Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China.
Emergency Department, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China.
BMC Nephrol. 2019 Sep 2;20(1):339. doi: 10.1186/s12882-019-1535-3.
Microscopic polyangiitis (MPA) is a systemic autoimmune disease, and renal involvement is frequently present in MPA. MPA patients with renal involvement may have a worse prognosis. In this study, we aimed to evaluate the prognostic factors associated with all-cause death and renal survival in MPA patients with renal involvement.
A retrospective observational cohort study was performed. One hundred twenty-four patients newly diagnosed with MPA with renal involvement excluding end-stage renal disease (ESRD) who were hospitalized at the First Affiliated Hospital of Chongqing Medical University from January 2012 to July 2017 were included. All the survivors were followed up with until July 2018. The clinical and laboratory data at the time of the initial MPA diagnosis were collected, and the predictive values of the variables for mortality and renal outcome were analysed.
Among the 124 patients, 52 were men (41.9%) and 72 were women (58.1%), and the age range was from 25 to 85 years (63.9±10.6 years). Seventy-six patients (61.3%) had pulmonary involvement. Multivariate Cox analysis revealed that age≥65 years (HR: 2.437; P=0.021), serum creatinine≥500 μmol/L (HR=2.207; P=0.009) and interstitial lung disease (ILD) (HR=2.366; P=0.013) were associated with mortality. Cox multivariate analysis identified that serum creatinine≥500 μmol/L (HR=8.236; P<0.001) and ILD (HR=2.649; P=0.001) were independent detrimental factors for renal survival, and immunosuppressive treatment was a protective factor for renal survival (HR=0.349; P=0.001). The area under the ROC curve (AUC) of the serum creatinine level at diagnosis was 0.705 for mortality and 0.870 for progression to ESRD or the doubling of serum creatinine.
Age, serum creatinine level at diagnosis and ILD were independent predictors of mortality in MPA patients with renal involvement. Serum creatinine level at diagnosis, ILD and immunosuppressive treatment were independently related to renal survival.
显微镜下多血管炎（MPA）是一种系统性自身免疫性疾病，肾脏受累在 MPA 中很常见。肾脏受累的 MPA 患者预后可能更差。本研究旨在评估与肾脏受累的 MPA 患者全因死亡和肾脏生存相关的预后因素。
这是一项回顾性观察队列研究。纳入 2012 年 1 月至 2017 年 7 月期间在重庆医科大学第一附属医院住院的新诊断为肾脏受累但不包括终末期肾病（ESRD）的 MPA 患者 124 例。所有幸存者均随访至 2018 年 7 月。收集初始 MPA 诊断时的临床和实验室数据，并分析变量对死亡率和肾脏结局的预测价值。
124 例患者中，男 52 例（41.9%），女 72 例（58.1%），年龄 25-85 岁，平均年龄（63.9±10.6）岁。76 例（61.3%）患者有肺部受累。多因素 Cox 分析显示，年龄≥65 岁（HR：2.437；P=0.021）、血清肌酐≥500μmol/L（HR：2.207；P=0.009）和间质性肺病（ILD）（HR：2.366；P=0.013）与死亡率相关。多因素 Cox 分析确定，血清肌酐≥500μmol/L（HR：8.236；P<0.001）和 ILD（HR：2.649；P=0.001）是肾脏生存的独立不利因素，免疫抑制治疗是肾脏生存的保护因素（HR：0.349；P=0.001）。诊断时血清肌酐水平对死亡率和进展为 ESRD 或血清肌酐加倍的 ROC 曲线下面积（AUC）分别为 0.705 和 0.870。
年龄、诊断时的血清肌酐水平和间质性肺病是肾脏受累的 MPA 患者死亡的独立预测因素。诊断时的血清肌酐水平、ILD 和免疫抑制治疗与肾脏生存独立相关。
