Skip to main content
Erschienen in: Clinical Rheumatology 11/2022

02.08.2022 | Original Article

Predicting bacterial infection risk in patients with ANCA-associated vasculitis in southwest China: development of a new nomogram

verfasst von: Naidan Zhang, Jiaxiang Sun, Chaixia Ji, Xiao Bao, Chenliang Yuan

Erschienen in: Clinical Rheumatology | Ausgabe 11/2022

Einloggen, um Zugang zu erhalten

Abstract

Objectives

The aim of this study was to develop and assess a risk nomogram of bacterial infection in patients with ANCA-associated vasculitis (AAV) in southwest China.

Method

We established a prediction model based on a training dataset of 249 AAV patients. The least absolute shrinkage and selection operator (Lasso) was used to screen feature variables. Multivariate logistic regression analysis was used to build a prediction model for feature variables. Nomogram was used to predict the risk of bacterial infection in AAV patients. Receiver operating characteristic (ROC) curve was used to evaluate and verify the prediction accuracy of the model. Calibration and clinical useful range was assessed using calibration curve and decision curve analysis, respectively.

Results

Bactericidal permeability enhancement protein of ANCAs (BPI-ANCAs), procalcitonin (PCT), and white blood cell (WBC) were the characteristic variables in this study. Nomogram showed that positive BPI-ANCAs and PCT had higher positive predictive value for bacterial infection in AAV patients. The area under curve (AUC) of the model was 0.703 (95% confidence interval: 0.640–0.766). In the validation model, the AUC was 0.745 (95% confidence interval: 0.617–0.872). Decision curve analysis showed that the nonadherence nomogram was clinically useful within the threshold probability range of 0.31–0.85.

Conclusions

Nomogram combined with BPI-ANCAs and PCT has the guiding significance for predicting bacterial infection risk in AAV. As an ANCA-specific autoantibody, BPI-ANCAs is helpful for clinicians to understand the role of specific autoantibodies in the pathogenesis of AAV.
Key Points
BPI-ANCAs, PCT, and WBC could predict bacterial infection in AAV patients.
Nomogram showed that positive BPI-ANCAs had a high positive predictive value for bacterial infection in AAV patients.
Literatur
4.
8.
Zurück zum Zitat Sunderkotter CH, Zelger B, Chen KR, Requena L, Piette W, Carlson JA, Dutz J, Lamprecht P, Mahr A, Aberer E, Werth VP, Wetter DA, Kawana S, Luqmani R, Frances C, Jorizzo J, Watts JR, Metze D, Caproni M, Alpsoy E, Callen JP, Fiorentino D, Merkel PA, Falk RJ, Jennette JC (2018) Nomenclature of cutaneous vasculitis: dermatologic addendum to the 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheumatol 70(2):171–184. https://doi.org/10.1002/art.40375CrossRefPubMed Sunderkotter CH, Zelger B, Chen KR, Requena L, Piette W, Carlson JA, Dutz J, Lamprecht P, Mahr A, Aberer E, Werth VP, Wetter DA, Kawana S, Luqmani R, Frances C, Jorizzo J, Watts JR, Metze D, Caproni M, Alpsoy E, Callen JP, Fiorentino D, Merkel PA, Falk RJ, Jennette JC (2018) Nomenclature of cutaneous vasculitis: dermatologic addendum to the 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheumatol 70(2):171–184. https://​doi.​org/​10.​1002/​art.​40375CrossRefPubMed
9.
Zurück zum Zitat Walsh M, Merkel PA, Peh CA, Szpirt WM, Puechal X, Fujimoto S, Hawley CM, Khalidi N, Flossmann O, Wald R, Girard LP, Levin A, Gregorini G, Harper L, Clark WF, Pagnoux C, Specks U, Smyth L, Tesar V, Ito-Ihara T, de Zoysa JR, Szczeklik W, Flores-Suarez LF, Carette S, Guillevin L, Pusey CD, Casian AL, Brezina B, Mazzetti A, McAlear CA, Broadhurst E, Reidlinger D, Mehta S, Ives N, Jayne DRW, Investigators P (2020) Plasma exchange and glucocorticoids in severe ANCA-associated vasculitis. N Engl J Med 382(7):622–631. https://doi.org/10.1056/NEJMoa1803537CrossRefPubMedPubMedCentral Walsh M, Merkel PA, Peh CA, Szpirt WM, Puechal X, Fujimoto S, Hawley CM, Khalidi N, Flossmann O, Wald R, Girard LP, Levin A, Gregorini G, Harper L, Clark WF, Pagnoux C, Specks U, Smyth L, Tesar V, Ito-Ihara T, de Zoysa JR, Szczeklik W, Flores-Suarez LF, Carette S, Guillevin L, Pusey CD, Casian AL, Brezina B, Mazzetti A, McAlear CA, Broadhurst E, Reidlinger D, Mehta S, Ives N, Jayne DRW, Investigators P (2020) Plasma exchange and glucocorticoids in severe ANCA-associated vasculitis. N Engl J Med 382(7):622–631. https://​doi.​org/​10.​1056/​NEJMoa1803537CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat El Sharouni MA, Ahmed T, Varey AHR, Elias SG, Witkamp AJ, Sigurdsson V, Suijkerbuijk KPM, van Diest PJ, Scolyer RA, van Gils CH, Thompson JF, Blokx WAM, Lo SN (2021) Development and validation of nomograms to predict local, regional, and distant recurrence in patients with thin (T1) melanomas. J Clin Oncol 39(11):1243–1252. https://doi.org/10.1200/JCO.20.02446CrossRefPubMed El Sharouni MA, Ahmed T, Varey AHR, Elias SG, Witkamp AJ, Sigurdsson V, Suijkerbuijk KPM, van Diest PJ, Scolyer RA, van Gils CH, Thompson JF, Blokx WAM, Lo SN (2021) Development and validation of nomograms to predict local, regional, and distant recurrence in patients with thin (T1) melanomas. J Clin Oncol 39(11):1243–1252. https://​doi.​org/​10.​1200/​JCO.​20.​02446CrossRefPubMed
11.
Zurück zum Zitat Gafita A, Calais J, Grogan TR, Hadaschik B, Wang H, Weber M, Sandhu S, Kratochwil C, Esfandiari R, Tauber R, Zeldin A, Rathke H, Armstrong WR, Robertson A, Thin P, D’Alessandria C, Rettig MB, Delpassand ES, Haberkorn U, Elashoff D, Herrmann K, Czernin J, Hofman MS, Fendler WP, Eiber M (2021) Nomograms to predict outcomes after (177)Lu-PSMA therapy in men with metastatic castration-resistant prostate cancer: an international, multicentre, retrospective study. Lancet Oncol 22(8):1115–1125. https://doi.org/10.1016/S1470-2045(21)00274-6CrossRefPubMed Gafita A, Calais J, Grogan TR, Hadaschik B, Wang H, Weber M, Sandhu S, Kratochwil C, Esfandiari R, Tauber R, Zeldin A, Rathke H, Armstrong WR, Robertson A, Thin P, D’Alessandria C, Rettig MB, Delpassand ES, Haberkorn U, Elashoff D, Herrmann K, Czernin J, Hofman MS, Fendler WP, Eiber M (2021) Nomograms to predict outcomes after (177)Lu-PSMA therapy in men with metastatic castration-resistant prostate cancer: an international, multicentre, retrospective study. Lancet Oncol 22(8):1115–1125. https://​doi.​org/​10.​1016/​S1470-2045(21)00274-6CrossRefPubMed
14.
Zurück zum Zitat Sarica SH, Dhaun N, Sznajd J, Harvie J, McLaren J, McGeoch L, Kumar V, Amft N, Erwig L, Marks A, Black C, Basu N (2020) Characterizing infection in anti-neutrophil cytoplasmic antibody-associated vasculitis: results from a longitudinal, matched-cohort data linkage study. Rheumatology (Oxford) 59(10):3014–3022. https://doi.org/10.1093/rheumatology/keaa070CrossRef Sarica SH, Dhaun N, Sznajd J, Harvie J, McLaren J, McGeoch L, Kumar V, Amft N, Erwig L, Marks A, Black C, Basu N (2020) Characterizing infection in anti-neutrophil cytoplasmic antibody-associated vasculitis: results from a longitudinal, matched-cohort data linkage study. Rheumatology (Oxford) 59(10):3014–3022. https://​doi.​org/​10.​1093/​rheumatology/​keaa070CrossRef
15.
Zurück zum Zitat Houben E, Bax WA, van Dam B, Slieker WAT, Verhave G, Frerichs FCP, van Eijk IC, Boersma WG, de Kuyper GTM, Penne EL (2016) Diagnosing ANCA-associated vasculitis in ANCA positive patients: a retrospective analysis on the role of clinical symptoms and the ANCA titre. Medicine (Baltimore) 95(40):e5096. https://doi.org/10.1097/MD.0000000000005096CrossRef Houben E, Bax WA, van Dam B, Slieker WAT, Verhave G, Frerichs FCP, van Eijk IC, Boersma WG, de Kuyper GTM, Penne EL (2016) Diagnosing ANCA-associated vasculitis in ANCA positive patients: a retrospective analysis on the role of clinical symptoms and the ANCA titre. Medicine (Baltimore) 95(40):e5096. https://​doi.​org/​10.​1097/​MD.​0000000000005096​CrossRef
24.
Zurück zum Zitat Schultz H, Schinke S, Mosler K, Herlyn K, Schuster A, Gross WL (2004) BPI-ANCA of pediatric cystic fibrosis patients can impair BPI-mediated killing of E. coli DH5alpha in vitro. Pediatr Pulmonol 37(2):158–164 https://doi.org/10.1002/ppul.10416 Schultz H, Schinke S, Mosler K, Herlyn K, Schuster A, Gross WL (2004) BPI-ANCA of pediatric cystic fibrosis patients can impair BPI-mediated killing of E. coli DH5alpha in vitro. Pediatr Pulmonol 37(2):158–164 https://​doi.​org/​10.​1002/​ppul.​10416
25.
Zurück zum Zitat Schultz H, Csernok E, Schuster A, Schmitz TS, Ernst M, Gross WL (2000) Anti-neutrophil cytoplasmic antibodies directed against the bactericidal/permeability-increasing protein (BPI) in pediatric cystic fibrosis patients do not recognize N-terminal regions important for the anti-microbial and lipopolysaccharide-binding activity of BPI. Pediatr Allergy Immunol 11(2):64–70. https://doi.org/10.1034/j.1399-3038.2000.00069.xCrossRefPubMed Schultz H, Csernok E, Schuster A, Schmitz TS, Ernst M, Gross WL (2000) Anti-neutrophil cytoplasmic antibodies directed against the bactericidal/permeability-increasing protein (BPI) in pediatric cystic fibrosis patients do not recognize N-terminal regions important for the anti-microbial and lipopolysaccharide-binding activity of BPI. Pediatr Allergy Immunol 11(2):64–70. https://​doi.​org/​10.​1034/​j.​1399-3038.​2000.​00069.​xCrossRefPubMed
28.
Zurück zum Zitat Papp M, Sipeki N, Vitalis Z, Tornai T, Altorjay I, Tornai I, Udvardy M, Fechner K, Jacobsen S, Teegen B, Sumegi A, Veres G, Lakatos PL, Kappelmayer J, Antal-Szalmas P (2013) High prevalence of IgA class anti-neutrophil cytoplasmic antibodies (ANCA) is associated with increased risk of bacterial infection in patients with cirrhosis. J Hepatol 59(3):457–466. https://doi.org/10.1016/j.jhep.2013.04.018CrossRefPubMed Papp M, Sipeki N, Vitalis Z, Tornai T, Altorjay I, Tornai I, Udvardy M, Fechner K, Jacobsen S, Teegen B, Sumegi A, Veres G, Lakatos PL, Kappelmayer J, Antal-Szalmas P (2013) High prevalence of IgA class anti-neutrophil cytoplasmic antibodies (ANCA) is associated with increased risk of bacterial infection in patients with cirrhosis. J Hepatol 59(3):457–466. https://​doi.​org/​10.​1016/​j.​jhep.​2013.​04.​018CrossRefPubMed
29.
Zurück zum Zitat Zycinska K, Wardyn KA, Zielonka TM, Tyszko P, Straburzynski M (2008) Procalcitonin as an indicator of systemic response to infection in active pulmonary Wegener’s granulomacytosis. J Physiol Pharmacol 59(Suppl 6):839–844PubMed Zycinska K, Wardyn KA, Zielonka TM, Tyszko P, Straburzynski M (2008) Procalcitonin as an indicator of systemic response to infection in active pulmonary Wegener’s granulomacytosis. J Physiol Pharmacol 59(Suppl 6):839–844PubMed
32.
35.
Zurück zum Zitat Eberhard OK, Haubitz M, Brunkhorst FM, Kliem V, Koch KM, Brunkhorst R (1997) Usefulness of procalcitonin for differentiation between activity of systemic autoimmune disease (systemic lupus erythematosus/systemic antineutrophil cytoplasmic antibody-associated vasculitis) and invasive bacterial infection. Arthritis Rheum 40(7):1250–1256. https://doi.org/10.1002/1529-0131CrossRefPubMed Eberhard OK, Haubitz M, Brunkhorst FM, Kliem V, Koch KM, Brunkhorst R (1997) Usefulness of procalcitonin for differentiation between activity of systemic autoimmune disease (systemic lupus erythematosus/systemic antineutrophil cytoplasmic antibody-associated vasculitis) and invasive bacterial infection. Arthritis Rheum 40(7):1250–1256. https://​doi.​org/​10.​1002/​1529-0131CrossRefPubMed
43.
Zurück zum Zitat Fukuda M, Motokawa M, Usami T, Oikawa T, Morozumi K, Yoshida A, Kimura G (2006) PR3-ANCA-positive crescentic necrotizing glomerulonephritis accompanied by isolated pulmonic valve infective endocarditis, with reference to previous reports of renal pathology. Clin Nephrol 66(3):202–209. https://doi.org/10.5414/cnp66202CrossRefPubMed Fukuda M, Motokawa M, Usami T, Oikawa T, Morozumi K, Yoshida A, Kimura G (2006) PR3-ANCA-positive crescentic necrotizing glomerulonephritis accompanied by isolated pulmonic valve infective endocarditis, with reference to previous reports of renal pathology. Clin Nephrol 66(3):202–209. https://​doi.​org/​10.​5414/​cnp66202CrossRefPubMed
Metadaten
Titel
Predicting bacterial infection risk in patients with ANCA-associated vasculitis in southwest China: development of a new nomogram
verfasst von
Naidan Zhang
Jiaxiang Sun
Chaixia Ji
Xiao Bao
Chenliang Yuan
Publikationsdatum
02.08.2022
Verlag
Springer International Publishing
Erschienen in
Clinical Rheumatology / Ausgabe 11/2022
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-022-06314-9

Weitere Artikel der Ausgabe 11/2022

Clinical Rheumatology 11/2022 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren. 

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Die „Zehn Gebote“ des Endokarditis-Managements

30.04.2024 Endokarditis Leitlinie kompakt

Worauf kommt es beim Management von Personen mit infektiöser Endokarditis an? Eine Kardiologin und ein Kardiologe fassen die zehn wichtigsten Punkte der neuen ESC-Leitlinie zusammen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.