Background/Purpose: It is important to determine the biomarkers for assessing disease activity of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Plasma levels of fibrin/fibrinogen degradation products (FDP) are fibrinolytic markers and elevates after any thrombotic event. We hypothesized that plasma levels of FDP reflect to hypercoagulable state and thrombosis in AAV. The purpose of the present study is to investigate whether plasma levels of FDP could be an indicator of disease states and complications of organ involvements in patients of AAV.
Methods: Patients with microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA) who were admitted to Showa University Hospital for induction therapy and had their plasma FDP levels checked in the active state from October 2005 to May 2013 were retrospectively included. Plasma FDP levels were compared between the active and inactive states of AAV. Among patients in the active state, vasculitis disease clinical activity was assessed using Birmingham Vasculitis Activity Scores (BVAS), and the relationship between plasma FDP levels and BVAS, scores of each system were discussed. Plasma FDP levels were evaluated for differences in each disease and were compared between patients with and without complications of nephritis, interstitial pneumonia and peripheral neuropathy. Laboratory markers of AAV and nephritis activity were examined to determine their correlations with plasma FDP levels.
Results: Thirty-seven MPA, 12 GPA, and 6 EGPA patients were included. Plasma FDP levels were high in the active state and decreased significantly after therapy (p<0.001). Among patients in the active state, plasma FDP levels significantly correlated with BVAS (rs=0.35, p<0.05). Especially, positive correlations were observed among plasma FDP levels and the system of general (rs=0.57, p<0.001) and renal involvement (rs=0.33, p<0.05) in the systems of BVAS. Plasma FDP levels were significantly higher in patients with MPA than in patients with GPA (p<0.05) and with EGPA (p<0.05). Although plasma FDP levels were significantly higher in patients with nephritis than in patients without nephritis (p<0.01), there were no differences between patients with and without complications of interstitial pneumonia and peripheral neuropathy. Plasma FDP levels significantly correlated with serum C-reactive protein levels (rs=0.52, p<0.001), peripheral blood neutrophil count (rs=0.53, p<0.001), plasma D-dimer levels (rs=0.87, p<0.001), serum creatinine levels (rs=0.34, p<0.05), estimated glomerular filtration rates (rs=-0.43, p<0.01), and urinary N-acetyl-beta-D-glucosaminidase index (rs=0.37, p<0.05). Plasma FDP levels were significantly higher in the patients with proteinuria (p<0.01) and hematuria (p<0.05).
Conclusion: Plasma FDP levels might be a useful indicator of disease activity and complications of nephritis in patients with AAV. Better understanding of the association of thrombosis with inflammation in AAV might lead to development new approaches to therapy.
Disclosure:
K. Wakabayashi,
None;
N. Oguro,
None;
Y. Miura,
None;
S. Ishii,
None;
S. Seki,
None;
M. Umemura,
None;
T. Tokunaga,
None;
H. Tsukamoto,
None;
S. Isojima,
None;
H. Furuya,
None;
R. Yanai,
None;
K. Otsuka,
None;
R. Takahashi,
None;
T. Isozaki,
None;
N. Yajima,
None;
Y. Miwa,
None;
T. Kasama,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/plasma-levels-of-fibrinfibrinogen-degradation-products-might-be-a-useful-indicator-of-disease-activity-classification-and-nephritis-complications-in-antineutrophil-cytoplasmic-antibody-associated-va/