Lymphopenia and Treatment-Related Infectious Complications in ANCA-Associated Vasculitis

• Published in: Clinical journal of the American Society of Nephrology 2013-03, Vol.8 (3), p.416-423
• Main Authors: Goupil, Rémi, Brachemi, Soumeya, Nadeau-Fredette, Annie-Claire, Déziel, Clément, Troyanov, Yves, Lavergne, Valery, Troyanov, Stéphan
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - drug therapy; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - immunology; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - mortality; Chi-Square Distribution; Communicable Diseases - chemically induced; Communicable Diseases - diagnosis; Communicable Diseases - immunology; Communicable Diseases - mortality; Cyclophosphamide - adverse effects; Female; Hospitals, University; Humans; Immunocompromised Host; Immunosuppressive Agents - adverse effects; Kaplan-Meier Estimate; Linear Models; Lymphocyte Count; Lymphopenia - chemically induced; Lymphopenia - diagnosis; Lymphopenia - immunology; Lymphopenia - mortality; Male; Methotrexate - adverse effects; Methylprednisolone - adverse effects; Middle Aged; Multivariate Analysis; Neutropenia - chemically induced; Neutropenia - immunology; Original; Plasmapheresis; Quebec; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.07300712

ANCA-associated vasculitis (AAV) is treated with potent immunosuppressive regimens. This study sought to determine risk factors associated with infections during first-intention therapy. This retrospective study involved two separate cohorts of consecutive cases of AAV seen from 2004 to 2011 at two university hospitals. The following were assessed: vasculitis severity; therapy; and periods with no, moderate (lymphocyte count, 0.3-1.0× 10(9)/L), or severe (lymphocyte count ≤ 0.3×10(9)/L) lymphopenia and neutropenia (neutrophil count ≤ 1.5×10(9)/L). One hundred patients had a mean age of 57±15 years and a Birmingham vasculitis activity score of 7.7±3.6. Therapy consisted of pulse methylprednisolone (59%), cyclophosphamide (85%), methotrexate (6%), and plasmapheresis (25%) in addition to oral corticosteroids. During follow-up, 53% of patients experienced infection and 28% were hospitalized for infection (severe infection). Only 18% experienced neutropenia, but 72% and 36% presented moderate and severe lymphopenia for a total duration of