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SP205THE ROLE OF ANAEMIA IN ANCA ASSOCIATED VASCULITIS – DATA FROM CROATIAN REFERRAL CENTER

INTRODUCTION: Anaemia is often a part of clinical presentation of ANCA associated vasculitis (AAV). There is research data that show anaemia as possibly important predictor of outcomes in AAVs. We wish to present our data supporting the role of anaemia in prediction of clinical outcomes in AAVs. METHODS: 106 patients from our Center diagnosed with AAV with renal involvement in period from 2007-2017 were analyzed. All patients had ultrasound guided kidney biopsy performed. Patients were categorized according to clinical (microscopic polyangiitis = MPA, granulomatosis with polyangiitis = GPA and renal limited vasculitis = RLV), serological (MPO-ANCA, PR3- ANCA, MPO and PR3- ANCA, ANCA negative) and histopathological phenotypes (according to Berden et al. classification). We analyzed clinical, laboratory and pathohistological data as predictors for combined outcome end-stage renal disease and death (ESRDD), ESRD alone, death alone and relapse rate. Survival univariate analysis was performed using Kaplan- Meier method and log-rank (Mantel-Cox) test. Variables that had p<0, 1 in univariate analysis were alongside age and gender included in multivariate Cox proportional hazard model. RESULTS: There was significant difference in hemoglobin levels among clinical phenotypes: and post hoc analysis showed MPA (p=0.036) and GPA (p=0.01) both had lower hemoglobin levels compared to RLV, while there was no difference between MPA and GPA. In histopathological phenotypes sclerotic and crescentic groups showed trends to have lower hemoglobin levels compared to focal and mixed (p=0.05). There was however no significant difference in hemoglobin levels between serological (ANCA type) phenotypes nor between ANCA positive and ANCA negative patients. As for the anemia being predictor for clinical outcomes, in univariate analysis hemoglobin was significant predictor for ESRDD (HR 0.969 CI 0.949-0.99), death (HR 0.951 CI 0.919-0.983) and ESRD (HR 0.97 CI 0.946-0.995) while in multivariate analysis it remained significant predictor for ESRDD (p=0.022 ; HR 0.969 ; CI 0.943-0.996) and death (p=0.04 ; HR 0.952 ; CI 0.9-0.99). CONCLUSIONS: Anaemia is a serious clinical manifestation in many diseases, AAVs included. It is more pronounced in patients with MPA and GPA probably due to more systemic nature of these clinical phenotypes. Our data along some other research suggest the importance of initial anaemia at the time of diagnosis and that perhaps hemoglobin levels should be included in AAV severity indexes as well as prediction models for clinical outcomes.

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