Infection-related hospitalization after intensive immunosuppressive therapy among lupus nephritis and ANCA glomerulonephritis patients

Abstract

Introduction: This study aimed to investigate the clinical characteristics, risk factors, and outcomes of infection-related hospitalization (IRH) in patients with lupus nephritis (LN) and ANCA glomerulonephritis after intensive immunosuppressive therapy.Methods: Patients diagnosed with LN or ANCA glomerulonephritis who received intensive immunosuppressive therapy at the First Affiliated Hospital of Sun Yat-sen University from 2005 to 2014 were enrolled. Demographics, laboratory parameters, immunosuppressive agents, and IRH details were collected. Multivariable Cox regression was used, and hazard ratios (HRs) and 95% confidence intervals (CIs) were reported.Results: Totally, 872 patients with 806 LN and 66 ANCA glomerulonephritis were enrolled, and 304 (34.9%) patients with 433 episodes of IRH were recorded. ANCA glomerulonephritis patients were more vulnerable to IRH than LN patients (53.0% vs. 33.4%, p = .001). Multivariable Cox regression analysis showed that ANCA glomerulonephritis (HR = 1.62, 95% CI: 1.06-2.49, p = .027), diabetes (HR = 1.82, 95% CI: 1.03-3.22, p = .039) and a higher initial dose of prednisone (HR = 1.01, 95% CI: 1.00-1.02, p = .013) were associated with a higher likelihood of IRH. Higher albumin (HR = 0.96, 95% CI: 0.94-0.98, p < .001), globulin (HR = 0.98, 95% CI: 0.96-0.99, p = .008), and eGFR (HR = 0.99, 95% CI: 0.99-1.00, p < .001), were associated with a lower likelihood of IRH. The rates of transfer to ICU and mortality for ANCA glomerulonephritis patients were higher than those for LN patients (22.9% vs. 1.9%, p < .001, and 20.0% vs. 0.7%, p < .001, respectively).Conclusions: ANCA glomerulonephritis patients had a higher risk of IRH and poorer outcome once infected after intensive immunosuppressive therapy than LN patients. More strict control for infection risks is required for ANCA glomerulonephritis patients who undergo intensive immunosuppressive therapy.

Keywords: ANCA glomerulonephritis; Lupus nephritis; hospitalization; immunosuppression; infection.

Figure 1.

Infection rate of patients after intensive immunosuppressive therapy. Infection rate referred to the percentage of patients with at least one episode of IRH. The serious infection rate referred to the percentage of patients with at least one episode of severe infection. p=.001 compared to lupus nephritis; p<.001 compared to lupus nephritis.

Figure 2.

Pathogens of infection for IRH among patients with LN and ANCA glomerulonephritis after intensive immunosuppressive therapy. The determination of pathogen was based on clinical manifestation, therapeutic efficacy of antibiotic agents, etiological examination, or image-based diagnosis. Lupus nephritis vs. ANCA glomerulonephritis: bacteria: p = .413; virus: p = .524; fungus: p = .906, respectively. IRH: infection-related hospitalization.

Figure 3.

Survival curve and log rank test analysis for first-year IRH among patients with autoimmune renal diseases after intensive immunosuppressive therapy. IRH: infection-related hospitalization.