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Association Between Body Mass Index and Severe Infection in Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Retrospective Cohort in Japan
Yasuhiko Ito
Aichi Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9676-6961
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Background: Although previous studies have evaluated risk factors for the incidence of severe infection in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), the relationship between body mass index (BMI) and severe infection in AAV has not been elucidated. We hypothesized that elderly AAV patients with a low BMI would be at a higher risk of infection. To evaluate this hypothesis, we investigated the association between underweight at AAV diagnosis and subsequent severe infection in elderly AAV patients.
Methods: This single-center retrospective cohort study included 98 consecutive elderly AAV patients treated at the Aichi Medical University Hospital in Japan between 2004 and 2018. The relationships between BMI at diagnosis and subsequent first severe infection were assessed using multivariate Cox proportional hazards models.
Results: During the entire follow-up period (median, 22 months; interquartile range, 7‒52 months), 32 (32.7%) patients developed at least one severe infection. Low BMI (< 18.5 kg/m2 compared with normal BMI [18.5‒23.0 kg/m2], adjusted hazard ratio [HR] = 2.70, 95% confidence interval [CI]: 1.18–6.17; P = 0.018) and use of methylprednisolone pulse therapy (adjusted HR = 3.09, 95% CI: 1.37–6.99; P = 0.007) were the significant predictors of severe infection. Furthermore, an interaction effect between unintentional body weight loss (> 10%) within 6 months before diagnosis and low BMI was observed (P < 0.001).
Conclusions: Low BMI was associated with a higher risk of severe infection in elderly AAV patients, suggesting that careful management may be required to prevent the development of infection in patients with a low BMI. Further studies are needed to elucidate the optimal treatment strategy for these patients.
Keywords
Antibodies, Antineutrophil Cytoplasmic Antibody-Associated Vasculitis, Body Mass Index, Infection
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On 30 Sep, 2020
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This preprint is under consideration at BMC Geriatrics. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Association Between Body Mass Index and Severe Infection in Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Retrospective Cohort in Japan
Yasuhiko Ito
Aichi Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9676-6961
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 22 Sep, 2020
No community comments so far
Editorial decision: Major revision
On 10 Nov, 2020
Review #2 received
Received 02 Nov, 2020
Reviewer #2 agreed
On 26 Oct, 2020
Review #1 received
Received 24 Oct, 2020
Reviewer #1 agreed
On 30 Sep, 2020
Reviewers invited
Invitations sent on 29 Sep, 2020
Editor assigned
On 28 Sep, 2020
Submission checks complete
On 18 Sep, 2020
Editor invited
On 16 Sep, 2020
First submitted
On 14 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Geriatrics & Gerontology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Although previous studies have evaluated risk factors for the incidence of severe infection in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), the relationship between body mass index (BMI) and severe infection in AAV has not been elucidated. We hypothesized that elderly AAV patients with a low BMI would be at a higher risk of infection. To evaluate this hypothesis, we investigated the association between underweight at AAV diagnosis and subsequent severe infection in elderly AAV patients.
Methods: This single-center retrospective cohort study included 98 consecutive elderly AAV patients treated at the Aichi Medical University Hospital in Japan between 2004 and 2018. The relationships between BMI at diagnosis and subsequent first severe infection were assessed using multivariate Cox proportional hazards models.
Results: During the entire follow-up period (median, 22 months; interquartile range, 7‒52 months), 32 (32.7%) patients developed at least one severe infection. Low BMI (< 18.5 kg/m2 compared with normal BMI [18.5‒23.0 kg/m2], adjusted hazard ratio [HR] = 2.70, 95% confidence interval [CI]: 1.18–6.17; P = 0.018) and use of methylprednisolone pulse therapy (adjusted HR = 3.09, 95% CI: 1.37–6.99; P = 0.007) were the significant predictors of severe infection. Furthermore, an interaction effect between unintentional body weight loss (> 10%) within 6 months before diagnosis and low BMI was observed (P < 0.001).
Conclusions: Low BMI was associated with a higher risk of severe infection in elderly AAV patients, suggesting that careful management may be required to prevent the development of infection in patients with a low BMI. Further studies are needed to elucidate the optimal treatment strategy for these patients.
Figure 1
Figure 2