Pneumocystis jirovecii pneumonia in autoimmune rheumatic diseases: a nationwide population-based study

被引：40

作者：

Hsu, Hui-Ching ^{[1
,2
]}

Chang, Yu-Sheng ^{[2
,3
]}

Hou, Tsung-Yun ^{[1
,2
,4
]}

Chen, Lung-Fang ^{[1
]}

Hu, Li-Fang ^{[5
]}

Lin, Tzu-Min ^{[2
,5
]}

Chiou, Chi-Sheng ^{[5
]}

Tsai, Kai-Len ^{[3
]}

Lin, Sheng-Hong ^{[2
,3
]}

Kuo, Pei-, I ^{[5
,6
]}

Chen, Wei-Sheng ^{[7
]}

Lin, Yi-Chun ^{[8
]}

Chen, Jin-Hua ^{[8
,9
]}

Chang, Chi-Ching ^{[2
,5
]}

机构：

[1] Taipei Med Univ, Div Allergy Immunol & Rheumatol, Dept Internal Med, Wan Fang Hosp, Taipei, Taiwan

[2] Taipei Med Univ, Sch Med, Div Allergy Immunol & Rheumatol, Dept Internal Med,Coll Med, Taipei, Taiwan

[3] Taipei Med Univ, Div Allergy Immunol & Rheumatol, Dept Internal Med, Shuang Ho Hosp, New Taipei, Taiwan

[4] Triserv Gen Hosp, Dept Internal Med, Div Rheumatol Immunol & Allergy, Natl Def Med Ctr, Taipei, Taiwan

[5] Taipei Med Univ Hosp, Dept Internal Med, Div Rheumatol Immunol & Allergy, Taipei, Taiwan

[6] Cardinal Tien Hosp, Dept Internal Med, Div Rheumatol Immunol & Allergy, Yonghe Branch, New Taipei, Taiwan

[7] Natl Yang Ming Univ, Taipei Vet Gen Hosp, Dept Internal Med, Div Allergy Immunol & Rheumatol, Taipei, Taiwan

[8] Taipei Med Univ, Biostat Ctr, Coll Management, Taipei, Taiwan

[9] Taipei Med Univ, Coll Management, Grad Inst Data Sci, Taipei, Taiwan

来源：

CLINICAL RHEUMATOLOGY | 2021年 / 40卷 / 09期

关键词：

Autoimmune rheumatic diseases; Cyclophosphamide; Mycophenolate; Pneumocystis jirovecii pneumonia; Steroid;

D O I：

10.1007/s10067-021-05660-4

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective To compare Pneumocystis jirovecii pneumonia (PJP) risk between patients with autoimmune rheumatic diseases (ARD) and the general population Methods We identified patients with ARD recorded in the National Health Insurance Research Database of Taiwan from 2002 to 2015 and randomly selected a comparison cohort from the general population matched for age and sex. We analyzed PJP risk stratified by sex, age, comorbidities, and medications using Cox proportional hazard model. Results We enrolled 103,117 patients with ARD. PJP risk significantly increased in patients with any ARD and with each individual ARD like rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren's syndrome (SjS), polymyositis and dermatomyositis (PM/DM), systemic sclerosis (SSc), and systemic vasculitis. Patients with PM/DM showed prominent risk with incidence rate of 12.47/100,000 patient year (95% confidence interval (CI), 32.16-86.70). In a time-dependent Cox proportional hazard model with comorbidities and medications as covariates, PM/DM, SSc, SLE, and SjS significantly increased adjusted hazard ratios (aHR) of 5.40, 5.12, 4.09, and 3.64, respectively (95% CI of 2.82-10.35, 2.16-12.13, 2.41-6.95, and 2.06-6.42, respectively). AHR after adjusting for male sex, cancer, human immunodeficiency virus infection (HIV), and interstitial lung disease also significantly increased. Use of daily oral steroid dose of >10 mg conferred the highest risk followed by mycophenolate. Use of injected steroids, cyclophosphamide, biological agents, methotrexate, and cyclosporine conferred a significantly higher risk. Conclusion Underlying ARD significantly predisposes patients to PJP, with PM/DM posing the highest threat. In addition to underlying disease, comorbidities and concomitant immunosuppressants are major risks. The strongest risk is recent daily steroid dose of >10 mg. Mycophenolate seems to be a more prominent risk factor than cyclophosphamide.

引用

页码：3755 / 3763

页数：9

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