Session Type: Poster Session (Tuesday)
Session Time: 9:00AM-11:00AM
Background/Purpose: Mortality of patients with ANCA-associated vasculitis (AAV) is higher than the general population. There are few papers in the literature regarding the factors associated with this unfavorable outcome, most of them in the eastern population or from nephrology centers. To date, there is no study with this approach in Latin-American patients, a miscegenated population.
Our objective was to identify clinical and laboratory features associated with increased mortality in Latin-American patients with AAV.
Methods: All the patients fulfilling the Chapel Hill Criteria (2012) and ACR criteria (1990) for AAV followed between 2000 and 2018 in our Rheumatology Vasculitis Outpatient Clinics were selected. Data were obtained from an ongoing electronic database protocol that was carried out for all patients at 1- to 6-month intervals. Patients were divided in two groups – dead or alive in 2018. Information about the death was obtained from medical records, family members and death certificates. Variables analyzed were age at the onset of the vasculitis, ANCA frequency, Birmingham Vasculitis Activity Score (BVAS), Vasculitis Damage Index (VDI) and laboratory parameters in the most recent attendance or in the last attendance before death. Comparisons were made by non-paired t-tests or Mann-Whitney tests for continuous variables and Fisher’s exact test for categorical variables. Logistic regression was used to analyze association between death (dependent variable) and variables with significance in the univariate analyses. A log-Rank survival analysis was performed. Statistical significance was set at p < 0.05.
Results: 128 patients were included; 101 had GPA, 21 had EGPA and 6 had MPA. In 2018, 78 were alive, 25 had died and 25 had lost contact. The main cause of death was infection (64%). The vasculitis was considered a contributing factor in 40% of the deaths. The patients who died were older at diagnosis (40.9 vs. 51.2 years, p=0.007) and had higher activity and damage index (BVAS 3 vs. 8, p =0.001; VDI 3.5 vs. 6.9, p< 0.001). Laboratorial features related with mortality were creatinine (1.24 vs. 3.5 mg/dL, p < 0.001), hemoglobin (13.3 vs. 10.7 g/dL, p< 0.001), ESR (19.7 vs. 38.6 mm/1sthour, p=0.038) and CRP (5.4 vs. 68.9 mg/L, p< 0.001). The dose of prednisone taken in the last attendance was higher in the dead-group (9.8 vs. 18.9 mg/day, p=0.018). No difference was observed regarding the presence of ANCA or the immunosuppressive treatment. Logistic regression showed that VDI (OR 1.35, p=0.03), creatinine (OR 1.31, p=0.01) and CRP (OR 1.04, p=0.04) were independent factors related to mortality. The VDI items statistically different between the groups were: EGFR < 50%, proteinuria >0.5 g/24h, end stage renal disease, chronic breathlessness, significant muscular atrophy/weakness, malignancy, visual impairment and oral ulcers. Survival was importantly decreased among patients with GFR < 50% (p < 0.001) (figure).
Conclusion: This is the first study analyzing outcomes of Latin-Americans patients with AAV. Damage index, renal impairment and high CRP were independent factors associated with mortality. Survival rates were significantly decreased among patients with lower GFR.
To cite this abstract in AMA style:Dagostin M, Nunes S, Shinjo S, Pereira R. Mortality Predictors in ANCA-associated Vasculitis: Experience of a Brazilian Monocentric Cohort of a Rheumatology Center [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/mortality-predictors-in-anca-associated-vasculitis-experience-of-a-brazilian-monocentric-cohort-of-a-rheumatology-center/. Accessed December 10, 2019.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mortality-predictors-in-anca-associated-vasculitis-experience-of-a-brazilian-monocentric-cohort-of-a-rheumatology-center/