■利妥昔单抗(RTX)治疗后,自身免疫性肾病患者严重感染(SIs)的发生率差异很大。我们的研究旨在识别高危人群,特别是通过比较原发性肾病患者与全身性自身免疫性疾病(称为继发性肾病)的肾病患者之间SI风险的差异。
■这项回顾性队列研究调查了2017年至2022年在我们机构接受RTX治疗的免疫相关肾脏疾病成年患者中SI的发生情况。多变量COX回归模型用于分析肾病类型(原发性或继发性)与SIs之间的关联。倾向得分分析,亚组分析,和E值计算,以确保结果的可靠性。
■在123名患者中,32(26%)在RTX治疗后19.7±14.6个月的平均随访期内出现了39例SI,导致18.9/100患者年的发病率。多变量COX回归分析显示,继发性肾病患者发生SIs的风险明显高于原发性肾病患者(HR=5.86,95%CI:1.05~32.63,P=0.044)。即使在考虑了包括性别在内的混杂变量之后,年龄,BMI,以前的SI的历史,基线eGFR,淋巴细胞计数,IgG水平,以及其他免疫抑制疗法的应用。各种敏感性分析一致支持这些发现,E值为5.99。此外,高龄(HR:1.03;95%CI:1.01-1.06;P=0.023),低基线IgG水平(HR:0.75;95%CI:0.64-0.89;P<0.001),和最近的SIs病史(HR:5.68;95%CI:2.2-14.66;P<0.001)被确定为独立的危险因素。
■在自身免疫性肾病患者中RTX给药后SIs的发生率是显著的。至关重要的是,原发性和继发性肾病的亚组之间存在明显差异。继发性肾病患者,特别是那些老年人,基线IgG水平低,并且有最近的SI历史,更容易受到SI的影响。
UNASSIGNED: The incidence of severe infections (SIs) in patients with autoimmune nephropathy after rituximab (RTX) treatment varies significantly. Our study aims to identify high-risk populations, specifically by comparing the differences in the risk of SIs between patients with primary nephropathy and those with nephropathy in the context of systemic autoimmune diseases (referred to as secondary nephropathy).
UNASSIGNED: This retrospective cohort study investigated the occurrence of SIs in adult patients with immune-related kidney disease who received RTX treatment at our institution from 2017 to 2022. Multivariable COX regression models were used to analyze the association between the type of nephropathy (primary or secondary) and SIs. Propensity score analyses, subgroup analyses, and E-value calculations were performed to ensure the reliability of the results.
UNASSIGNED: Out of 123 patients, 32 (26%) developed 39 cases of SIs during a mean follow-up period of 19.7 ± 14.6 months post-RTX treatment, resulting in an incidence rate of 18.9/100 patient-years. The multivariable COX regression analysis indicated that patients with secondary nephropathy had a significantly higher risk of SIs compared to those with primary nephropathy (HR = 5.86, 95% CI: 1.05-32.63, P = 0.044), even after accounting for confounding variables including gender, age, BMI, history of prior SIs, baseline eGFR, lymphocyte counts, IgG levels, and the utilization of other immunosuppressive therapies. Various sensitivity analyses consistently supported these findings, with an E-value of 5.99. Furthermore, advanced age (HR: 1.03; 95% CI: 1.01-1.06; P = 0.023), low baseline IgG levels (HR: 0.75; 95% CI: 0.64-0.89; P < 0.001), and recent history of SIs (HR: 5.68; 95% CI: 2.2-14.66; P < 0.001) were identified as independent risk factors.
UNASSIGNED: The incidence of SIs following RTX administration in patients with autoimmune nephropathy is significant. It is crucial to note that there are distinct differences between the subgroups of primary and secondary nephropathy. Patients with secondary nephropathy, particularly those who are elderly, have low baseline IgG levels, and have a recent history of SI, are more susceptible to SIs.