Vasculitis & polymyalgia rheumatica
The effects of age and frailty on the risks of end-stage renal disease, death, and severe infection in older adults with antineutrophil cytoplasmic antibody-associated vasculitis: a retrospective cohort study
Authors' conclusion
Adults with ANCA-associated vasculitis aged 75 years or older had a higher incidence of end-stage renal disease, death, and severe infections within 2 years of diagnosis than adults aged 65-74 years. Frailty, an approximation of biological age, was a risk factor for severe infection.
Study context
- Population
- Adults aged ≥65 years with incident AAV (excluding EGPA), Mass General Brigham AAV cohort, USA, treated 2002–2019136 (58%) women
- Participants
- 234 adults
- Exposure
- Age ≥75 vs 65-74 years and frailty vs non-frail or pre-frail
- Aged 65-74 yearsn = 116reference
- Aged ≥75 yearsn = 118
- Outcome
- ESRD or death, and severe infections (infections leading to hospital admission or death)
- Follow-up
- 2 years
Methodological detailsmultivariable analysis, additive interaction analysis
- Multivariable analysis
- Additive interaction analysis
Main finding
As reported in the abstract
ESRD or death (multivariable)
Hazard ratio (95% CI)
Aged ≥75 yearsvs Aged 65-74 years
4.50(1.83–11.09)
Frailvs Non-frail or pre-frail
1.08(0.50–2.36)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Severe infections (multivariable) · 2 yearsAged ≥75 yearsvs Aged 65-74 yearsBoth independent risk factors | 2.52 (1.26–5.04) | |
| Severe infections (multivariable) · 2 yearsFrailvs Non-frail or pre-frailBoth independent risk factors | 8.46 (3.95–18.14) | |
| 0.050.21520Hazard ratio (log scale) |
| Outcome | Aged 65-74 years | Aged ≥75 years |
|---|---|---|
| Frailty prevalence by age · baseline | 22% | 37% |
- ESRD or death incidence, frail vs non-frail or pre-frail, by age (subgroup)
- P for interaction = 0.276
- ESRD or death incidence, frail vs non-frail or pre-frail, by age (subgroup) — Aged 65-74 years: frail vs non-frail or pre-frail incidence rate (cases per 100 person-years)
- 7.5 vs 2.0
- ESRD or death incidence, frail vs non-frail or pre-frail, by age (subgroup) — Aged ≥75 years: frail vs non-frail or pre-frail incidence rate (cases per 100 person-years)
- 13.5 vs 16.0
- Serious infection incidence, frail vs non-frail or pre-frail, by age (subgroup)
- P for interaction = 0.650
- Serious infection incidence, frail vs non-frail or pre-frail, by age (subgroup) — Aged 65-74 years: frail vs non-frail or pre-frail incidence rate (cases per 100 person-years)
- 38.9 vs 0.8
- Serious infection incidence, frail vs non-frail or pre-frail, by age (subgroup) — Aged ≥75 years: frail vs non-frail or pre-frail incidence rate (cases per 100 person-years)
- 61.9 vs 12.3
Original publication
The effects of age and frailty on the risks of end-stage renal disease, death, and severe infection in older adults with antineutrophil cytoplasmic antibody-associated vasculitis: a retrospective cohort study. Lancet Rheumatol. Published 18 September 2024. doi:10.
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