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. 2012 Sep;64(9):2847-55.
doi: 10.1002/art.34530.

Development and validation of a risk score for serious infection in patients with rheumatoid arthritis

Cynthia S Crowson  1 , Deana D Hoganson, Patrick D Fitz-Gibbon, Eric L Matteson
Affiliations

Development and validation of a risk score for serious infection in patients with rheumatoid arthritis

Cynthia S Crowson et al. Arthritis Rheum. 2012 Sep.

Abstract

Objective: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

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Figures

Figure 1
Figure 1
Comparison of observed and predicted 1 year risk of serious infection in the validation cohort according to deciles of predicted risk obtained from our risk score for serious infections developed in the original cohort. The observed risk was obtained using Kaplan-Meier methods. Note that predicted risk for patients in deciles 1–3 was identical, so these 3 deciles of patients are included in the bars labeled decile 3.
Figure 2
Figure 2
Comparison of observed and predicted 1 year risk of serious infection in the validation cohort according to deciles of predicted risk obtained from our re-calibrated score for serious infections. The observed risk was obtained using Kaplan-Meier methods. Note that predicted risk for patients in deciles 1–3 was identical, so these 3 deciles of patients are included in the bars labeled decile 3.
See this image and copyright information in PMC

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