Clinical outcome and prognosis of anti-neutrophil cytoplasmic antibody-associated vasculitis in Japan

Nephron Clin Pract. 2010;115(1):c21-7. doi: 10.1159/000286346. Epub 2010 Feb 19.

Abstract

Background/aims: We conducted a broad survey of 99 patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis and investigated both prognosis and outcomes.

Methods: Clinical data evaluated were age, sex, patient survival, renal survival, serum albumin, serum creatinine, urinary protein, hematuria, C-reactive protein (CRP), ANCA titer, IgG and the Birmingham Vasculitis Activity Score (BVAS).

Results: The patient survival rate at 6 months after onset was 84.8%, and that at 2 years after onset was 82.0%. Most deaths were within 6 months of onset. Infection accounted for 9 deaths (60.0%). Infection together with pulmonary involvement of active vasculitis accounted for 2 deaths (13.3%). Organ-specific involvement of active vasculitis alone caused 3 deaths (20.0%). Others died of cardiac events. At 1 and 3 months after onset, BVAS (p < 0.0001, p = 0.002), albumin (p = 0.006, p = 0.0004) and CRP (p = 0.04, p = 0.0002) were also associated with patient death.

Conclusion: To improve the prognosis of those with ANCA-associated vasculitis, the intensity of initial treatment should be aimed at disease severity. Employing BVAS improved the ability to evaluate therapeutic responses. Finally, prescription with sulfamethoxazole-trimethoprim during the induction therapy with immunosuppressive agents may be advised.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents / therapeutic use
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / mortality*
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / therapy*
  • Female
  • Humans
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Prevalence
  • Prognosis
  • Risk Assessment / methods
  • Risk Factors
  • Survival Analysis
  • Survival Rate
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents