Early predictors of one-year mortality in ...
Document type :
Article dans une revue scientifique
PMID :
Permalink :
Title :
Early predictors of one-year mortality in patients over 65 presenting with ANCA-associated renal vasculitis: a retrospective, multicentre study.
Author(s) :
Titeca-Beauport, Dimitri [Auteur]
Francois, Alexis [Auteur]
Lobbedez, Thierry [Auteur]
Guerrot, Dominique [Auteur]
Launay, David [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Vrigneau, Laurence [Auteur]
Daroux, Maite [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Lebas, Celine [Auteur]
Bienvenu, Boris [Auteur]
Hachulla, Eric [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Diouf, Momar [Auteur]
Choukroun, Gabriel [Auteur]
Francois, Alexis [Auteur]
Lobbedez, Thierry [Auteur]
Guerrot, Dominique [Auteur]
Launay, David [Auteur]

Lille Inflammation Research International Center - U 995 [LIRIC]
Vrigneau, Laurence [Auteur]
Daroux, Maite [Auteur]

Lille Inflammation Research International Center - U 995 [LIRIC]
Lebas, Celine [Auteur]
Bienvenu, Boris [Auteur]
Hachulla, Eric [Auteur]

Lille Inflammation Research International Center - U 995 [LIRIC]
Diouf, Momar [Auteur]
Choukroun, Gabriel [Auteur]
Journal title :
BMC Nephrology
Abbreviated title :
BMC Nephrol.
Volume number :
19
Pages :
317
Publication date :
2018-11-09
Keyword(s) :
ANCA
Glomerulonephritis
Infection
Mortality
Elderly
Glomerulonephritis
Infection
Mortality
Elderly
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
Background: The risk of early death is particularly high in patients over the age of 65 presenting with antineutrophil cytoplasmic antibody (ANCA)-associated renal vasculitis. We hypothesized that by combining disease ...
Show more >Background: The risk of early death is particularly high in patients over the age of 65 presenting with antineutrophil cytoplasmic antibody (ANCA)-associated renal vasculitis. We hypothesized that by combining disease severity markers, a comorbidity index and serious adverse event reports, we would be able to identify early predictors of one-year mortality in this population. Methods: We performed a multicentre, retrospective study in the nephrology and internal medicine departments of six tertiary hospitals in northern France. A total of 149 patients (median [interquartile range (IQR)] age: 72.7 [68.5–76.8] years) presenting with ANCA-associated vasculitis and renal involvement were included between January 2002 and June 2015. The primary endpoint was the one-year mortality rate. Results: Renal function was severely impaired at presentation (median [IQR] peak serum creatinine (SCr): 337 [211–522] μmol/l), and 45 patients required dialysis. The Five-Factor Score (FFS, scored as + 1 point for each poor prognostic factor (age > 65 years, cardiac symptoms, gastrointestinal involvement, SCr ≥150 μmol/L, and the absence of ear, nose, and throat involvement)) was ≥3 in 120 cases. The one-year mortality rate was 19.5%. Most of the deaths occurred before month 6, and most of these were related to severe infections. In a univariate analysis, age, a high comorbidity index, a performance status of 3 or 4, a lack of co-trimoxazole prophylaxis, early severe infection, and disease activity parameters (such as the albumin level, haemoglobin level, peak SCr level, dialysis status, and high FFS) were significantly associated with one-year mortality. In a multivariable analysis, the best predictors were a high FFS (relative risk (RR) [95% confidence interval (CI)] = 2.57 [1.30–5.09]; p = 0.006) and the occurrence of a severe infection during the first month (RR [95%CI] = 2.74 [1.27–5.92]; p = 0.01). Conclusions: When considering various disease severity markers in over-65 patients with ANCA-associated renal vasculitis, we found that an early, severe infection (which occurred in about a quarter of the patients) is a strong predictor of one-year mortality. A reduction in immunosuppression, the early detection of infections, and co-trimoxazole prophylaxis might help to reduce mortality in this population.Show less >
Show more >Background: The risk of early death is particularly high in patients over the age of 65 presenting with antineutrophil cytoplasmic antibody (ANCA)-associated renal vasculitis. We hypothesized that by combining disease severity markers, a comorbidity index and serious adverse event reports, we would be able to identify early predictors of one-year mortality in this population. Methods: We performed a multicentre, retrospective study in the nephrology and internal medicine departments of six tertiary hospitals in northern France. A total of 149 patients (median [interquartile range (IQR)] age: 72.7 [68.5–76.8] years) presenting with ANCA-associated vasculitis and renal involvement were included between January 2002 and June 2015. The primary endpoint was the one-year mortality rate. Results: Renal function was severely impaired at presentation (median [IQR] peak serum creatinine (SCr): 337 [211–522] μmol/l), and 45 patients required dialysis. The Five-Factor Score (FFS, scored as + 1 point for each poor prognostic factor (age > 65 years, cardiac symptoms, gastrointestinal involvement, SCr ≥150 μmol/L, and the absence of ear, nose, and throat involvement)) was ≥3 in 120 cases. The one-year mortality rate was 19.5%. Most of the deaths occurred before month 6, and most of these were related to severe infections. In a univariate analysis, age, a high comorbidity index, a performance status of 3 or 4, a lack of co-trimoxazole prophylaxis, early severe infection, and disease activity parameters (such as the albumin level, haemoglobin level, peak SCr level, dialysis status, and high FFS) were significantly associated with one-year mortality. In a multivariable analysis, the best predictors were a high FFS (relative risk (RR) [95% confidence interval (CI)] = 2.57 [1.30–5.09]; p = 0.006) and the occurrence of a severe infection during the first month (RR [95%CI] = 2.74 [1.27–5.92]; p = 0.01). Conclusions: When considering various disease severity markers in over-65 patients with ANCA-associated renal vasculitis, we found that an early, severe infection (which occurred in about a quarter of the patients) is a strong predictor of one-year mortality. A reduction in immunosuppression, the early detection of infections, and co-trimoxazole prophylaxis might help to reduce mortality in this population.Show less >
Language :
Anglais
Audience :
Internationale
Popular science :
Non
Administrative institution(s) :
Inserm
Université de Lille
CHU Lille
Université de Lille
CHU Lille
Research team(s) :
Immunity, inflammation and fibrsis in auto and allo-reactivity
Glycation from inflammation to aging
Glycation from inflammation to aging
Submission date :
2019-03-01T14:34:29Z
2023-12-13T15:49:59Z
2023-12-13T15:49:59Z
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