Risk Assessment of Pulmonary Infections in Primary Glomerular Diseases Treated with Rituximab

Chunyun YangQIUYUE LI^*

• The First Affiliated Hospital of Nanchang University, Nanchang, China

Purpose: This study aims to evaluate the incidence and risk factors of pulmonary infections in patients with primary glomerular diseases (PGD) treated with Rituximab (RTX). Methods: Clinical data of patients treated with RTX were collected, along with instances of pulmonary infections occurring within 6 months of RTX administration to analyze risk factors associated with pulmonary infections in PGD. Results: A total of 246 patients were included in the study, Within 6 months, 39 patients developed pulmonary infections, corresponding to an infection rate of 15.85%. The infected group had higher levels of age, Scr, WBC, neutrophils ， Neutrophil Percentage to Albumin Ratio (NPAR), and the proportion of latent tuberculosis compared to the non-infected group (P<0.05). Conversely, sALB, eGFR, C3 and HGB were lower in the infected group (P<0.05). No significant differences were observed between the two groups concerning gender, BMI, comorbidities (hypertension, diabetes, hepatitis B), concomitant use of corticosteroids or immunosuppressants, total dose of RTX, blood pressure, lymphocytes, percentage of neutrophils (NEUT%), UPCR, CRP, sIgG, and B cell counts (P>0.05). Four feature variables were identified through LASSO binary logistic regression: sALB, age, C3, and eGFR. Univariate Cox proportional hazard regression analysis included clinically relevant factors and those differing significantly between groups (P<0.1), identifying LTB, Age,C3 and eGFR as potential risk factors for infection (P<0.05). sALB was identified as potential protective factors (P<0.01). Multivariate Cox proportional hazard regression analysis indicated that sALB is an independent protective factor against infection (P<0.05); age, C3 and eGFR are independent risk factors (P<0.01). The RCS curves showed that the risk of infection increased with advancing age and higher sALB, but decreased with eGFR and C3 . Furthermore, a nonlinear association was observed between RTX dose and infection risk. Conclusion: The incidence of pulmonary infections within 6 months of RTX treatment in patients with PGD was 15.85%. sALB is a protective factor against pulmonary infections, while age, C3 and eGFR are risk factors. The total dose of RTX, concomitant use of corticosteroids or immunosuppressants, and levels of sIgG, LYM, NEUT, and NPAR were not related to infection risk.