PMID- 19574233
OWN - NLM
STAT- MEDLINE
DCOM- 20100716
LR  - 20100525
IS  - 1468-2060 (Electronic)
IS  - 0003-4967 (Linking)
VI  - 69
IP  - 6
DP  - 2010 Jun
TI  - Early mortality in systemic vasculitis: relative contribution of adverse events 
      and active vasculitis.
PG  - 1036-43
LID - 10.1136/ard.2009.109389 [doi]
AB  - 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.
FAU - Little, Mark A
AU  - Little MA
AD  - Renal Institute of Birmingham, School of Infection, Immunity and Inflammation, 
      College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 
      2TT, UK.
FAU - Nightingale, Peter
AU  - Nightingale P
FAU - Verburgh, C A
AU  - Verburgh CA
FAU - Hauser, Thomas
AU  - Hauser T
FAU - De Groot, Kirsten
AU  - De Groot K
FAU - Savage, Caroline
AU  - Savage C
FAU - Jayne, David
AU  - Jayne D
FAU - Harper, Lorraine
AU  - Harper L
CN  - European Vasculitis Study (EUVAS) Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20090701
PL  - England
TA  - Ann Rheum Dis
JT  - Annals of the rheumatic diseases
JID - 0372355
RN  - 0 (Antibodies, Antineutrophil Cytoplasmic)
RN  - 0 (Glucocorticoids)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Antibodies, Antineutrophil Cytoplasmic/blood
MH  - Cardiovascular Diseases/epidemiology/etiology
MH  - Epidemiologic Methods
MH  - Europe/epidemiology
MH  - Female
MH  - Glomerular Filtration Rate
MH  - Glucocorticoids/*adverse effects/therapeutic use
MH  - Humans
MH  - Immunosuppressive Agents/*adverse effects/therapeutic use
MH  - Leukopenia/etiology/mortality
MH  - Male
MH  - Opportunistic Infections/complications/mortality
MH  - Prognosis
MH  - Systemic Vasculitis/complications/drug therapy/immunology/*mortality
EDAT- 2009/07/04 09:00
MHDA- 2010/07/17 06:00
CRDT- 2009/07/04 09:00
PHST- 2009/07/04 09:00 [entrez]
PHST- 2009/07/04 09:00 [pubmed]
PHST- 2010/07/17 06:00 [medline]
AID - ard.2009.109389 [pii]
AID - 10.1136/ard.2009.109389 [doi]
PST - ppublish
SO  - Ann Rheum Dis. 2010 Jun;69(6):1036-43. doi: 10.1136/ard.2009.109389. Epub 2009 
      Jul 1.