Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea.
J Clin Lab Anal. 2022 Feb;36(2):e24237. doi: 10.1002/jcla.24237. Epub 2022 Jan 8.
This study investigated whether the discordance between erythrocyte sedimentation rate (ESR) and C-reactive protein at diagnosis could estimate the simultaneous clinical and laboratory variables and predict the poor outcomes during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).
The medical records of 254 AAV patients were reviewed. Clinical and laboratory and AAV-specific indices at diagnosis and all-cause mortality, relapse and end-stage renal disease during follow-up were obtained. ESR and CRP levels were categorised as high and low based on the median values. Accordingly, the patients were divided into the following four groups: high ESR/low CRP; low ESR/high CRP; low ESR/low CRP; and high ESR/high CRP.
Of the 254 AAV patients, 51 patients exhibited discordance between ESR and CRP. Among the 51 AAV patients, the median age was 59.0 years, and 20 patients were men (29 MPA, 13 GPA and 9 EGPA). Cardiovascular and nervous systemic manifestations were observed more frequently in AAV patients with low ESR/high CRP than in those with high ESR/low CRP. Six patients from the low ESR/high CRP group died. AAV patients with low ESR/high CRP exhibited significantly lower cumulative patients' survival rates than both those with high ESR/low CRP and those with low ESR/low CRP. Also, AAV patients with low ESR/high CRP exhibited significantly higher simultaneous BVAS than those with low ESR/low CRP.
Low ESR/high CRP at diagnosis could not only estimate the simultaneous high BVAS but also predict all-cause mortality during follow-up in AAV patients.
本研究旨在探讨抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）患者诊断时红细胞沉降率（ESR）与 C 反应蛋白（CRP）不相符能否评估同时存在的临床和实验室变量，并预测随访期间不良结局。
回顾性分析了 254 例 AAV 患者的病历资料。获得了诊断时的临床和实验室以及 AAV 特异性指标以及随访期间的全因死亡率、复发和终末期肾病。根据中位数将 ESR 和 CRP 水平分为高和低。据此，将患者分为以下四组：高 ESR/低 CRP；低 ESR/高 CRP；低 ESR/低 CRP；高 ESR/高 CRP。
在 254 例 AAV 患者中，有 51 例患者 ESR 和 CRP 不相符。在这 51 例 AAV 患者中，中位年龄为 59.0 岁，20 例为男性（29 例 MPA，13 例 GPA 和 9 例 EGPA）。与高 ESR/低 CRP 相比，低 ESR/高 CRP 的 AAV 患者更常出现心血管和神经系统表现。低 ESR/高 CRP 组有 6 例患者死亡。低 ESR/高 CRP 的 AAV 患者累积生存率明显低于高 ESR/低 CRP 和低 ESR/低 CRP 的患者。此外，低 ESR/高 CRP 的 AAV 患者的同时 BVAS 明显高于低 ESR/低 CRP 的患者。
诊断时的低 ESR/高 CRP 不仅可以评估同时存在的高 BVAS，还可以预测 AAV 患者随访期间的全因死亡率。
