Early mortality in systemic vasculitis: relative contribution of adverse events and active vasculitis
Early mortality in systemic vasculitis: relative contribution of adverse events and active vasculitis
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DOI：
10.1136/ard.2009.109389
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发表时间：
2010-06-01
影响因子：
27.4
通讯作者：
Harper, Lorraine
中科院分区：
文献类型：
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作者：
Little, Mark A.;Nightingale, Peter;Harper, Lorraine
目的比较血管炎活动负荷和不良事件负荷对抗中性粒细胞胞浆抗体相关性小血管炎(AAV)患者1年死亡率的影响。纳入了524例新诊断的AAV患者的数据。使用白细胞减少、感染和其他不良事件的严重程度评分来量化不良事件的负担，并对随访持续时间进行额外的加权。每个患者的“综合事件负担”(CBOE)评分通过将单个评分相加而产生。结果1年死亡率为11.1%，其中59%和14%的死亡分别由治疗相关的不良事件和活动性脉管炎引起。通过COX回归分析，感染评分(p<；0.001)、不良事件评分(p<；0.001)、白细胞减少评分(p<；0.001)和肾小球滤过率(p=0.002)与死亡率独立相关。当CBOE评分低于7分时，1年内死亡的风险仍然很低(5%)，但如果评分高于7分，则会显著增加。CBOE>7的死亡风险比为14.4(95%可信区间为8.4比24.8)。年龄和GFR是CBOE评分的独立预测因素。结论AAV患者在治疗第一年的最大威胁来自不良事件，而不是活动性脉管炎。使用这种计分方法监测的不良事件的累积，应该促使人们更多地意识到患者处于高死亡风险。
Objective To contrast the effect of the burden of vasculitis activity with the burden of adverse events on 1-year mortality of patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).Methods This study assessed the outcome and adverse events in patients prospectively recruited to four European AAV clinical trials. Data on 524 patients with newly diagnosed AAV were included. The burden of adverse events was quantified using a severity score for leucopenia, infection and other adverse events, with an additional weighting for follow-up duration. A 'combined burden of events' (CBOE) score was generated for each patient by summing the individual scores. Vasculitis severity was quantified using the Birmingham vasculitis activity score and glomerular filtration rate (GFR).Results 1-year mortality probability was 11.1%; 59% and 14% of deaths were caused by therapy-associated adverse events and active vasculitis, respectively. Using Cox regression analysis, infection score (p < 0.001), adverse event score (p < 0.001), leucopenia score (p < 0.001) and GFR (p = 0.002) were independently associated with mortality. The risk of 1-year mortality remained low (5%) with CBOE scores less than 7, but increased dramatically with scores above this. Hazard ratio for death with a CBOE greater than 7 was 14.4 (95% CI 8.4 to 24.8). Age and GFR were independent predictors of CBOE score.Conclusions The greatest threat to patients with AAV in the first year of therapy is from adverse events rather than active vasculitis. The accumulation of adverse events, monitored using this scoring method, should prompt increased awareness that the patient is at high risk of death.