背景:严重感染是自身免疫性疾病患者的重要关注点。我们试图估计与台湾和美国的普通人群相比,某些自身免疫性疾病患者的严重感染率。
方法:这项回顾性队列研究估计了系统性红斑狼疮患者中特定的标准化严重感染发生率和比率,包括肾外狼疮和狼疮性肾炎,类风湿性关节炎和原发性膜性肾病,与2000年至2013年间使用保险索赔住院的普通人群相比。多变量Cox比例风险模型用于估计严重感染的调整后风险比,调整年龄,性别,指数年,之前的严重感染,合并症和药物。
结果:在台湾,在普通人群和原发性膜性肾病患者队列中,严重感染率为22.7、28.7、70.6、43.4和215.3/1000人年,类风湿性关节炎,肾外狼疮和狼疮性肾炎,分别。在美国,在普通人群和原发性膜性肾病患者队列中,严重感染率为2.6、9.0、15.6、21.0和63.3/1000人年,类风湿性关节炎,肾外狼疮和狼疮性肾炎,分别。在这两种情况下,患者的严重感染率明显高于普通人群,主要由细菌驱动,呼吸,尿路感染和机会性感染。与普通人群相比,狼疮性肾炎患者的严重感染负担最高,在台湾和美国,调整后的危险比高出7到25倍,分别。
结论:这项研究发现,与台湾和美国的普通人群相比,患有靶向自身免疫疾病的患者的严重感染负担明显过高。
BACKGROUND: Serious infections are an important concern for patients with autoimmune conditions. We sought to estimate serious infection rates among patients with select autoimmune conditions relative to the general population in Taiwan and the USA.
METHODS: This retrospective cohort
study estimated setting-specific standardized serious infection incidence rates and ratios among patients with systemic lupus erythematosus, including extra-renal lupus and lupus nephritis, rheumatoid arthritis and primary membranous nephropathy, compared with the general population using insurance claims for hospitalizations between 2000 and 2013. Multivariable Cox proportional hazard models were used to estimate adjusted hazard ratios for serious infections, adjusting for age, sex, index year, prior serious infection, comorbidities and medications.
RESULTS: In Taiwan, serious infection rates were 22.7, 28.7, 70.6, 43.4 and 215.3 per 1000 person-years among the general population and among cohorts of patients with primary membranous nephropathy, rheumatoid arthritis, extra-renal lupus and lupus nephritis, respectively. In the USA, serious infection rates were 2.6, 9.0, 15.6, 21.0 and 63.3 per 1000 person-years among the general population and among cohorts of patients with primary membranous nephropathy, rheumatoid arthritis, extra-renal lupus and lupus nephritis, respectively. Patients had significantly higher serious infection rates than the general population in both settings, largely driven by bacterial, respiratory, urinary tract and opportunistic infections. Patients with lupus nephritis had the highest burden of serious infections relative to the general population, with 7- to 25-fold higher adjusted hazard ratios in Taiwan and the USA, respectively.
CONCLUSIONS: This
study identified a significant excess serious infection burden among patients with targeted autoimmune conditions compared with the general populations in Taiwan and the USA.