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Abstract: TH-PO584

Corticosteroid Dose and Risk of Infection in Children and Adults with Glomerular Disease: An Analysis of the CureGN Study

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Glenn, Dorey A., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Andrews, Calvin, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Zee, Jarcy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Mansfield, Sarah, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • O'Shaughnessy, Michelle M., Galway University Hospitals, Galway, Galway, Ireland
  • Bomback, Andrew S., Columbia University, New York, New York, United States
  • Gibson, Keisha L., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Greenbaum, Larry A., Children's Healthcare of Atlanta Inc, Atlanta, Georgia, United States
  • Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States
  • Falk, Ronald, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Hogan, Susan L., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Mottl, Amy K., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Group or Team Name

  • On Behalf of the CureGN Consortium.
Background

Corticosteroid (CS) exposure is associated with risk of infection leading to increased morbidity and mortality in patients with glomerular disease (GD). We describe longitudinal CS exposure and measure its association with risk of infection in the Cure Glomerulonephropathy (CureGN) study.

Methods

CureGN is a prospective cohort study of patients with biopsy-proven primary GD. CS dose and duration were abstracted from participant medical records at interval study visits and harmonized to prednisone (oral) and methylprednisolone (IV) dose equivalents. Marginal structural models (MSM) were used to estimate effects of CS dose (see Figure), with or without other IS exposure, on hazards of first infection-related hospitalization or ED visit, adjusting for baseline age, race, sex, ethnicity, GD subtype, comorbid conditions, and time-varying markers of disease activity [eGFR, UPCR, and serum albumin].

Results

Of 2568 participants (43% female, 35% <18 years), 446 (17%) experienced a first infection over a median follow-up of 58 months (IQR 32-77). Children and adults were exposed to CS for 14% and 9% of their follow-up time, respectively. Median daily exposure to oral and intravenous CS was 13 mg (IQR 5-32) and 65 mg (IQR 40-500) in children and 10 mg (IQR 5-22) and 125 mg (IQR 125-125) in adults. In a multivariable MSM model, low, medium, and high dose CS exposure was associated with 1.22 (95% CI 0.53-2.84), 3.06 (95% CI 1.84-5.10), and 3.03 (95% CI 1.64-5.59) times higher hazards of infection without concurrent IS, and 2.30 (95% CI 1.40-3.77), 2.71 (95% CI 1.75-4.21), and 3.66 (95% CI 2.35-5.71) times higher hazards of infection with concurrent IS, compared to no IS exposure.

Conclusion

Medium and high dose CS independently increase risk of infection when used alone. When used in combination with other IS, all doses of CS increase risk of infection. These results can inform clinical care and highlight the importance of CS sparing medication regimens for patients with GD.

Funding

  • NIDDK Support