Emily Yeung1, Dennison Cheung1, A Richard Kitching1,2,3, Michael Gingold4, Jessica Ryan1,5
1Department of Nephrology, Monash Health, Clayton, Australia, 2Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre,, Clayton, Australia, 3Department of Paediatric Nephrology, Monash Health, Clayton, Australia, 4Department of Rheumatology, Monash Health, Clayton, Australia, 5Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Australia
Aim
To determine the burden of infection-related hospitalisations in patients with antineutrophil cytoplasm antibody associated vasculitis (AAV) in an Australian setting.
Background
AAV is managed with combination immunosuppressive therapies. Infection has been the most common cause of excess mortality. Dedicated multidisciplinary clinics have improved outcomes in several chronic diseases but have not been evaluated in AAV.
Methods
A retrospective cohort study was performed of patients diagnosed with AAV at Monash Health between January 1, 2000 and February 28, 2018, excluding children and those with eosinophilic granulomatosis with polyangiitis. Hospitalisation risk was calculated as number of hospitalised patients out of those at risk excluding day admissions. Survival analysis was performed, with subjects entering analysis at AAV diagnosis.
Results
Of 171 patients, 30 were admitted to hospital (33 episodes) due to infection within the first 12 months of AAV diagnosis accounting for 515.1 hospital days. Hospitalisation risk before and after establishment of vasculitis clinic in March 2014 did not change (21/120 [24 episodes] vs. 9/51 [9 episodes], p=0.50), but average length of stay reduced from 16.8 days to 12.5 days. After infection, kidney disease (excluding routine dialysis), cardiovascular complications, and thrombotic or bleeding events accounted for the greatest burden of hospital days. There were 46 deaths overall, most commonly due to infection, cardiovascular disease, and malignancy where cause of death was known, with no significant survival difference between those with microscopic polyangiitis or granulomatosis with polyangiitis. Of those who died, 45 had renal involvement of AAV.
Conclusions
Infection-related hospitalisation is a significant burden for patients with AAV. Establishment of a multidisciplinary vasculitis clinic was associated with reduced length of stay for infection-related hospitalisations in this cohort.
Biography:
Emily is a first year renal advanced trainee at Monash Health with an interest in global health and public and preventative health. She completed her MBBS at Monash University in 2018.