Double positivity for antineutrophil cytoplasmic antibody (ANCA) and anti-glomerular basement membrane antibody could predict end-stage renal disease in ANCA-associated vasculitis: a monocentric pilot study

• Published in: Clinical rheumatology 2020-03, Vol.39 (3), p.831-840
• Main Authors: Yoo, Byung-Woo, Ahn, Sung Soo, Jung, Seung Min, Song, Jason Jungsik, Park, Yong-Beom, Lee, Sang-Won
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - blood; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - complications; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - mortality; Antibodies, Antineutrophil Cytoplasmic - blood; Antineutrophil cytoplasmic antibodies; Autoantibodies - blood; Basement membranes; Diagnosis; End-stage renal disease; Female; Health risk assessment; Humans; Kaplan-Meier Estimate; Kidney diseases; Kidney Failure, Chronic - etiology; Male; Medical records; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patients; Peroxidase; Pilot Projects; Proportional Hazards Models; Republic of Korea; Retrospective Studies; Rheumatology; Survival; Survival analysis; Survival Rate; Vasculitis
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-019-04854-1

Objectives To investigate the detection rate of double positivity for antineutrophil cytoplasmic antibody (ANCA) and anti-glomerular basement membrane (GBM) antibody at diagnosis and its clinical implication during follow-up in Korean patients with ANCA-associated vasculitis (AAV). Methods We retrospectively reviewed the medical records of 96 Korean AAV patients. We obtained data at diagnosis and assessed the poor outcomes of AAV such as all-cause mortality, relapse and end-stage renal disease (ESRD). Comparison of cumulative survivals were analysed by the Kaplan-Meier survival analysis, and hazard ratios (HRs) were obtained by the multivariable Cox hazard model. Results Seven of 96 AAV patients (7.3%) had double positivity for ANCA and anti-GBM. Among variables at diagnosis, there were no significant differences between patients with double positivity for ANCA and anti-GBM and those without. In the cumulative survival analysis, AAV patient with double positivity for ANCA and anti-GBM at diagnosis exhibited the lower cumulative ESRD-free survival rate than those without ( P  = 0.044) and furthermore, than those with positive for only ANCA and those with double negativity ( P  = 0.022). Myeloperoxidase (MPO)-ANCA, renal manifestation and five-factor score at diagnosis were also associated with ESRD occurrence in AAV patients. In the multivariable Cox hazards model using these 4 variables, only double positivity for ANCA and anti-GBM exhibited the significant association with ESRD occurrence during follow-up (HR 3.831). Conclusions Double positivity for ANCA and anti-GBM at diagnosis were observed in 7.3% of AAV patients, and it could predict ESRD occurrence during follow-up in Korean patients with AAV. Key Points • 7.3% of AAV patients had double positivity for ANCA and anti-GBM at diagnosis (total n = 96) • Double positivity for ANCA and anti-GBM could predict ESRD occurrence during follow-up (HR 9.021, P = 0.004) • AAV patients with double positivity for ANCA and anti-GBM exhibited the lower cumulative ESRD-free survival rate compared with those without (P = 0.044)