Session Title: 4M090: Infection-Related Rheumatic Disease (1800–1805)
Session Type: ACR Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: The biologics therapies in rheumatoid arthritis (RA) implies a well-known risk of infection. It is of utterly importance to count with predictive models to define risk factors for infection. Objectives: Validate the RABBIT risk score for serious infections in a cohort of RA patients followed for 12 months. Evaluate which variables of our population could be of relevance to optimize the score.
Methods: Patients ≥18 years old fulfilling 2010 ACR/EULAR criteria for RA were included and followed for 12 months. Basal sociodemographic data, comorbidities, RA characteristics and vaccination was consigned . Basal RABBIT score was calculed. Serious infections were consigned, describing site and time since enrollment. Statistical analysis: Categorical variables were compared using x2 test and continual variables using Student´s t test or Mann Whitney. Cumulative survival of infection was assessed using Kaplan Meier curves. Variables associated serious infections were evaluated using Cox proportional regression model.
Results: 605 patients were included. 83.5% female, mean age 52.8±12.8 years, 96.2% urban residence, 83% GRAFFAR III/IV (middle, middle-low class), median years of formal studies 10 (IQR 7-13) years. 70% had health insurance. Median time of RA evolution 84 (36-168) months, 90% RF+, 80% ACPA+, median DAS-28 3.5 (2.4-4.8), median CDAI 10 (3-19) and median HAQ 0.87 (0.37-1.50). Comorbidities: 7% Previous infection, 10% lung disease, 1% chronic kidney disease, 6% diabetes. Vaccination status: 67% antiinfluenza, 66.5% antipneumococcal, 47% antiHBV. Treatment: 75% patients were on MTX. 60% were on csDMARDs alone and 40% on bDMARDs (60% TNFi, 20% Tocilizumab, 13% Abatacept, 7% Tofacitinib). 15.6% had a prior history of bDMARDs use. Mean dose of prednisone was 3.6 mg/day and 75% of patients received under 7.5 mg/day. Incidence of serious infection was 5% (CI95% 3-7). Most frequent sites were respiratory and urinary (90%). Mean time to serious infection was 3.5 mont. Variables associated with serious infection: High disease activity by CDAI 4.1 (1.8-9.5) and DAS-28 3.2 (1.3-7.3), previous serious infection 19.3 (8-47), pulmonary disease 5.2 (2.1-13), diabetes 6.4 (2.3-17.6), prednisone >20mg/day 14.3 (4.8-42.5), Tocilizumab treatment 12.4 (3-53) and current use of DMARDs 0.24 (0.1-0.6). Cox regresión model (serious infection): Previous serious infection (expB:10.6 p:0.00001), diabetes (expB:4.8 p:0.02), Tocilizumab treatment (expB: 11.4 p:0.012), high dose of corticoids (expB: 9.3 p:0.008) and current use of DMARDs (expB: 0.3 p:0.04) were independently associated. Performance of RABBIT score: Patients with no infection during follow up had a median score of 1.2 (IQR 0.8-2.1) and patients with infection a median score of 5.1 (IQR 2.15-12.6)(p=0.00001). ROC curve analysis: AUC 0.86 (CI95% 0.8-0.94), best cut-off 2.85 (sensibility 75%, specificity 85%).
Conclusion: The RABBIT score performed excellently in our patients. Serious infections was 5% during the 12 months, mean time to serious infection was 3.5 months and it was independently associated with previous serious infection, diabetes, use of Tocilizumab, prednisone dose >20 mg/day and negatively with current use of DMARDs.
To cite this abstract in AMA style:Garcia Salinas R, Lazaro M, Scarafia S, Cusa A, Capozzi N, Casalla L, Zarate L, de la Vega M, Correa M, Casado G, Papasidero S, Rillo O, Muñoz N, Benegas M, Kirmayr K, Girard Bosch M, Martire M, Gomez R. Performance of the RABBIT Infection Score in a Prospective Multicenter Cohort of Rheumatoid Arthritis Patients from Argentina [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/performance-of-the-rabbit-infection-score-in-a-prospective-multicenter-cohort-of-rheumatoid-arthritis-patients-from-argentina/. Accessed January 19, 2022.
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