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Risk Factors of Pneumonia in Primary Antibody Deficiency Patients Receiving Immunoglobulin Therapy: Data from the US Immunodeficiency Network (USIDNET)

Year: 2022

Type: article

Abstract: Background Despite immunoglobulin replacement (IgRT) therapy, some patients with Primary Antibody Deficiency (PAD) continue to develop respiratory infections. Recurrent and severe respiratory infections, particularly pneumonia, can lead to significant morbidity and mortality. Therefore, we sought to determine the risk factors of developing pneumonia in PAD patients, already receiving IgRT.MethodsWe evaluated clinical, and laboratory features of PAD patients enrolled in the US Immune Deficiency Network (USIDNET) registry by April 2017. Patients were included if they met the following criteria: 1) PAD diagnosis (common variable immunodeficiency (CVID), Agammaglobulinemia, hypogammaglobinemia, and specific antibody deficiency (SAD). 2) Available data on infections before and after IgRT. Patients were excluded if they were not receiving IgRT, or no pre/post infections data were available. Descriptive and multivariable logistic regression analyses were used to identify factors associated with pneumonia post-IgRT.Results A total of 1286 patients met the inclusion criteria. Following IgRT, 226 patients (17.6%) were reported to have at least one pneumonia episode. Using multivariate logistic regression analysis, we found a statistically significant increased risk of pneumonia in patients with asthma (OR: 1.79, 95% CI [1.20-2.67], p=0.004), bronchiectasis (OR: 2.81, 95% CI [1.64-4.80], p<0.001), and interstitial lung disease (ILD) (OR: 2.90, 95% CI [1.26-6.70], p=0.013). Patients who did not receive prophylactic antibiotics had a much higher risk of pneumonia (OR: 27.65, 95% CI [8.63-88.59]; p<0.001), compared to those who received prophylactic antibiotics. For every 50 unit increase in IgA, the odds of reporting pneumonia post-IgRT decreased significantly (OR: 0.82, 95% CI [0.69-0.97], p=0.018). Patients with X-Linked Agammaglobulinemia had a lower risk of pneumonia than other PAD diagnoses (OR: 0.84; 95% CI [0.75-0.93]; p=0.001). The infectious organism was reported in 39 of 226 patients who reported pneumonia after IgRT. Haemophilus influenzae was the most frequently reported (n=11, 28.21%), followed by Streptococcus Pneumoniae (n=9, 23.08%).ConclusionOur findings suggest a role for prophylactic antibiotics patients with PAD, especially in those with pre-existing lung disease. However, our study is limited by the cross-sectional nature of the USIDNET database and limited longitudinal data. Therefore, prospective studies evaluating the indications of prophylactic antibiotics are warranted.Clinical ImplicationsPatients with primary antibody deficiency and structural lung disease may benefit from prophylactic antibiotics to prevent persisted infections despite IgRT.

Source: Journal of Clinical Immunology

DOI: 10.1007/s10875-022-01317-2