0113 Cost of Head Injuries Caused by Motorcycle Crash among Helmet Users and Non-Users in a Public Tertiary Care Hospital of Karachi, Pakistan

Objective to analyse the role that infections play on the ANCA-associated vasculitis outcome. Methods retrospective study of adult patients with AAV diagnosed in a tertiary centre. Clinical features, laboratory findings, treatment, relapses, major infections and outcome were evaluated. Results 132 patients (51 MPA, 52 GPA, 29 EGPA) with a mean follow-up of 140 (96- 228) months were included. ANCAs were positive in 85% of cases. A total of 300 major infections, mainly bacterial (87%), occurred in 60% patients during the followup. Lower respiratory tract (64%) and urinary tract infections (11%) were the most frequent, followed by bacteraemia (9%). A total of 7.4% opportunistic infections were observed, most due to systemic mycosis. Up to 46% of all opportunistic infections took place in the first year of diagnosis, and 55% of them under CYC treatment. Bacterial infections were associated with BVASv.3>15 at the disease onset (OR 2.35, 95%CI 1.14-4.76, p=0.021), a total cumulative CYC dose >8.65gr (OR 2.67, 95%CI 1.15-4.82, p=0.008), dialysis (OR3.07, 95%CI 1.07-8.79, p=0.04) and development of leukopenia during the follow-up (OR 2.63, 95%CI 1.23-5.64, p=0.016). Leukopenia was the only factor independently related to opportunistic infections (OR 4.31, 95%CI 1.43-12.98, p=0.006). Forty-four patients died: 25 with MPA, 11 with GPA and 8 with EGPA. Death was due to infection in 50% of cases, directly (34%) or associated to active disease (16%). Patients who suffered from major infections had an increased mortality from any cause. Conclusion Our results confirm that major infections are the main cause of death in patients with AAV.