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Severe Infection in Anti-Glomerular Basement Membrane Disease: A Retrospective Multicenter French Study

Pauline Caillard 1 Cécile Vigneau 2, 3 Jean-Michel Halimi 4 Marc Hazzan 5 Eric Thervet 6 Morgane Heitz 7 Laurent Juillard 8 Vincent Audard 9, 10 Marion Rabant Alexandre Hertig Jean-François Subra 11 Vincent Vuiblet 12 Dominique Guerrot 13, 14 Mathilde Tamain 15 Marie Essig 16 Thierry Lobbedez 17 Thomas Quémeneur Jean-Michel Rebibou 18 Alexandre Ganea Marie-Noelle Peraldi Francois Vrtovsnik 19 Maite Daroux Adnane Lamrani 1 Raifah Makdassi 1 Gabriel Choukroun 1 Dimitri Titeca-Beauport 1, *
Abstract : In patients presenting with anti-glomerular basement membrane (GBM) disease with advanced isolated kidney involvement, the benefit of intensive therapy remains controversial due to adverse events, particularly infection. We aim to describe the burden of severe infections (SI) (requiring hospitalization or intravenous antibiotics) and identify predictive factors of SI in a large cohort of patients with anti-GBM disease. Among the 201 patients (median [IQR] age, 53 [30-71] years) included, 74 had pulmonary involvement and 127 isolated glomerulonephritis. A total of 161 SI occurred in 116 patients during the first year after diagnosis. These infections occurred during the early stage of care (median [IQR] time, 13 [8-19] days after diagnosis) with mainly pulmonary (45%), catheter-associated bacteremia (22%) and urinary tract (21%) infections. In multivariable analysis, positive ANCA (HR [95% CI] 1.62 [1.07-2.44]; p = 0.02) and age at diagnosis (HR [95% CI] 1.10 [1.00-1.21]; p = 0.047) remained independently associated with SI. Age-adjusted severe infection during the first three months was associated with an increased three-year mortality rate (HR [95% CI] 3.13 [1.24-7.88]; p = 0.01). Thus, SI is a common early complication in anti-GBM disease, particularly in the elderly and those with positive anti-neutrophil cytoplasmic antibodies (ANCA). No significant association was observed between immunosuppressive strategy and occurrence of SI.
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Pauline Caillard, Cécile Vigneau, Jean-Michel Halimi, Marc Hazzan, Eric Thervet, et al.. Severe Infection in Anti-Glomerular Basement Membrane Disease: A Retrospective Multicenter French Study. Journal of Clinical Medicine, MDPI, 2020, 9 (3), pp.698. ⟨10.3390/jcm9030698⟩. ⟨hal-02796989⟩

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