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Abstract: TH-PO604

Burden of Infection-Related Hospitalization and the Impact of Multidisciplinary Care in ANCA-Associated Vasculitis: A Retrospective Cohort

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Yeung, Emily K., Monash Health, Clayton, Victoria, Australia
  • Kitching, A. Richard, Monash Health, Clayton, Victoria, Australia
  • Gingold, Michael, Monash Health, Clayton, Victoria, Australia
  • Polkinghorne, Kevan, Monash Health, Clayton, Victoria, Australia
  • Ryan, Jessica, Monash Health, Clayton, Victoria, Australia
Background

ANCA associated vasculitis (AAV) is managed with combination immunosuppression. Infections are the most common cause of excess morbidity and mortality. 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 in Melbourne, Australia between January 1, 2000 and February 28, 2018, excluding children and those with EGPA. Hospitalization rate was calculated as number of hospitalized patients out of those at risk excluding day admissions. Survival analysis was performed, with subjects entering analysis at diagnosis.

Results

Of 165 patients, 22 were hospitalized for infection within the first 12 months of AAV diagnosis with a hospitalization rate of 15 per 100 person-years. Median length of stay was 9.4 days. Hospitalization rate for infection did not change with vasculitis clinic establishment in 2014 (18 per 100 person-years pre vs. 8 per 100 person-years post, p=0.10). After infection, kidney disease (excluding routine dialysis), cardiovascular disease, and disease relapse accounted for the greatest burden of hospital days. Hospitalization rate for any cause reduced from 70 per 100 person-years before clinic establishment to 51 per 100 person-years after (p=0.02). Those with MPA were at comparable risk of death to those with GPA (HR 1.22, 95% CI 0.53-2.80). Where known, the most common cause of death was infection, followed by kidney failure (dialysis non-commencement for medical or social reasons), and malignancy within the first 12 months of AAV diagnosis.

Conclusion

Establishment of a multidisciplinary vasculitis clinic was associated with a significant reduction in hospitalization rate for any cause, with a trend toward a reduction in hospitalization rate for infection. Infection was the most common cause of death.