Prognosis Value of Geriatric Assessment Scales in Older Adults with New Onset ANCA-Associated Vasculitis: A Pilot Retrospective Study

Antoine Néel¹, Josephine Thomazeau¹, Christelle Volteau², Laure De Decker³, Christian Agard¹, Marie Lino⁴, Julie Graveleau¹, Fadi Fakhouri⁴ and Mohamed Hamidou¹, ¹Internal Medicine Department, Nantes University Hospital, Nantes, France, ²Clinical Research Department, Nantes University Hospital, Nantes, France, ³Department of Geriatrics, Nantes University Hospital, Nantes, France, ⁴Nephrology, Nantes University Hospital, Nantes, France

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Elderly, prognostic factors and vasculitis

Session Information

Date: Sunday, November 8, 2015

Title: Vasculitis Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: 1/to assess the prognostic value of comorbidities, frailty and dependency as measures by dedicated geriatric scales, in older adults with ANCA-associated vasculitis (AAV). 2/ to identify factors that predict functional decline in Instrumental Activities of Daily Living.

Methods: Retrospective single center study of patients diagnosed with AAV after 65 y between 2000 and 2013. Comorbidities, frailty and dependency were measured using the Charlson Index, the CSHA Clinical Frailty Scale (CFS) and the Instrumental Activities of Daily Living 4 items (IADL4). These score were evaluated at 3 time points: 1 year prior to AAV diagnosis (baseline), at AAV diagnosis and 1 year after AAV diagnosis. Multivariate analysis was performed using Cox model.

Results: Fourty four patients were analysed, including 33 with MPA and 11 with GPA. Mean age was 76 years. Mean eGFR was 49ml/min/1.73m². As first line, 29 patients (66%) were treated with corticosteroids plus cyclophosphamide. Overall, a significant improvement of CFS and IADL were seen between disease onset and year 1 after the diagnosis. In multivariate analysis mortality was higher in patient with PR3 ANCA (HR=4.2), palliative care (HR:3.5) and worse baseline IADL4 (HR:1.84). Relapse-free survival was longer in patients with worse baseline CFS score (HR=0.41) and those with MPA (HR=0.25). IALD4 was the only factor that predicted infection-free survival (HR=1.95). Predictive factor of functional decline at 1 year were PR3 ANCA (HR=85), Charlson comorbidity index (3.2) and IADL4 at time of diagnosis (HR=3.9).

Conclusion: Geriatric assessment scales appear to have high prognostic value in older adults with AAV. These simple tools can be better predictors of outcome than age or some usual biological parameters such as eGFR. Multicenter prospective studies are needed to confirm our results. These tools may help identify at risk patients who may require more intensive supportive care.

Disclosure: A. Néel, None; J. Thomazeau, None; C. Volteau, None; L. De Decker, None; C. Agard, None; M. Lino, None; J. Graveleau, None; F. Fakhouri, None; M. Hamidou, None.

To cite this abstract in AMA style:

Néel A, Thomazeau J, Volteau C, De Decker L, Agard C, Lino M, Graveleau J, Fakhouri F, Hamidou M. Prognosis Value of Geriatric Assessment Scales in Older Adults with New Onset ANCA-Associated Vasculitis: A Pilot Retrospective Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/prognosis-value-of-geriatric-assessment-scales-in-older-adults-with-new-onset-anca-%c2%adassociated-vasculitis-a-pilot-retrospective-study/. Accessed .

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