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Predicting mortality in microscopic polyangiitis with renal involvement: a survival analysis based on 64 patients
Qin Wang1, Shan Mou, Weijia Xu
1Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
Background:
To determine predictors of survival in patients with microscopic polyangiitis (MPA).
Methods:
A cohort of 64 patients who met the Chapel Hill criteria for MPA with renal involvement participated in the study. All subjects received cytotoxic drugs. All of the diagnoses were biopsy proven.
Results:
We retrospectively studied 64 patients (median age, 59 years; male/female ratio, 1.6:1). The mean follow-up was 38 months; 34 (53.13%) patients died or acquired end-stage renal disease. According to univariate analysis, a preliminary prognostic value was attributed to serum creatinine (Scr) > 459 μmol/L (p < 0.001); erythrocyte sedimentation rate (ESR) > 99 mm/h (p < 0.001); serum albumin < 30 g/L (p < 0.001); and hemoglobin < 84 g/L (p < 0.001). Logistic regression analysis showed that Scr level (β = 1.02, p = 0.0002) and ESR (β = 1.02, p = 0.0002) at baseline were associated with poor prognosis, and Cox regression analysis further confirmed this result [Scr: β = 1.004, 95% confidence interval (CI): 1.002-1.006, p < 0.001; ESR: β = 1.018, 95% CI: 1.000-1.037, p = 0.046]. The receiver operating characteristic curve showed that Scr and ESR were predictors of MPA patient prognosis, their areas under the curves were 0.95 and 0.80, their sensitivities were 94.1% and 92.3%, and their specificities were 94% and 70%, respectively.
Conclusion:
Despite the small number of patients in this study, the prevalence of renal vasculitis was high in patients with MPA. The level of Scr and ESR may be a useful clinical biomarker for monitoring prognosis.
Insights
Predicting survival in microscopic polyangiitis (MPA) is crucial. Elevated serum creatinine (Scr) and erythrocyte sedimentation rate (ESR) are key indicators of poor prognosis in MPA patients.
Area of Science:
- Nephrology
- Rheumatology
- Internal Medicine
Background:
- Microscopic polyangiitis (MPA) is a systemic vasculitis often affecting the kidneys.
- Predicting survival and disease progression in MPA is essential for patient management.
- Renal involvement is a significant factor influencing outcomes in MPA.
Purpose of the Study:
- To identify predictors of survival in patients diagnosed with microscopic polyangiitis (MPA).
- To evaluate the prognostic value of baseline clinical and laboratory parameters in MPA patients with renal involvement.
Main Methods:
- Retrospective analysis of a cohort of 64 patients with biopsy-proven MPA and renal involvement.
- All patients received cytotoxic drug therapy.
- Statistical analysis included univariate, logistic regression, and Cox regression models.
Main Results:
- Over a mean follow-up of 38 months, 53.13% of patients experienced death or end-stage renal disease.
- Univariate analysis identified high serum creatinine (Scr), elevated erythrocyte sedimentation rate (ESR), low serum albumin, and low hemoglobin as significant prognostic factors.
- Logistic and Cox regression confirmed that baseline Scr and ESR levels are independently associated with poor prognosis.
Conclusions:
- Renal vasculitis is highly prevalent in MPA patients.
- Serum creatinine (Scr) and erythrocyte sedimentation rate (ESR) levels serve as valuable clinical biomarkers for monitoring prognosis in MPA.
- These biomarkers can aid in early identification of high-risk patients requiring closer monitoring and potentially intensified treatment.
