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, 20) , Dimitri Titeca-Beauport (1)

1 CHU Amiens-Picardie
2 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
3 Irset - Institut de recherche en santé, environnement et travail
4 CHU Trousseau [Tours]
5 INFINITE (Ex-Liric) - Institute for Translational Research in Inflammation - U 1286
6 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
7 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
8 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
9 CHU Henri Mondor [Créteil]
10 IMRB - Institut Mondor de Recherche Biomédicale
11 CRCINA-ÉQUIPE 7 - Innate Immunity and Immunotherapy
12 Hôpital universitaire Robert Debré [Reims]
13 CHU Rouen
14 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
15 CHU Clermont-Ferrand
16 Service de Néphrologie, Dialyse, Transplantations [CHU Limoges]
17 Service de Néphrologie-Dialyse-Transplantation rénale [CHU Caen]
18 Service de néphrologie (CHU de Dijon)
19 EMily (UMR_S_1160 / U1160) - Ecotaxie, microenvironnement et développement lymphocytaire
20 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517

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.

Mots clés: anti-GBM disease; ANCA; infection; age; survival

Domaines: Sciences du Vivant [q-bio]

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, 2020, 9 (3), pp.698. ⟨10.3390/jcm9030698⟩. ⟨hal-02796989⟩