Introduction: Alveolar haemorrhage (AH) is considered an important cause of morbidity and early mortality in anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV). Objectives: The aim of this study was to identify predictors of outcome in patients with AH-AAV and to evaluate outcome and causes of death in this subset. Materials and methods: A multicenter retrospective study was conducted in 29 Italian Centers. Clinicians were asked to recruit all patients diagnosed with AAV-associated AH during the last 10 years, from 2007 to 2016. Univariate and multivariable analysis were performed. Results: One-hundred and six patients were included (median age at onset of 55 years [IQR 42–67]). The majority were ANCA-positive (PR3 57.1%, MPO 33.7%) and 72.6% had also renal involvement. At presentation, anaemia was shown in 97 (92.4%) patients, hemoptysis in 54 (51.9%), respiratory failure in 68 (66.7%), of whom 48 (70.6%), requiring respiratory support. At the end of the 37 months [IQR 13–77] follow-up, 19/106 (17.9%) patients were dead. The main causes of death were active disease and infections. By stepwise regression analysis, age >65 years (HR 3.66 [95% CI 1.4–9.51], p = 0.008) and the need for respiratory support (HR 4.58 [95% CI 1.51–13.87], p = 0.007) at AH onset were confirmed to be predictive of mortality. Conclusions: Predictors of outcome in AAV-AH were determined. Factors related to the patient's performance status and the severity of the lung involvement strongly influenced the outcome. Balancing harms and benefits for the individual patient in induction and maintenance treatment strategies is crucial.

Alveolar haemorrhage in ANCA-associated vasculitis: Long-term outcome and mortality predictors / Quartuccio L.; Bond M.; Isola M.; Monti S.; Felicetti M.; Furini F.; Murgia S.; Berti A.; Silvestri E.; Pazzola G.; Bozzolo E.; Leccese P.; Raffeiner B.; Parisi S.; Leccese I.; Cianci F.; Bettio S.; Sainaghi P.; Ianniello A.; Ravagnani V.; Bellando Randone S.; Faggioli P.; Lomater C.; Stobbione P.; Ferro F.; Colaci M.; Alfieri G.; Carubbi F.; Erre G.L.; Giollo A.; Franzolini N.; Ditto M.C.; Balduzzi S.; Padoan R.; Bortolotti R.; Bortoluzzi A.; Cariddi A.; Padula A.; Di Scala G.; Gremese E.; Conti F.; D'Angelo S.; Matucci Cerinic M.; Dagna L.; Emmi G.; Salvarani C.; Paolazzi G.; Roccatello D.; Govoni M.; Schiavon F.; Caporali R.; De Vita S.. - In: JOURNAL OF AUTOIMMUNITY. - ISSN 0896-8411. - ELETTRONICO. - 108:(2020), pp. 102397-102397. [10.1016/j.jaut.2019.102397]

Alveolar haemorrhage in ANCA-associated vasculitis: Long-term outcome and mortality predictors

Silvestri E.;Bellando Randone S.;Di Scala G.;Matucci Cerinic M.;Emmi G.;
2020

Abstract

Introduction: Alveolar haemorrhage (AH) is considered an important cause of morbidity and early mortality in anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV). Objectives: The aim of this study was to identify predictors of outcome in patients with AH-AAV and to evaluate outcome and causes of death in this subset. Materials and methods: A multicenter retrospective study was conducted in 29 Italian Centers. Clinicians were asked to recruit all patients diagnosed with AAV-associated AH during the last 10 years, from 2007 to 2016. Univariate and multivariable analysis were performed. Results: One-hundred and six patients were included (median age at onset of 55 years [IQR 42–67]). The majority were ANCA-positive (PR3 57.1%, MPO 33.7%) and 72.6% had also renal involvement. At presentation, anaemia was shown in 97 (92.4%) patients, hemoptysis in 54 (51.9%), respiratory failure in 68 (66.7%), of whom 48 (70.6%), requiring respiratory support. At the end of the 37 months [IQR 13–77] follow-up, 19/106 (17.9%) patients were dead. The main causes of death were active disease and infections. By stepwise regression analysis, age >65 years (HR 3.66 [95% CI 1.4–9.51], p = 0.008) and the need for respiratory support (HR 4.58 [95% CI 1.51–13.87], p = 0.007) at AH onset were confirmed to be predictive of mortality. Conclusions: Predictors of outcome in AAV-AH were determined. Factors related to the patient's performance status and the severity of the lung involvement strongly influenced the outcome. Balancing harms and benefits for the individual patient in induction and maintenance treatment strategies is crucial.
2020
108
102397
102397
Quartuccio L.; Bond M.; Isola M.; Monti S.; Felicetti M.; Furini F.; Murgia S.; Berti A.; Silvestri E.; Pazzola G.; Bozzolo E.; Leccese P.; Raffeiner B.; Parisi S.; Leccese I.; Cianci F.; Bettio S.; Sainaghi P.; Ianniello A.; Ravagnani V.; Bellando Randone S.; Faggioli P.; Lomater C.; Stobbione P.; Ferro F.; Colaci M.; Alfieri G.; Carubbi F.; Erre G.L.; Giollo A.; Franzolini N.; Ditto M.C.; Balduzzi S.; Padoan R.; Bortolotti R.; Bortoluzzi A.; Cariddi A.; Padula A.; Di Scala G.; Gremese E.; Conti F.; D'Angelo S.; Matucci Cerinic M.; Dagna L.; Emmi G.; Salvarani C.; Paolazzi G.; Roccatello D.; Govoni M.; Schiavon F.; Caporali R.; De Vita S.
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in FLORE sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1192890
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 26
  • ???jsp.display-item.citation.isi??? 26
social impact