engleski

SP187CLINICAL OUTCOMES FOR ANCA ASSOCIATED VASCULITIS PATIENTS IN CROATIAN REFERRAL CENTER

INTRODUCTION: Predictors of clinical outcomes in patients with ANCA associated vasculitis (AAV) are often variable and can vary in different research studies and populations. We present data from Croatian referral center. 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. We analyzed clinical, laboratory and pathohistological data as predictors for combined outcome end-stage renal disease and death (ESRDD), ESRD alone, the death outcome 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: 106 patients with ANCA associated vasculitis have been analyzed, 61 females (55.6%) with median age of 61 (Interquartile range-IQR 51-70) years. According to clinical phenotype (microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), renal limited vasculitis (RLV), eosinophilic granulomatosis with polyangiitis) there were 66 (61.1%) patients with MPA, 20 (18.5%) with GPA, 20 (18.5%) with RLV and 2(1, 9%) with EGPA which were, due to small number, excluded from analysis. Follow up period ranged from 1 to 127 months (median 21 months, IQR 7-44 months). During follow up out of 106 patients, 36 (34%) reached ESRDD, 21 (19.8%) death, 26 (24.5%) ESRD and 10 (9.4%) relapsed. In univariate analysis for ESRDD age, serum creatinine (SCr), C-reactive protein (CRP), hemoglobin, leukocytes, plasma exchange treatment (PLEX), need for acute dialysis, percentage of normal glomeruli and IFTA >50% were significant predictors while in multivariate analysis only hemoglobin (p=0.022 ; HR 0.969 ; CI 0.943-0.996), leukocytes (p=0.038 ; HR 1.07 ; CI 1.004-1.140) and IFTA >50% (p= 0.01 ; HR 2.964 ; CI 1.223- 7.182) remained significant predictors. For the death outcome in univariate analysis age, SCr, CRP, hemoglobin, serum albumin, BVAS and need for acute dialysis were significant predictors while in multivariate only age (p=0.046 ; HR 1.05 ; CI 1.0-1.12), hemoglobin (p=0.04 ; HR 0.952 ; CI 0.9-0.99) and BVAS (p=0.003 ; HR 1.093 (1.03-1.159) remained significant. For ESRD in univariate analysis SCr, CRP, hemoglobin, PLEX, need for acute dialysis, percentage of normal glomeruli and IFTA >50% were significant predictors while in multivariate analysis only need for acute dialysis (p=<0.001 ; HR 4.67 ; CI 1.99-10.94) and IFTA >50% (p=0.02 ; HR 2.65 ; CI 1.15-6.08) remained significant predictors. For relapse in univariate analysis age, SCr, need for acute dialysis, PLEX and percentage of normal glomeruli were significant predictors while in multivariate analysis only age (p=0.01 ; HR 0.924 ; CI 0.87-0.98), SCr (p=0.033 ; HR 0.996 ; CI 0.992-1.0) and need for acute dialysis (p=0.005 ; HR 59.545 ; CI 3.467-1022.66) remained significant predictors. CONCLUSIONS: Depending on the outcome, our data shows, as somewhat expected, that age, kidney function at presentation and need for renal replacement therapy and some pathohistological characteristics play important role in clinical outcomes in AAV patients. What appears to be also important, (as shown in some research) is the level of anemia at presentation as well as unclear effects of PLEX in these outcomes.

patient referraltreatment outcomeanca-associated vasculitiscroatian

nije evidentirano