Skip to main content

Advertisement

SpringerLink
Log in

RABBIT risk score and ICU admission due to infection in patients with rheumatoid arthritis

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Rheumatoid arthritis (RA) patients are at increased risk of infection. Aim of the present study was to investigate whether RA patients admitted to an intensive care unit (ICU) due to infection have higher Rheumatoid Arthritis Observation of Biologic Therapy (RABBIT) risk scores compared to control RA patients. Seventy-four RA patients (32.4% male) admitted to an ICU due to infection (from January 2002 to December 2013) and 74 frequency-matched control RA patients (16.2% male) were included in this cross-sectional study. There was strong evidence for a higher RABBIT risk score in ICU patients (median 2.0; IQR 1.3–3.2) as compared to controls (1.3; IQR 0.8–2.0; p < 0.0001). Traditional disease-modifying anti-rheumatic drugs (DMARDs) (82.4 vs 64.9%; p = 0.015) and biological DMARDs (28.4 vs 14.9%; p = 0.012) were more frequently given to RA patients without ICU admission. Glucocorticoid users were more frequently found in the ICU group (51.4 vs 31.1%; p = 0.012). In a multivariable analysis tDMARD use was associated with lower (OR 0.38; 95% CI 0.15–0.93; p = 0.034) and glucocorticoid use with borderline higher odds of ICU admission (OR 2.05; 95% CI 0.92–4.58; p = 0.078). Chronic obstructive pulmonary disease (OR 2.89; 95% CI 1.10–7.54; p = 0.03), chronic kidney disease (OR 16.08; 95% CI 2.00–129.48; p = 0.009), and age category (OR 2.67; 95% CI 1.46–4.87; p = 0.001) were strongly associated with ICU admission. There was a strong trend towards higher odds of ICU admission with increasing RABBIT risk score. Use of tDMARDs was associated with lower odds of ICU admission. In an adjusted analysis, bDMARDs were not associated with ICU admission. COPD, CKD, and age were strong risk factors for ICU admission.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Avouac J, Amrouche F, Meune C, Rey G, Kahan A, Allanore Y (2016) Mortality profile of patients with rheumatoid arthritis in France and its change in 10 years. Semin Arthritis Rheum 68:1–26

    Google Scholar 

  2. Thomas E, Symmons DPM, Brewster DH, Black RJ, Macfarlane GJ (2003) National study of cause-specific mortality in rheumatoid arthritis, juvenile chronic arthritis, and other rheumatic conditions: a 20 year followup study. J Rheumatol 30:958–965

    PubMed  Google Scholar 

  3. Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE (2002) Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum 46:2287–2293

    Article  PubMed  Google Scholar 

  4. Galloway JB, Hyrich KL, Mercer LK, Dixon WG, Ustianowski AP, Helbert M et al (2011) Risk of septic arthritis in patients with rheumatoid arthritis and the effect of anti-TNF therapy: results from the British Society for Rheumatology Biologics Register. Ann Rheum Dis 70:1810–1814

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Greenberg JD, Reed G, Kremer JM, Tindall E, Kavanaugh A, Zheng C et al (2010) Association of methotrexate and tumour necrosis factor antagonists with risk of infectious outcomes including opportunistic infections in the CORRONA registry. Ann Rheum Dis 69:380–386

    Article  CAS  PubMed  Google Scholar 

  6. Singh JA, Cameron C, Noorbaloochi S, Cullis T, Tucker M, Christensen R et al (2015) Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis. Lancet 386:258–265

    Article  PubMed  PubMed Central  Google Scholar 

  7. Listing J, Strangfeld A, Kary S, Rau R, von Hinueber U, Stoyanova-Scholz M et al (2005) Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum 52:3403–3412

    Article  CAS  PubMed  Google Scholar 

  8. Wolfe F, Caplan L, Michaud K (2006) Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: associations with prednisone, disease-modifying antirheumatic drugs, and anti-tumor necrosis factor therapy. Arthritis Rheum 54:628–634

    Article  CAS  PubMed  Google Scholar 

  9. Haraoui B, Jovaisas A, Bensen WG, Faraawi R, Kelsall J, Dixit S et al (2015) Use of corticosteroids in patients with rheumatoid arthritis treated with infliximab: treatment implications based on a real-world Canadian population. RMD open 1:e000078

    Article  PubMed  PubMed Central  Google Scholar 

  10. Strangfeld A, Eveslage M, Schneider M, Bergerhausen HJ, Klopsch T, Zink A et al (2011) Treatment benefit or survival of the fittest: what drives the time-dependent decrease in serious infection rates under TNF inhibition and what does this imply for the individual patient? Ann Rheum Dis 70:1914–1920

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Zink A, Manger B, Kaufmann J, Eisterhues C, Krause A, Listing J et al (2014) Evaluation of the RABBIT Risk Score for serious infections. Ann Rheum Dis 73:1673–1676

    Article  CAS  PubMed  Google Scholar 

  12. Quintero OL, Rojas-Villarraga A, Mantilla RD, Anaya J-M (2013) Autoimmune diseases in the intensive care unit. An update. Autoimmun Rev 12:380–395

    Article  PubMed  Google Scholar 

  13. Godeau B, Boudjadja A, Dhainaut JF, Schlemmer B, Chastang C, Brunet F et al (1992) Outcome of patients with systemic rheumatic disease admitted to medical intensive care units. Ann Rheum Dis 51:627–631

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Peschken CA, Hitchon CA, Garland A, Bernstein CN, Chen H, Fransoo R et al (2016) A population-based study of intensive care unit admissions in rheumatoid arthritis. J Rheumatol 43:26–33

    Article  PubMed  Google Scholar 

  15. Faguer S, Ciroldi M, Mariotte E, Galicier L, Rybojad M, Canet E et al (2013) Prognostic contributions of the underlying inflammatory disease and acute organ dysfunction in critically ill patients with systemic rheumatic diseases. Eur J Intern Med 24:e40–e44

    Article  PubMed  Google Scholar 

  16. Lehmann EL, D’Abrera HJM (1998) Nonparametrics: statistical methods based on ranks. Rev Edn. Englewood Cliffs, NJ, Prentice Hall. pp. 292–323.

  17. Brünnler T, Susewind M, Hoffmann U, Rockmann F, Ehrenstein B, Fleck M (2015) Outcomes and prognostic factors in patients with rheumatologic diseases admitted to the ICU. Intern Med 54:1981–1987

    Article  PubMed  Google Scholar 

  18. Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V (2006) Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 295:2275–2285

    Article  CAS  PubMed  Google Scholar 

  19. Askling J, Fored CM, Brandt L, Baecklund E, Bertilsson L, Feltelius N et al (2016) Time-dependent increase in risk of hospitalisation with infection among Swedish RA patients treated with TNF antagonists. Ann Rheum Dis 66:1339–1344

    Article  Google Scholar 

  20. Richter A, Listing J, Schneider M, Klopsch T, Kapelle A, Kaufmann J et al (2016) Impact of treatment with biologic DMARDs on the risk of sepsis or mortality after serious infection in patients with rheumatoid arthritis. Ann Rheum Dis 75:1667–1673

    Article  CAS  PubMed  Google Scholar 

  21. Schneeweiss S, Setoguchi S, Weinblatt ME, Katz JN, Avorn J, Sax PE et al (2007) Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis. Arthritis Rheum 56:1754–1764

    Article  CAS  PubMed  Google Scholar 

  22. Kawashima H, Kagami S-I, Kashiwakuma D, Takahashi K, Yokota M, Furuta S et al (2017) Long-term use of biologic agents does not increase the risk of serious infections in elderly patients with rheumatoid arthritis. Rheumatol Int 37:369–376

    Article  CAS  PubMed  Google Scholar 

  23. Schmajuk G, Trivedi AN, Solomon DH, Yelin E, Trupin L, Chakravarty EF et al (2011) Receipt of disease-modifying antirheumatic drugs among patients with rheumatoid arthritis in Medicare managed care plans. JAMA 305:480–486

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Jin X-M, Lee J, Choi N-K, Seong JM, Shin JY, Kim YJ et al (2014) Utilization patterns of disease-modifying antirheumatic drugs in elderly rheumatoid arthritis patients. J Korean Med Sci 29:210–216

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Tutuncu Z, Reed G, Kremer J, Kavanaugh A (2006) Do patients with older-onset rheumatoid arthritis receive less aggressive treatment? Ann Rheum Dis 65:1226–1229

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Fraenkel L, Rabidou N, Dhar R (2006) Are rheumatologists’ treatment decisions influenced by patients’ age? Rheumatology (Oxford) 45:1555–1557

    Article  CAS  Google Scholar 

  27. Köller MD, Aletaha D, Funovits J, Pangan A, Baker D, Smolen JS (2009) Response of elderly patients with rheumatoid arthritis to methotrexate or TNF inhibitors compared with younger patients. Rheumatology (Oxford) 48:1575–1580

    Article  Google Scholar 

  28. Sugihara T, Harigai M (2016) Targeting low disease activity in elderly-onset rheumatoid arthritis: current and future roles of biological disease-modifying antirheumatic drugs. Drugs Aging 33:97–107

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Caplan L, Wolfe F, Russell AS, Michaud K (2007) Corticosteroid use in rheumatoid arthritis: prevalence, predictors, correlates, and outcomes. J Rheumatol 34:696–705

    PubMed  Google Scholar 

Download references

Funding

There was no sponsor for this study. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

Author information

Authors and Affiliations

  1. Academic Research Unit, 2nd Department of Internal Medicine, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria

    Herwig Pieringer, Rainer Hintenberger, Erich Pohanka & Lorenz Auer-Hackenberg

  2. Paracelsus Private Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria

    Herwig Pieringer & Clemens Steinwender

  3. 1st Department of Internal Medicine, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria

    Clemens Steinwender

  4. Department of Anesthesiology and Operative Intensive Care Medicine, Kepler University Hospital Linz, Krankenhausstr. 9, Linz, Austria

    Jens Meier

  5. Department of Neurology 2, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, Linz, Austria

    Franz Gruber

Authors
  1. Herwig Pieringer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rainer Hintenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Erich Pohanka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Clemens Steinwender
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jens Meier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Franz Gruber
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lorenz Auer-Hackenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Herwig Pieringer.

Ethics declarations

Disclosures

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pieringer, H., Hintenberger, R., Pohanka, E. et al. RABBIT risk score and ICU admission due to infection in patients with rheumatoid arthritis. Clin Rheumatol 36, 2439–2445 (2017). https://doi.org/10.1007/s10067-017-3825-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-017-3825-0

Keywords

Search

Navigation