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Published on: September 22, 2020
Risk prediction model for mortality in microscopic polyangiitis: multicentre REVEAL cohort study
Takuya Kotani1, Shogo Matsuda2, Ayana Okazaki2
1Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Daigaku-Machi 2-7, Takatsuki, Osaka, 569-8686, Japan. takuya.kotani@ompu.ac.jp.
Background:
To establish refined risk prediction models for mortality in patients with microscopic polyangiitis (MPA) by using comprehensive clinical characteristics.
Methods:
Data from the multicentre Japanese registry of patients with vasculitis (REVEAL cohort) were used in our analysis. In total, 194 patients with newly diagnosed MPA were included, and baseline demographic, clinical, laboratory, and treatment details were collected. Univariate and multivariate analyses were conducted to identify the significant risk factors predictive of mortality.
Results:
Over a median follow-up of 202.5 (84-352) weeks, 60 (30.9%) of 194 patients died. The causes of death included MPA-related vasculitis (18.3%), infection (50.0%), and others (31.7%). Deceased patients were older (median age 76.2 years) than survivors (72.3 years) (P < 0.0001). The death group had shorter observation periods (median 128.5 [35.3-248] weeks) than the survivor group (229 [112-392] weeks). Compared to survivors, the death group exhibited a higher smoking index, lower serum albumin levels, higher serum C-reactive protein levels, higher Birmingham Vasculitis Activity Score (BVAS), higher Five-Factor Score, and a more severe European Vasculitis Study Group (EUVAS) categorization system. Multivariate analysis revealed that higher BVAS and severe EUVAS independently predicted mortality. Kaplan-Meier survival curves demonstrated lower survival rates for BVAS ≥20 and severe EUVAS, and a risk prediction model (RPM) based on these stratified patients into low, moderate, and high-risk mortality groups.
Conclusions:
The developed RPM is promising to predict mortality in patients with MPA and provides clinicians with a valuable tool for risk assessment and informed clinical decision-making.
Insights
This study developed a risk prediction model for microscopic polyangiitis (MPA) mortality. Higher Birmingham Vasculitis Activity Score (BVAS) and severe EUVAS classification predict mortality in MPA patients.
Area of Science:
- Rheumatology
- Clinical Epidemiology
- Internal Medicine
Background:
- Microscopic polyangiitis (MPA) is a systemic autoimmune disease requiring accurate mortality risk assessment.
- Existing risk prediction models for MPA may not fully capture the complexity of the disease and its outcomes.
Purpose of the Study:
- To develop refined risk prediction models for mortality in patients with microscopic polyangiitis (MPA).
- To identify comprehensive clinical characteristics that predict mortality in MPA patients.
Main Methods:
- Analysis of data from 194 newly diagnosed MPA patients in the Japanese REVEAL cohort.
- Collection of baseline demographic, clinical, laboratory, and treatment details.
- Univariate and multivariate analyses to identify significant mortality risk factors.
Main Results:
- A total of 60 (30.9%) of 194 patients died during a median follow-up of 202.5 weeks.
- Higher Birmingham Vasculitis Activity Score (BVAS) and severe EUVAS categorization independently predicted mortality.
- A risk prediction model (RPM) stratified patients into low, moderate, and high-risk mortality groups.
Conclusions:
- The developed risk prediction model (RPM) shows promise for predicting mortality in MPA patients.
- This tool can aid clinicians in risk assessment and informed clinical decision-making for MPA management.
