Please use this identifier to cite or link to this item: http://hdl.handle.net/10668/2627
Título : Clinical characteristics and outcome of Spanish patients with ANCA-associated vasculitides: Impact of the vasculitis type, ANCA specificity, and treatment on mortality and morbidity
Autor : Solans-Laqué, Roser
Fraile, Guadalupe
Rodriguez-Carballeira, Monica
Caminal, Luis
Castillo, Maria J
Martínez-Valle, Ferran
Sáez, Luis
Rios, Juan J
Solanich, Xavier
Oristrell, Joaquim
Pasquau, Francisco
Fonseca, Eva
Zamora, Monica
Callejas, Jose L
Frutos, Begoña
Abdilla, Monica
Fanlo, Patricia
García-Sánchez, Isabel
López-Dupla, Miguel
Sopeña, Bernardo
Pérez-Iglesias, Almudena
Bosch, Josep A
Filiación: [Solans-Laqué,R; Martínez-Valle,F; Bosch,JA] Hospital Valle Hebrón, Barcelona. [Fraile,G] Hospital Ramón y Cajal, Madrid. [Rodriguez-Carballeira,M] Mutua Terrassa, Barcelona. [Caminal,L] Hospital Central de Asturias. [Castillo,MJ] Hospital Virgen del Rocío, Sevilla. [Sáez,L] Hospital Miguel Servet, Zaragoza. [Rios,JJ] Hospital La Paz, Madrid. [Solanich,X] Hospital Bellvitge. [Oristrell,J] Hospital Parc Tauli Sabadell, Barcelona. [Pasquau.F] Hospital Marina Baixa, Villajoyosa, Alicante. [Fonseca,E] Hospital Cabueñes, Asturias. [Zamora,M] Hospital Virgen de las Nieves. [Callejas,JL] Hospital Clínico San Cecilio, Granada. [Frutos,B] Hospital Fuenlabrada, Madrid. [Abdilla,O] Hospital La Ribera, Alzira, Valencia. [Fanlo,P] Clínica de Navarra. [García-Sánchez,I] Hospital Infanta Leonor, Madrid. [López-Dupla,M] Hospital Joan XXIII, Tarragona. [Sopeña,B] Centro Hospitalário Vigo. [Pérez-Iglesias,A] Hospital Ourense, Galicia, Spain. [Bosch,JA] Spanish Registry of systemic vasculitis (REVAS) from the Autoimmune Diseases Study Group (GEAS) of the Spanish Society of Internal Medicine (SEMI).
Grupo de Investigación: Spanish Registry of systemic vasculitis (REVAS) from the Autoimmune Diseases Study Group (GEAS) of the Spanish Society of Internal Medicine (SEMI)
Palabras clave : ANCA-associated vasculitides
Eosinophilic granulomatosis with polyangiitis
Granulomatosis with polyangiitis
Infections
Microscopic polyangiitis
Mortality predictors
Outome
Spanish people
Resultado del tratamiento
Adulto joven
Adolescente
Adulto
Anciano
Anciano de 80 o más años
Vasculitis asociada a anticuerpos citoplasmáticos antineutrófilos
Anticuerpos anticitoplasma de neutrófilos
Comorbilidad
Femenino
Estudios de seguimiento
Estudios longitudinales
Masculino
Mediana edad
Recurrencia
Estudios retrospectivos
Prevalencia
España
Factores de tiempo
MeSH: Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies
Medical Subject Headings::Check Tags::Male
Medical Subject Headings::Persons::Persons::Age Groups::Adult::Middle Aged
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Case-Control Studies::Retrospective Studies
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Morbidity::Prevalence
Medical Subject Headings::Geographical Locations::Geographic Locations::Europe::Spain
Medical Subject Headings::Phenomena and Processes::Physical Phenomena::Time::Time Factors
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Recurrence
Medical Subject Headings::Persons::Persons::Age Groups::Adult::Young Adult
Medical Subject Headings::Persons::Persons::Age Groups::Adolescent
Medical Subject Headings::Persons::Persons::Age Groups::Adult
Medical Subject Headings::Persons::Persons::Age Groups::Adult::Aged
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Persons::Persons::Age Groups::Adult::Aged::Aged, 80 and over
Medical Subject Headings::Diseases::Immune System Diseases::Autoimmune Diseases::Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins::Antibodies::Autoantibodies::Antibodies, Antineutrophil Cytoplasmic
Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Epidemiologic Factors::Comorbidity
Medical Subject Headings::Check Tags::Female
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Follow-Up Studies
Fecha de publicación : Feb-2017
Editorial : Lippincott, Williams & Wilkins
Cita Bibliográfica: Solans-Laqué R, Fraile G, Rodriguez-Carballeira M, Caminal L, Castillo MJ, Martínez-Valle F et al. Clinical characteristics and outcome of Spanish patients with ANCA-associated vasculitides: Impact of the vasculitis type, ANCA specificity, and treatment on mortality and morbidity.Medicine (Baltimore). 2017;96(8):e6083.
Abstract: The aim of this study was to describe the clinical characteristics of ANCA-associated vasculitides (AAV) at presentation, in a wide cohort of Spanish patients, and to analyze the impact of the vasculitis type, ANCA specificity, prognostic factors, and treatments administered at diagnosis, in the outcome.A total of 450 patients diagnosed between January 1990 and January 2014 in 20 Hospitals from Spain were included. Altogether, 40.9% had granulomatosis with polyangiitis (GPA), 37.1% microscopic polyangiitis (MPA), and 22% eosinophilic granulomatosis with polyangiitis (EGPA). The mean age at diagnosis was 55.6 ± 17.3 years, patients with MPA being significantly older (P < 0.001). Fever, arthralgia, weight loss, respiratory, and ear-nose-throat (ENT) symptoms, were the most common at disease onset. ANCAs tested positive in 86.4% of cases: 36.2% C-ANCA-PR3 and 50.2% P-ANCA-MPO. P-ANCA-MPO was significantly associated with an increased risk for renal disease (OR 2.6, P < 0.001) and alveolar hemorrhage (OR 2, P = 0.010), while C-ANCA-PR3 was significantly associated with an increased risk for ENT (OR 3.4, P < 0.001) and ocular involvement (OR 2.3, P = 0.002). All patients received corticosteroids (CS) and 74.9% cyclophosphamide (CYC). The median follow-up was 82 months (IQR 100.4). Over this period 39.9% of patients suffered bacterial infections and 14.6% opportunistic infections, both being most prevalent in patients with high-cumulated doses of CYC and CS (P < 0.001). Relapses were recorded in 36.4% of cases with a mean rate of 2.5 ± 2.3, and were more frequent in patients with C-ANCA-PR3 (P = 0.012). The initial disease severity was significantly associated with mortality but not with the occurrence of relapses. One hundred twenty-nine (28.7%) patients (74 MPA, 41 GPA, 14 EGPA) died. The mean survival was 58 months (IQR 105) and was significantly lower for patients with MPA (P < 0.001). Factors independently related to death were renal involvement (P = 0.010), cardiac failure (P = 0.029) and age over 65 years old (P < 0.001) at disease onset, and bacterial infections (P < 0.001). An improved outcome with significant decrease in mortality and treatment-related morbidity was observed in patients diagnosed after 2000, and was related to the implementation of less toxic regimens adapted to the disease activity and stage, and a drastic reduction in the cumulated CYC and CS dose.
URI: http://hdl.handle.net/10668/2627
Versión del editor : http://journals.lww.com/md-journal/pages/results.aspx?fs=%5b%7b%22Operator%22%3a%22and%22%2c%22Field%22%3a%22Title%22%2c%22Key%22%3a%22Clinical+characteristics+and+outcome+of+Spanish+patients+with+ANCA+associated+vasculitides%22%7d%2c%7b%22Operator%22%3a%22and%22%2c%22Field%22%3a%22Volume%22%2c%22Key%22%3a%2296%22%7d%2c%7b%22Operator%22%3a%22and%22%2c%22Field%22%3a%22Issue%22%2c%22Key%22%3a%228%22%7d%5d
DOI: 10.1097/MD.0000000000006083
ISSN : 0025-7974 (Print)
1536-5964 (Online)
Appears in Collections:01- Artículos - Hospital Virgen del Rocío
01- Artículos - Complejo Hospitalario Universitario de Granada

Files in This Item:
File Description SizeFormat 
SolansLaque_ClinicalCharacteristics.pdfArtículo publicado338,19 kBAdobe PDFView/Open


This item is licensed under a Creative Commons License Creative Commons