Toraman Aysun, Soysal Gündüz Özgül
Department of Internal Medicine, Division of Nephrology, Celal Bayar University, Faculty of Medicine, Manisa, Turkey.
Department of Internal Medicine, Division of Rheumatology, Celal Bayar University, Faculty of Medicine, Manisa, Turkey.
Arch Rheumatol. 2021 May 11;36(3):445-457. doi: 10.46497/ArchRheumatol.2021.8687. eCollection 2021 Sep.
This study aims to assess the different predictors of renal and patient prognosis in anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) patients with and without renal involvement.
A total of 79 patients (51 males, 28 females; mean age: 57.3±14.2 years; range, 18 to 71 years) with AAV between January 2006 and November 2019 were retrospectively analyzed. Demographic and laboratory data including the complement 3 (C3) serum levels and renal biopsy findings were extracted from the electronic and printed medical records of the hospital registry. Survival, renal survival, remission, and relapse outcomes were analyzed.
A total of 35% of the patients with renal involvement progressed to end-stage renal disease (ESRD). The dialysis requirement at the time of admission (hazard ratio [HR]: 21.95 [2.93-164.22]; p=0.003), estimated glomerular filtration rate (eGFR) (HR: 0.97 [0.94-0.99]; p=0.024) and Five-Factor Score (FFS) ≥2 at the time of diagnosis (HR: 3.59 [1.08-11.94]; p=0.037) were the predictors of ESRD. The five-year patient survival rate was 87.1%. The only predictor of mortality was age (HR: 1.07 [1.01-1.14]; p=0.024). The patients with hypocomplementemia (22%) had a lower remission rate (p=0.049), FFS ≥2 at the time of diagnosis (p=0.026), and higher levels of hematuria (p=0.004) and proteinuria (p=0.037). The FFS ≥2 at the time of diagnosis was an independent predictor of relapse (HR: 8.9 [1.02-77.36]; p=0.047).
Our study suggests that the baseline renal function and FFS ≥2 at the time of diagnosis are the major prognostic factors for progression to ESRD in AAV patients. In addition, AAV patients with hypocomplementemia may have a lower remission rate.
本研究旨在评估抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）患者有无肾脏受累情况下肾脏及患者预后的不同预测因素。
回顾性分析2006年1月至2019年11月期间共79例AAV患者（51例男性，28例女性；平均年龄：57.3±14.2岁；范围18至71岁）。从医院登记处的电子和纸质病历中提取人口统计学和实验室数据，包括补体3（C3）血清水平和肾脏活检结果。分析生存、肾脏生存、缓解和复发结局。
共有35%的肾脏受累患者进展至终末期肾病（ESRD）。入院时的透析需求（风险比[HR]：21.95[2.93 - 164.22]；p = 0.003）、估计肾小球滤过率（eGFR）（HR：0.97[0.94 - 0.99]；p = 0.024）以及诊断时五因素评分（FFS）≥2（HR：3.59[1.08 - 11.94]；p = 0.037）是ESRD的预测因素。患者五年生存率为87.1%。死亡的唯一预测因素是年龄（HR：1.07[1.01 - 1.14]；p = 0.024）。低补体血症患者（22%）缓解率较低（p = 0.049）,诊断时FFS≥2（p = 0.026），血尿水平较高（p = 0.004）和蛋白尿水平较高（p = 0.037）。诊断时FFS≥2是复发的独立预测因素（HR：8.9[1.02 - 77.36]；p = 0.047）。
我们的研究表明，基线肾功能和诊断时FFS≥2是AAV患者进展至ESRD的主要预后因素。此外，低补体血症的AAV患者缓解率可能较低。
