scholarly journals P203 Incidence, characteristics and determinants of severe infections in patients with anti-neutrophil cytoplasm antibody-associated vasculitis receiving rituximab therapy: a single centre study

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Francesco Dernie ◽  
Nadia Ahmad ◽  
Raashid Luqmani ◽  
Joel David
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Regression Analysis ◽  
Severe Infection ◽  
Infection Risk ◽  
P Value ◽  
Risk Of Infection ◽  
Electronic Patient Records ◽  
Increased Risk ◽  
Severe Infections

Abstract Background/Aims  The efficacy of rituximab in managing anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is well-established; however its associated complications, including risk of developing serious infections, are less well characterised. Identifying infection risk factors may help to improve care of patients with AAV receiving rituximab. We characterised severe infections in a cohort of patients over a three-year period and identified factors affecting their risk of developing severe infections. Methods  Electronic patient records were interrogated over a retrospective period (August 2016-August 2019) to compile baseline data and episodes of severe infection. Differences between groups were determined using appropriate parametric or non-parametric methods. Risk factors for severe infections were identified through multivariate binomial logistic regression analysis. Variables with an event count of ≥ 5 and a p-value ≤0.1 at univariate level were entered into the final multivariate analysis, where p ≤ 0.05 was taken as significant. Results  Fifty patients were included. 24 (48%) were male, and 26 (52%) female. Average age was 60 years (range 25-90). 36 (72%) had GPA, 2 (4%) MPA, 1 (2%) EGPA, and 11 (22%) had overlap or undefined AAV. 14 (28%) patients developed at least one severe infection (≥grade 3, CTCAE criteria), giving an incidence of 15.4 severe infections per 100 person-years. The 18 severe infection events included 10 (56%) respiratory tract, 5 (28%) sepsis/neutropenic sepsis, 1 (6%) cellulitis, 1 (6%) complicated UTI and 1 (6%) recurrent wound infection. Patients who developed severe infections had lower immunoglobulin levels (IgG<6g/L, 36% vs 6%, p = 0.009), concomitant COPD (21% vs 3%, p = 0.029), and lower rates of concomitant co-trimoxazole use (7% vs 44%, p = 0.012) compared to patients not developing severe infections. Regression analysis of demographic, baseline blood markers and concomitant therapy data was performed to identify risk factors for developing severe infections (Table.1). Hypogammaglobulinaemia increased risk of infection (OR = 8.782, 95%CI=1.194-64.605, p = 0.033), while co-trimoxazole decreased risk of infection (OR = 0.096, 95%CI=0.009-0.996, p = 0.050). P203 Table 1:Univariate analysisMultivariate analysisVariablesOR95% CIP valueOR95% CIP valueAge (years)1.0320.994-1.0720.105Sex (male)0.3200.084-1.2130.0940.2860.057-1.4350.128Creatinine1.0050.987-1.0240.577eGFR0.9750.945-1.0060.109CRP1.0010.989-1.0120.899ESR1.0030.960-1.0460.908Neutrophils0.9730.789-1.2010.802WBC0.9590.780-1.1800.694Lymphocytes0.8700.420-1.8050.709CD190.4780.000-2000.9670.862CD19%0.9870.906-1.0750.767CD30.3140.055-1.7750.190CD3%0.9960.941-1.0550.902CD40.3920.034-4.4870.451CD4%1.0110.959-1.0660.675CD80.0530.001-4.7440.200CD8%0.9850.914-1.0610.689IgG0.8900.749-1.0570.185Hypogammaglobulinemic?8.6111.423-52.0910.0198.7821.194-64.6050.033IgM0.8360.350-1.9970.686IgA1.0890.787-1.5070.607BMI0.9460.858-1.0430.262COPD*9.5450.899-101.3380.061DM0.8330.147-4.7230.837Hypertension0.4330.082-2.2910.325CV disease0.000-0.999AKI0.4580.088-2.3780.353Latent TB0.3710.022-6.3830.495DI2.6920.157-46.2640.495Hypothyroidism0.000-1.000RA5.8330.484-70.2440.165OP2.6920.157-46.2640.495OA0.000-1.000SLE0.000-1.000AIH0.000-1.000CKD0.000-1.000Co-trimoxazole use0.0960.011-0.8150.0320.0960.009-0.9960.050Cumulative dose of RTX0.6690.392-1.1410.140Did patient have prior RTX before Aug 2016?0.6940.194-2.4870.575Yearly influenza vaccine between 2016-2019 (patients for whom vaccine records exist on EPR)1.3850.188-16.2770.796Average length of follow-up (days)1.0010.999-1.0030.360Prednisolone cumulative dose1.0001.000-1.0000.843Prednisolone average dose0.9920.991-1.0800.852MTX cumulative dose1.0000.999-1.0010.701MTX average dose1.0200.696-1.4960.918HCQ cumulative dose1.0001.000-1.0000.331HCQ average dose0.9850.964-1.0060.162LFN cumulative dose1.0001.000-1.0000.855LFN average dose0.8510.605-1.1990.357MMF cumulative dose1.0010.999-1.0020.263MMF average dose3.9960.402-39.7260.237AZT cumulative dose1.0001.000-1.0000.372AZT average dose0.9440.878-1.0140.116*too few events for progression to multivariate analysis. Conclusion  The incidence of severe infections in patients with AAV receiving rituximab is significant. Our results support the monitoring of IgG levels to identify patients who may be more susceptible to infection, as well as the prescription of prophylactic co-trimoxazole to reduce overall severe infection risk. Disclosure  F. Dernie: None. N. Ahmad: None. R. Luqmani: None. J. David: None.

Lymphocytopenia Is Associated with an Increased Risk of Severe Infections in Patients with Multiple Myeloma Treated with Bortezomib-Based Regimens

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 5042-5042 ◽  
Author(s):  
Sung-Hoon Jung ◽  
Jae-Sook Ahn ◽  
Seung-Ji Kang ◽  
Deok-Hwan Yang ◽  
Yeo-Kyeoung Kim ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Multivariate Analysis ◽  
Conflicts Of Interest ◽  
Severe Infection ◽  
Infectious Complications ◽  
P Value ◽  
Factors Affecting ◽  
Increased Risk ◽  
Severe Infections ◽  
Grade 3

Abstract Abstract 5042 Bortezomib is a proteasome inhibitor with potent antimyeloma activity in relapsed/refractory multiple myeloma (MM) patients. We evaluated the type and factors affecting the onset of infectious complications and mortality owing to infection in MM patients treated with bortezomib-based regimens. We reviewed 139 patients with MM treated with regimens containing bortezomib in order to assess the type and factors affecting the development of severe infections. Infections occurred in 56 (40. 3%) of 139 patients and 83 (7. 8%) cases of the 1, 069 evaluable cycles. Severe infections developed in 43 (30. 9%) patients and ten patients (7. 1%) died during bortezomib-based treatment. Multivariate analysis determined lymphocytopenia grade 3–4 (OR 3. 17, 95% CI 1. 38–7. 31, p = 0. 007) and number of cycle ° Â 8 cycles (OR 3. 91, 95% CI 1. 39–11. 02, p =0. 010) as risk factors associated with increased severe infection. This study showed that MM patients who received bortezomib-based regimens are at a higher risk of severe infections within eight cycles of treatment during especially severe lymphocytopenic period. MM patients treated with bortezomib-based regimens should be closely monitored for the development of infectious complications during lymphocytopenia. Table I. Multivariate analysis of factors affecting severe infection development Parameter OR (95% CI) p-Value Age (> 65) 1.78 (0.77–4.13) 0.180 Immunophenotype IgA 1.51 (0.60–3.77) 0.379 Lymphocytopenia (grade 3–4) 3.17 (1.38–7.31) 0.007 Neutropenia (grade 3–4) 1.25 (0.55–2.85) 0.600 Number of cycles (°Â 8 cycles) 3.91 (1.39–11.02) 0.010 Disclosures: No relevant conflicts of interest to declare.

scholarly journals Clinical profile and factors determining outcome of intramural very low birth weight babies in a tertiary care centre: a retrospective study

2017 ◽  
Vol 5 (2) ◽  
pp. 520
Author(s):  
Devi Meenakshi K. ◽  
Arasar Seeralar A. T. ◽  
Srinivasan Padmanaban
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Logistic Regression Analysis ◽  
Very Low Birth Weight ◽  
Tertiary Care ◽  
P Value ◽  
Increased Risk

Background: Very low birth weight (VLBW) babies are at increased risk of a number of complications both immediate and late. Worldwide it has been observed that these babies contribute to a significant extent to neonatal mortality and morbidity. Aim of the study was to study the risk factors contributing to mortality in VLBW babies and to evaluate the morbidity pattern in these infants.Methods: A retrospective analysis of data retrieved from the case records of VLBW babies admitted in the NICU of Kilpauk Medical College between January 2015 to December 2015. Out of the 2360 intramural babies admitted during the study period, 99 babies were less than 1500 gms. The risk factors for these babies were analyzed for their association with the outcome. Data were statistically analyzed.Results: In present study, we found that sex of the baby, gestational age, obstetric score, birth asphyxia, pulmonary haemorrhage, ROP and presence of shock were found to be associated with increased mortality. By logistic regression analysis it was observed that birth weight of the baby (p value 0.002), duration of stay (p value 0.0006), presence of shock (p<0.0001), were the risk factors significantly associated with poor outcome.Conclusions: Among the maternal and neonatal factors analyzed in the study using logistic regression analysis, birth weight, duration of hospital stay and presence of shock were significantly related to poor outcome. Of these presence of shock was the single most important factor that predicted increased mortality.

Increased Bone Marrow Iron Stores, Severe Mucositis and Large Area under the Curve (AUC) of Profound Neutropenia Predict Severe Infection in 382 Myeloma Patients Undergoing Melphalan - Autologous Stem Cell Transplantation (MEL-ASCT).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1158-1158
Author(s):  
Elias J. Anaissie ◽  
Marisa H. Miceli ◽  
Li Dong ◽  
Monica L. Grazziutti ◽  
Sabitha Rajan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Severe Infection ◽  
Severe Neutropenia ◽  
Large Area ◽  
Iron Stores ◽  
Severe Infections ◽  
Severe Mucositis

Abstract Background: MEL-ASCT is standard therapy for multiple myeloma (MM) but is associated with severe infections, at times life-threatening. Objective: To determine the risk factors for severe infection (bacteremia, septic shock, colitis, pneumonia) following MEL - ASCT for MM. Materials and Methods: 382 consecutive MM patients (pts) enrolled in our Total Therapy 2 protocol and who received their first MEL - ASCT between 10/1998 and 12/2002 were included. Variables evaluated included age, sex and MM remission status, severity of mucositis and others. Because of the known association between increased body iron stores and infection, pre-ASCT bone marrow (BM) iron stores were also evaluated. The AUC for severe neutropenia (<100 absolute neutrophils (ANC) / mL) was used as a single variable accounting for both the depth and duration of neutropenia. Results: Median age was 56 years (range: 30–76) and 235 pts (62 %) were males. Severe infections developed in 77 pts (20%) including pneumonia (42 pts). Pre-ASCT risk factors for infection by univariate analysis were increased BM iron stores (OR= 3.601; 95%CI 1.795–7.222; p<0.0007) and low platelets counts (OR for -1000 platelets/μL = 0.997; 95% CI 0.994 – 1; p=0.0381). Increased BM iron stores remained significant by multivariate analysis (OR= 3.601; 95% CI 1.795–7.222; p<0.0007). Post-ASCT risk factors that were significant by both univariate and multivariate analysis were severe mucositis (Grades 3–4 by NCI Common Toxicity Criteria) (OR=1.916; 95% 1.093–3.36; p=0.02) and AUC of severe neutropenia (OR= 1.001/unit; 95% 1–1.002; p=0.03). Neither the duration (days with ANC <1000 / mL) nor the depth of moderate neutropenia (AUC < 1000 neutrophils / mL) predicted infection. Conclusion: MM pts scheduled to undergo MEL - ASCT and who have increased BM iron stores, and those who develop severe mucositis and / or prolonged and profound neutropenia following ASCT should be considered at greater risk for developing severe infection. AUC of severe neutropenia is a useful single marker of both depth and duration of neutropenia and should be included in studies evaluating risk for infection in neutropenic pts.

scholarly journals Risk Factors for Poor Prognosis of Severe Infection in Children With Idiopathic Nephrotic Syndrome: A Double-Center, Retrospective Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Hengci Zhang ◽  
Shiyuan Qiu ◽  
Cheng Zhong ◽  
Lin Shi ◽  
Jiacheng Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Nephrotic Syndrome ◽  
Logistic Regression Analysis ◽  
Poor Prognosis ◽  
Idiopathic Nephrotic Syndrome ◽  
Severe Infection ◽  
Infection Group ◽  
Severe Infections

Background: Infection is the most common complication of Idiopathic Nephrotic Syndrome (INS) and the main cause of INS recurrence, severe infection and even leading to mortality. The purpose of this study was to investigate the risk factors of severe infection in INS children and the clinical parameters influencing prognosis.Methods: Totally 147 children with INS and concomitant infections were enrolled and classified into the severe infection group (SIG) and Non-severe infection group (Non-SIG). The clinical characteristics and auxiliary examination results were compared between the two groups, and the early-warning parameters for severe infection and risk factors for poor prognosis were evaluated.Results: There were 49 patients in the SIG, 98 patients in the Non-SIG. In the SIG, the most common severe infections disease included severe pneumonia (63.6%), severe sepsis (30.6%), septic shock (4.1%). In SIG, Gram-positive bacteria (GPB) were more common, as was respiratory syncytial virus (RSV), and the three most common strains were Pseudomonas aeruginosa, Staphylococcus aureus (SA) and Staphylococcus epidermidis. There were more steroid-resistant nephrotic syndrome and combination of steroids and immunosuppressants in SIG, compared with the Non-SIG (P = 0.000). Patients in the SIG has lower complement 3 (C3, ≤ 0.55 g/L,) and absolute lymphocyte count (ALC, ≤ 1.5 × 109/L) (P = 0.004). Logistic regression analysis revealed that the independent risk factors for severe infections were the combined use of immunosuppressants [95% confidence interval (CI):1.569–463.541, P = 0.023], steroid resistance (95% CI: 4.845–2,071.880, P = 0.003), C-reactive protein (CRP) ≥8 mg/L (95% CI: 43.581–959, 935.668, P = 0.001), and infections caused by GPB (95% CI: 27.126–2,118, 452.938, P = 0.002), influenza (95% CI: 2.494–1, 932.221, P = 0.012) and RSV (95% CI: 5.011–24 963.819, P = 0.007). The patients in the SIG were classified into the survival group (N = 39) and the mortality group (N = 5). Logistic regression analysis showed that white blood cell count (WBC) &gt;15 × 109/L (95% CI: 1.046–2.844, P = 0.033) was an independent risk factor of poor prognosis for these patients.Conclusions: Resistance to steroids, combined with steroids and IS agents, and GPB infections (especially SA) are high-risk factors for severe infection in children with INS. We should monitor CRP ≥ 8 mg/L, C3 ≤ 0.55 g/L and ALC ≤ 1.5 × 109/L to avoid developing severe infection. Accompanied by an increase in ANC, WBC significantly increased, suggesting a fatal infection.

Predictive Factors to Hypogammaglobulinemia and Non-Neutropenic Infection Complications after Rituximab/Chemotherapy Treatment

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1288-1288 ◽  
Author(s):  
Kalman Filanovsky ◽  
Lev Shvidel ◽  
Mordechai Shtalrid ◽  
Michal Haran ◽  
Adrian Duek ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Chemotherapy Regimen ◽  
Bone Marrow Involvement ◽  
Severe Infection ◽  
Infectious Complications ◽  
Immunoglobulin Level ◽  
Increased Risk ◽  
Severe Infections ◽  
Related Mortality

Abstract Rituximab is a chimerical human/mouse monoclonal anti-CD20 antibody successfully applied in B-cell lymphoproliferative disorders. The suppression of B-lymphocytes may induce hypogammaglobulinemia and increased risk for infection. These complications are rarely observed as a result of monotherapy with rituximab but have been often noted following combination with aggressive chemotherapy or in the setting of autologous stem cell transplantation (ASCT). In an attempt to study the role of rituximab in induction of hypogamma, we analyzed the frequency of this phenomenon, its possible causes, infectious complications and infection-related mortality in lymphoma patients treated with different chemotherapy regimens with or without rituximab. We analyzed 136 patients who received rituximab concurrently with chemotherapy (R-Chemo) and 46 patients who were treated with chemotherapy only, with follow-up period of up to five years. Following R-Chemo, 17 cases (12.5%) of severe hypogamma (defined as <60% of normal IgG range) were diagnosed, 21 patients (15.5%) had mild and moderate hypogammaglobulinemia, and 16 (12%) were found with decreased IgM alone. Multivariate analysis showed a significant increase of severe hypogamma when >6 doses of rituximab were given. Moreover, rituximab in >8 doses leaded to severe hypogamma in 50% of patients compared to 11.8% in patients treated with <8 doses (p .006) associated with 3 times more infections. The type of chemotherapy regimen didn’t influence development of the hypogamma. Even myeloablative chemotherapy used in combination with rituximab before ASCT slightly increased the rate of severe hypogamma (p .06). Only the combination of fludarabine and rituximab (FR) compared to other Chemo-R, induced non-significant increase of severe hypogammaglobulinemia (21% vs 11%; p .02), severe non-neutropenic infection 19.4% vs 5.0% (p .005) and infection-related mortality 24% vs. 6% (p. 004). Multivariate analysis showed that patients post FR treatment were 6.4 times more prone to have severe infections than post other Chemo-R regimens (95% CI 1.49–27.0). Age and gender of patients, type of lymphoma, bone marrow involvement didn’t affect the immunoglobulin level. We found a strong correlation between the IgG level and frequency of severe infections and mortality from infection (p <.01). Finally, the pre-treatment hypogamma was not found as a risk factor for infection. However, the duration of this phenomenon was found important: patients with severe hypogamma lasted >6 months were 4.5 times more likely to have severe infection (95%CI 1.19–18.5). In conclusion, we emphasized the importance of follow-up on immunoglobulin level in patients receiving rituximab. Hypogammoglobulinemia is not rare and is a clinical important phenomenon, leading to increase in infection and mortality rate in patients receiving R-Chemo. Longer treatment with more than six doses of rituximab significantly increases the incidence of hypogammoglobulinemia. The type chemotherapy regimen, except for fludarabine didn’t affect the incidence of hypogammaglobulinemia and infection rate in our patients.

scholarly journals 1095. Investigation of Risk Factors Associated with Serious Bacterial, Viral and Invasive Fungal Infections in Hematologic Patients on Ibrutinib

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S576-S577
Author(s):  
Thomas Holowka ◽  
Harry Cheung ◽  
Maricar F Malinis ◽  
Sarah Perreault ◽  
Iris Isufi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fungal Infections ◽  
Antimicrobial Prophylaxis ◽  
Hematologic Malignancy ◽  
Invasive Fungal Infections ◽  
Risk Of Infection ◽  
Factors Associated ◽  
Serious Infection ◽  
Increased Risk ◽  
Serious Infections

Abstract Background Ibrutinib is a tyrosine kinase inhibitor used to treat hematologic malignancies that may increase the risk of serious infection including invasive fungal infections (IFI). In a study of 378 patients with hematologic malignancy on ibrutinib, serious infection and IFI occurred in 11% and 4% respectively (Varughese et al. Clin Infect Dis). The primary aims of our study were to determine the incidence of serious infection and associated risk factors in patients on ibrutinib. Methods We performed a retrospective analysis of patients with hematologic malignancy prescribed ibrutinib for ≥ 1 week at Yale New Haven Hospital from 2014 to 2019 to identify serious infections defined as those requiring inpatient management. We collected demographic, clinical and oncologic data. Chi-squared tests were used to determine factors associated with an increased risk of infection. Results A total of 254 patients received ibrutinib including 156 with CLL, 89 with NHL and 9 with other leukemias. Among these, 21 underwent HSCT, 9 complicated by GVHD. There were 51 (20%) patients with serious infections including 45 (17.7%) bacterial, 9 (3.5%) viral and 5 (2%) IFI (1 pulmonary cryptococcosis, 4 pulmonary aspergillosis). Anti-mold prophylaxis was prescribed to 7 (2.8%) patients, none of whom developed IFI. Risk factors associated with serious infection included ECOG score ≥ 2 (OR 4.6, p &lt; 0.001), concurrent steroid use (≥ 10 mg prednisone daily for ≥ 2 weeks; OR 3.0, p &lt; 0.001), neutropenia (OR 3.6, p &lt; 0.01), lymphopenia (OR 2.4, p &lt; 0.05) and maximum ibrutinib dose of 560 mg (OR 2, p &lt; 0.05). There was a dose dependent increase in infections based on number of chemotherapy regimens prior to ibrutinib initiation: 14.3% with 0, 19.7% with 1-2 and 28.7% with ≥ 3 prior treatments. Conclusion The incidence of serious infection in hematologic patients on ibrutinib was higher than previously reported (20% versus 11%) but the rate of IFI was lower (2% versus 4%). High ECOG score, leukopenia, steroids, and higher ibrutinib doses were associated with an increased risk for serious infection. Targeted antimicrobial prophylaxis should be considered for patients on ibrutinib with these risk factors. Improving functional status may also reduce the risk of infection in patients on ibrutinib. Disclosures All Authors: No reported disclosures

scholarly journals Examining the possible causal relationship between lung function, COPD and Alzheimer’s disease: a Mendelian randomisation study

2021 ◽  
Vol 8 (1) ◽  
pp. e000759
Author(s):  
Daniel Higbee ◽  
Raquel Granell ◽  
Esther Walton ◽  
Roxanna Korologou-Linden ◽  
George Davey Smith ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Lung Function ◽  
Causal Relationship ◽  
Mendelian Randomisation ◽  
P Value ◽  
Unmeasured Confounding ◽  
Increased Risk ◽  
Shared Risk

RationaleLarge retrospective case-control studies have reported an association between chronic obstructive pulmonary disease (COPD), reduced lung function and an increased risk of Alzheimer’s disease. However, it remains unclear if these diseases are causally linked, or due to shared risk factors. Conventional observational epidemiology suffers from unmeasured confounding and reverse causation. Additional analyses addressing causality are required.ObjectivesTo examine a causal relationship between COPD, lung function and Alzheimer’s disease.MethodsUsing two-sample Mendelian randomisation, we used single nucleotide polymorphisms (SNPs) identified in a genome wide association study (GWAS) for lung function as instrumental variables (exposure). Additionally, we used SNPs discovered in a GWAS for COPD in those with moderate to very severe obstruction. The effect of these SNPs on Alzheimer’s disease (outcome) was taken from a GWAS based on a sample of 24 807 patients and 55 058 controls.ResultsWe found minimal evidence for an effect of either lung function (OR: 1.02 per SD; 95% CI 0.91 to 1.13; p value 0.68) or liability for COPD on Alzheimer’s disease (OR: 0.97 per SD; 95% CI 0.92 to 1.03; p value 0.40).ConclusionNeither reduced lung function nor liability COPD are likely to be causally associated with an increased risk of Alzheimer’s, any observed association is likely due to unmeasured confounding. Scientific attention and health prevention policy may be better focused on overlapping risk factors, rather than attempts to reduce risk of Alzheimer’s disease by targeting impaired lung function or COPD directly.

scholarly journals Procedural and remote outcome among patients undergoing urgent trans-catheter aortic valve implantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Berkovitch ◽  
A Segev ◽  
A Finkelstein ◽  
R Kornowski ◽  
H Danenberg ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Hospital Mortality ◽  
Mortality Rates ◽  
P Value ◽  
Complication Rates ◽  
Increased Risk ◽  
Procedural Complication ◽  
Elective Procedure ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Severe aortic stenosis patients suffer frequent heart failure decompensations events often requiring hospitalization. In extreme situations patients can be found with pulmonary edema and cardiogenic shock, unresponsive to medical treatment. Urgent trans-catheter aortic valve implantation (TAVI) has emerged as a treatment option for these high-risk patients. Methods We investigated 3,599 patients undergoing TAVI. Subjects were divided into two groups based on procedure urgency: patients who were electively hospitalized for the procedure (N=3,448) and those who had an urgent TAVI (N=151). Peri-procedural complications were documented according to the VARC-2 criteria. In hospital and 1-year mortality rates were prospectively documented. Results Mean age of the study population was 82±7, of whom 52% were female. Peri-procedural complication rates was significantly higher among patients with an urgent indication for TAVI compared to those having an elective procedure: valve malposition 3.6% vs. 0.6% (p-value=0.023), valve migration 3.2% vs. 0.9% (p-value=0.016), post procedure myocardial infarction 3.7% vs. 0.3% (p-value=0.004), and stage 3 acute kidney injury 2.6% vs. 0.5%, (p-value=0.02). Univariate analysis found that patients with urgent indication for TAVI had significantly higher in hospital mortality (5.8% vs. 1.4%, p-value&lt;0.001). similarly, multivariate analysis adjusted for age, gender and cardio-vascular risk factors found that patients with urgent indication had more than 5-folds increased risk of in-hospital mortality (OR 5.94, 95% CI 2.28–15.43, p-value&lt;0.001). Kaplan-Meier's survival analysis showed that patients undergoing urgent TAVI had higher 1-year mortality rates compared to patients undergoing an elective TAVI procedure (p-value log-rank&lt;0.001, Figure). Multivariate analysis found they had more than 2-folds increased risk of mortality at 1-year (HR 2.27, 95% CI 1.53–3.38, p&lt;0.001 compared to those having an elective procedure. Conclusions Patients with urgent indication for TAVI have higher in-hospital mortality and higher peri-procedural complication rates. However, if these patients survive the index hospitalization, they enjoy good prognosis. Kaplan-Meier's survival analysis Funding Acknowledgement Type of funding source: None

SAT0188 HIGH-DOSE STEROIDS ARE IMPORTANT CONTRIBUTORS TO THE INFECTION BURDEN OF PATIENTS WITH LUPUS NEPHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1036.1-1036
Author(s):  
A. Vornicu ◽  
B. Obrisca ◽  
R. Jurubita ◽  
B. Sorohan ◽  
A. Andronesi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Female Gender ◽  
Neurological Involvement ◽  
High Dose ◽  
Pulse Methylprednisolone ◽  
Sledai Score ◽  
Oral Corticosteroids ◽  
Dose Oral ◽  
Severe Infections

Background:Infection remains a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE) and lupus nephritis (LN) treated with systemic immunosuppression (IS).Objectives:We sought to describe the infection profile in patients with LN treated with aggressive immunosuppression (induction and maintenance therapy) and to identify the associated risk factors.Methods:Patients with LN followed in the Nephrology Department of Fundeni Clinical Institute, were retrospectively reviewed for any infection that occurred from initiation of induction therapy. Infections were graded (1-5) according to the Common Terminology Criteria for Adverse Events. Infection site and type of microorganism were also recorded. Univariate and multivariate Cox proportional hazard regression analysis were performed in order to identify independent risk factors for infection.Results:The study cohort comprised 101 patients (86.1% females) with a mean age of 34 ± 14 years. Forty-eight patients (47.5%) had at least one infection with a total 92 episodes of infection occurring during a median follow-up of 17 months (IQR:8.5-52.5 months). The majority of patients (31 of 48) had infections during the first 12 months since IS treatment initiation. The most common site was lung infection (in 24.8% of patients), followed by urinary tract (20.8% of patients) and cutaneous/mucosal infections (11% of patients). Thirty-eight percent of patients had bacterial infections. Nineteen percent of patients had severe infections (grade 3 or higher) with 3.3% of infection-related deaths (3 patients). The most common induction regimen was cyclophosphamide in addition to corticosteroids (48.5%), with 44.6% of patients receiving pulse methylprednisolone and 45.5% of patients receiving more than 30 mg/d of prednisone as the maximum oral dose. In univariate Cox regression analysis, female gender (HR 3.34; 95% CI, 1.03-10.8, p=0.04), pulse methylprednisolone (HR 2.9; 95% CI, 1.6-5.24, p=0.001), high-dose (≥30 mg/day) oral corticosteroids (HR 4.22; 95% CI, 2.21-8.02,p=0.001) and SLEDAI score (HR 1.047; 95% CI, 1.012-1.084, p=0.008) were risk factors for infection. In multivariate Cox regression analysis, female gender (HR 6.35; 95%CI, 1.86-21.64,p=0.003), high-dose oral corticosteroids (HR 4.7; 95% CI, 2.25-9.87, p=0.003) and SLEDAI score (HR 1.046; 95% CI, 1.003-1.09, p=0.034) remained independent predictors of infection risk. Of the risk factors associated with severe infections (grade 3 or higher), in univariate analysis we identified younger age (HR 0.96, 95%CI, 0.92-0.99, p=0.035), neurological involvement (HR 2.59; 95%, 0.86-7.83, p=0.09), pulse methylprednisolone (HR 5.42; 95% CI, 1.79-16.35, p=0.003) and high-dose oral corticosteroids (HR 8.32; 95% CI, 2.4-28.77, p=0.001) as risk factors for infection. After multivariate adjustment, neurological involvement (HR 4.33; 95%, 1.29-14.51, p=0.01) and high-dose oral corticosteroids (HR 7.6; 95% CI, 1.6-35.39, p=0.01) were identified as independent predictors of infection risk.Conclusion:A high-dose oral corticosteroid regimen increased the risk for any infection and for severe infections by 4.7-fold and 7.6-fold, respectively. In addition, female gender and a higher SLEDAI score were identified as risk factors for any infection, while neurological involvement was associated with an increased risk for severe infections.References:[1]Jung JY, Yoon D, Choi Y, Kim HA, Suh CH. Associated clinical factors for serious infections in patients with systemic lupus erythematosus. Sci Rep. 2019;9(1):9704.Disclosure of Interests: :None declared

Since blood transfusion is linked to the magnitude of the surgical procedure, comparing transfused patients to untransfused patients will always be confounded by infection risks due to factors related to the procedure. To control for these factors one must compare patients transfused with red cells from different sources or prepared in a manner which minimize infection risk. Patients transfused with homologous blood have infection rates several fold higher than recipients of equal values of autologous blood undergoing the same operative procedure (20-23). Homologous blood recipients have significantly longer hospital stays attributed to treating infections. The cost of a blood transfusion exceeds the cost of collection, storage and administration because of transfusion's association with length of stay. In this era of cost-containment the association with prolonged stay may ultimately curtail the use of blood. Homologous blood can be filtered to remove donor leukocytes which may be contributing to immune suppression and infection risk. A prospective randomized trial comparing the infection rates among colorectal cancer patients receiving filtered and unfiltered blood has been conducted (9). There were 17 infectious complications among the 56 recipients of whole blood and one infectious complication among the 48 recipients of filtered blood. Infections were prevented by the seemingly simplistic addition of a $25/filter to every bag of blood transfused. These clinical studies are very convincing: homologous blood transfusion is associated with increased risk of infection in every clinical situation examined. In multivariate analyses transfusion was a significant predictor of infection after consideration of other variables measured and in the majority of those studies transfusion was the single most significant factor. Patients receiving homologous blood exhibited an incidence of infectious complications that was approximately four times higher than patients receiving autologous blood. The association of transfusion with infection is found among patients undergoing surgery for cardiac, orthopedic and gastrointestinal disorders and for trauma as well as among unoperated patients transfused for bums and gastrointestinal bleeding. The observation that nosocomial infections are increased in these studies argues strongly that the association of transfusion with infection is not simply a reflection of transfusion as a marker of tissue destruction and contamination. Infections that develop in transfused patients away from the site of trauma or in the absence of trauma, cannot be attributed to the quantity of tissue destroyed or to the degree of bacterial contamination. Filtered blood can remove leukocytes and prevent postoperative infections. Since filtering blood can significantly reduce the incidence of infection among transfused patients, all transfused blood will be passing through filters in the very near future. EXPERIMENTAL STUDIES RELATING BLOOD TRANSFUSION TO INCREASED RISK OF INFECTION Patients are extremely heterogeneous and even in prospective randomized trials, factors which influence patients' participation affect the outcome despite double-blinding and randomization. In animal studies using syngeneic strains with identical housing, lighting, access to food and water, control over the extent of injury, use of antibiotics and exposure to other variables the influence of a single variable such as blood transfusion can be measured. Dr. Waymack's laboratory has intensively studied parameters which interact with transfusion in

1995 ◽  
pp. 296-296
Keyword(s):  
Blood Transfusion ◽  
Autologous Blood ◽  
Experimental Studies ◽  
Infection Risk ◽  
Infectious Complications ◽  
Risk Of Infection ◽  
Infection Rates ◽  
Homologous Blood ◽  
Increased Risk ◽  
The Cost
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