Background/Purpose:

Granulomatosis with Polyangiitis (GPA) is a form of systemic vasculitis with necrotizing granulomatous inflammation commonly involving upper and lower respiratory tracts, necrotizing glomerulonephritis and other organ systems. Limited literature has addressed the prognostic factors impacting on patients with GPA due to relative small sample size of previous studies. The aim of this study is to identify potential risk factors associated with overall in hospital mortality among patients diagnosed with GPA.

Methods:

This is a retrospective analysis based on the 2005- 2014 National Inpatient Sample, the largest publically available inpatient database in the United States. The database is composed of discharge-level data from approximately 8 million hospitalizations annually. The inclusion criteria were patients diagnosed with GPA. There were no exclusion criteria. The outcome of interest was in-hospital mortality. Multivariate logistic regression analysis adjusting for age, gender, race, comorbidities and specific system involvement was performed to evaluate for independent associations between variables of interest and in-hospital mortality. Diagnoses were identified using validated ICD-9-CM codes. Analysis was performed using STATA version 14.2.

Results:

A cohort of 103,701 patients diagnosed with GPA was included. The mean age was 60 years and the overall in hospital mortality rate was 4.69%. Our study revealed that older age (OR 1.04, p<0.001) was associated with increased in-hospital mortality among patients with GPA requiring hospitalization, while African-American race was associated with less mortality rates (OR 0.59, p=0.012) compared with Caucasian patients. Preexisting comorbidities or specific systemic involvements associated with increased in-hospital mortality were: congestive heart failure (OR 1.25, p=0.039), neutropenia (OR 1.69, p=0.043), coagulopathy (OR 2.02, p<0.001), acute kidney injury (OR 1.68, p<0.001), acute respiratory failure (OR 9.56, p<0.001), sepsis (3.51, p<0.001), gastrointestinal bleed (OR 1.90, p<0.001), intracranial hemorrhage (OR 7.96, p<0.001) and ischemic stroke (OR 2.75, p<0.001). However preexisting hypertension (OR 0.77, p=0.004), diabetes mellitus (OR 0.77, p=0.013), chronic lung disease (OR 0.75, p=0.004) and anemia (OR 0.64, p<0.001) were associated with less in-hospital mortality. Other comorbidities that were not associated with in-hospital mortalities were: chronic kidney disease (OR 1.07, p=0.52) and chronic liver disease (OR 0.91, p=0.75).

Conclusion:

Clinical characteristics, preexisting comorbidities and major systemic involvements should be considered in the prognostication and risk stratification of patients diagnosed with GPA. Future prospective studies can be considered for further validation.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/prognostic-factors-in-patients-with-granulomatosis-with-polyangiitis-requiring-hospitalization-a-10-year-nationwide-analysis/