Predictors of serious infections in rheumatoid arthritis-a prospective Brazilian cohort.

IF 2 4区 医学 Q3 RHEUMATOLOGY Advances in Rheumatology Pub Date : 2024-03-29 DOI:10.1186/s42358-024-00363-1
Ana Luisa Bagno de Almeida, Maria Fernanda B Resende Guimarães, Maria Raquel da Costa Pinto, Leticia Rocha Pereira, Ana Paula Monteiro Gomides Reis, Karina Rossi Bonfiglioli, Paulo Louzada-Junior, Rina Dalva Neubarth Giorgi, Gláucio Ricardo Werner de Castro, Sebastião Cezar Radominski, Claiton Viegas Brenol, Alisson Pugliesi, Licia Maria Henrique da Mota, Geraldo da Rocha Castelar-Pinheiro
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Abstract

Background: Infections increase mortality and morbidity and often limit immunosuppressive treatment in rheumatoid arthritis patients.

Objective: To analyze the occurrence of serious infections and the associated factors in a cohort of rheumatoid arthritis patients under real-life conditions.

Methods: We analyzed data from the REAL, a prospective observational study, that evaluated Brazilian RA patients, with clinical and laboratory data collected over a year. Univariate and multivariate analyses were performed from the adjustment of the logistic regression model Generalized Estimating Equations (GEE), with the primary outcome being the occurrence of serious infection, defined as need for hospitalization or use of intravenous antibiotics for its treatment.

Results: 841 patients were included with an average follow-up time of 11.2 months (SD 2.4). Eighty-nine serious infections occurred, corresponding to 13 infections per 100 patient-years. Pulmonary fibrosis, chronic kidney disease (CKD) and central nervous system disease increased the chances of serious infection by 3.2 times (95% CI: 1.5-6.9), 3.6 times (95% CI: 1.2-10.4) and 2.4 times (95% CI: 1.2-5.0), respectively. The use of corticosteroids in moderate doses increased the chances by 5.4 times (95% CI: 2.3-12.4), and for each increase of 1 unit in the health assessment questionnaire (HAQ), the chance increased 60% (95% CI: 20-120%).

Conclusion: The use of corticosteroids at moderate doses increased the risk of serious infection in RA patients. Reduced functionality assessed by the HAQ and comorbidities were other important factors associated with serious infection in this cohort.

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类风湿性关节炎严重感染的预测因素--巴西前瞻性队列。
背景:感染会增加类风湿性关节炎患者的死亡率和发病率,并常常限制免疫抑制治疗:感染会增加类风湿性关节炎患者的死亡率和发病率,并常常限制免疫抑制治疗:分析类风湿性关节炎患者在实际生活条件下发生严重感染的情况及相关因素:我们分析了前瞻性观察研究 "REAL "的数据,该研究对巴西的类风湿关节炎患者进行了评估,收集了一年的临床和实验室数据。根据逻辑回归模型广义估计方程(GEE)的调整结果进行了单变量和多变量分析,主要结果是发生严重感染,即需要住院治疗或使用静脉注射抗生素进行治疗:共纳入 841 名患者,平均随访时间为 11.2 个月(SD 2.4)。共发生 89 例严重感染,相当于每 100 例患者年发生 13 例感染。肺纤维化、慢性肾病(CKD)和中枢神经系统疾病分别使严重感染的几率增加了 3.2 倍(95% CI:1.5-6.9)、3.6 倍(95% CI:1.2-10.4)和 2.4 倍(95% CI:1.2-5.0)。使用中等剂量皮质类固醇的几率增加了 5.4 倍(95% CI:2.3-12.4),健康评估问卷(HAQ)每增加 1 个单位,几率增加 60%(95% CI:20-120%):结论:适量使用皮质类固醇会增加 RA 患者发生严重感染的风险。结论:使用中等剂量的皮质类固醇会增加RA患者发生严重感染的风险,HAQ评估的功能减退和合并症是与该组严重感染相关的其他重要因素。
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来源期刊
Advances in Rheumatology
Advances in Rheumatology Medicine-Rheumatology
CiteScore
4.00
自引率
4.30%
发文量
41
审稿时长
53 weeks
期刊介绍: Formerly named Revista Brasileira de Reumatologia, the journal is celebrating its 60th year of publication. Advances in Rheumatology is an international, open access journal publishing pre-clinical, translational and clinical studies on all aspects of paediatric and adult rheumatic diseases, including degenerative, inflammatory and autoimmune conditions. The journal is the official publication of the Brazilian Society of Rheumatology and welcomes original research (including systematic reviews and meta-analyses), literature reviews, guidelines and letters arising from published material.
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