arteritis (GCA) is the most frequent form of vasculitis in adults. We sought to estimate the infectious risk associated with GCA and its treatment.Methods. We conducted a matched historical cohort study using data from The Health Improvement Research Network. Patients with newly diagnosed GCA were matched with up to 6 non-GCA patients by age, sex, general practice, and date of entry into the cohort. Random-effects Poisson regression models were used to obtain incidence rates and rate ratios for lower respiratory tract infections (LRTI), urinary tract infections (UTI), and sepsis, as well as for the subset of these that comprised serious infections (pneumonias, upper UTI, and sepsis). Effect modification by age, sex, and time since diagnosis of GCA was assessed.Results. A total of 1,664 patients with GCA were matched to 8,078 patients without GCA. Overall, 805 (48%) of the GCA patients and 3,007 (37%) of the non-GCA patients experienced >= 1 episode of systemic infection during followup, with adjusted rate ratios for LRTI, UTI, and serious infections of 1.48 (95% confidence interval [95% CI] 1.34-1.65), 1.27 (95% CI 1.10-1.46), and 1.55 (95% CI 1.22-1.96), respectively (P < 0.001 for all). The rate ratio for sepsis was 1.63 (95% CI 0.78-3.40, P = 0.20). Rate ratios for infection were highest in the first 6 months following diagnosis of GCA and in patients age < 75 years, but did not vary by sex.Conclusion. This is the first study to show that patients with GCA are at increased risk of systemic infections, particularly in the first few months following diagnosis. New GCA medications that allow steroid sparing are needed to treat this condition.