PMID- 26713723
OWN - NLM
STAT- MEDLINE
DCOM- 20170707
LR  - 20220419
IS  - 2326-5205 (Electronic)
IS  - 2326-5191 (Linking)
VI  - 68
IP  - 6
DP  - 2016 Jun
TI  - Diffuse Alveolar Hemorrhage Secondary to Antineutrophil Cytoplasmic 
      Antibody-Associated Vasculitis: Predictors of Respiratory Failure and Clinical 
      Outcomes.
PG  - 1467-76
LID - 10.1002/art.39562 [doi]
AB  - OBJECTIVE: To identify predictors of respiratory failure and to evaluate the 
      therapeutic efficacy of plasma exchange (PE) and of rituximab versus 
      cyclophosphamide in a cohort of patients with diffuse alveolar hemorrhage (DAH) 
      secondary to antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with 
      or without respiratory failure. METHODS: We performed a single-center historical 
      cohort study of all consecutive patients with AAV-associated DAH who were 
      evaluated over a 16-year period. Logistic regression models were developed to 
      examine the predictive role of the baseline clinical characteristics for the 
      development of respiratory failure, and for the effect of PE and remission 
      induction therapy on the main outcome (complete remission at 6 months). RESULTS: 
      Seventy-three patients with DAH were identified, and 34 of them experienced 
      respiratory failure. The degree of hypoxemia upon initial presentation, a higher 
      percentage of neutrophils in the bronchoalveolar lavage fluid cell count, and 
      higher C-reactive protein levels were independently associated with the 
      development of respiratory failure. PE was not associated with achieving complete 
      remission at 6 months, with an odds ratio (OR) of 0.49 (95% confidence interval 
      [95% CI] 0.12-1.95) (P = 0.32). Rituximab treatment was independently associated 
      with achieving complete remission at 6 months (OR 6.45 [95% CI 1.78-29], 
      P = 0.003). CONCLUSION: Our findings indicate that the most important predictor 
      of respiratory failure in patients with DAH secondary to AAV is the degree of 
      hypoxemia upon presentation. No clear benefit of the addition of PE to standard 
      remission induction therapy was demonstrated. Complete remission by 6 months was 
      achieved at a higher rate with rituximab than with cyclophosphamide in patients 
      with DAH secondary to AAV, including those needing mechanical ventilation.
CI  - (c) 2016, American College of Rheumatology.
FAU - Cartin-Ceba, Rodrigo
AU  - Cartin-Ceba R
AD  - Mayo Clinic, Rochester, Minnesota.
FAU - Diaz-Caballero, Luis
AU  - Diaz-Caballero L
AD  - Macon Lung Center, Macon, Georgia.
FAU - Al-Qadi, Mazen O
AU  - Al-Qadi MO
AD  - Brown University, Providence, Rhode Island.
FAU - Tryfon, Stavros
AU  - Tryfon S
AD  - Thessaloniki General Hospital, Thessaloniki, Greece.
FAU - Fervenza, Fernando C
AU  - Fervenza FC
AD  - Mayo Clinic, Rochester, Minnesota.
FAU - Ytterberg, Steven R
AU  - Ytterberg SR
AD  - Mayo Clinic, Rochester, Minnesota.
FAU - Specks, Ulrich
AU  - Specks U
AD  - Mayo Clinic, Rochester, Minnesota.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Arthritis Rheumatol
JT  - Arthritis & rheumatology (Hoboken, N.J.)
JID - 101623795
RN  - 0 (Immunologic Factors)
RN  - 0 (Immunosuppressive Agents)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 8N3DW7272P (Cyclophosphamide)
SB  - IM
CIN - Arthritis Rheumatol. 2016 Nov;68(11):2828-2829. PMID: 27483202
CIN - Arthritis Rheumatol. 2016 Nov;68(11):2827-2828. PMID: 27483392
EIN - Arthritis Rheumatol. 2016 Sep;68(9):2140. PMID: 27558405
MH  - Aged
MH  - Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/*complications
MH  - Cohort Studies
MH  - Cyclophosphamide/*therapeutic use
MH  - Female
MH  - Hemorrhage/*etiology/*therapy
MH  - Humans
MH  - Immunologic Factors/*therapeutic use
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Lung Diseases/*etiology/*therapy
MH  - Male
MH  - Middle Aged
MH  - *Plasma Exchange
MH  - *Pulmonary Alveoli
MH  - Remission Induction
MH  - Respiratory Insufficiency/*etiology/*therapy
MH  - Rituximab/*therapeutic use
MH  - Treatment Outcome
EDAT- 2015/12/30 06:00
MHDA- 2017/07/08 06:00
CRDT- 2015/12/30 06:00
PHST- 2015/06/15 00:00 [received]
PHST- 2015/12/17 00:00 [accepted]
PHST- 2015/12/30 06:00 [entrez]
PHST- 2015/12/30 06:00 [pubmed]
PHST- 2017/07/08 06:00 [medline]
AID - 10.1002/art.39562 [doi]
PST - ppublish
SO  - Arthritis Rheumatol. 2016 Jun;68(6):1467-76. doi: 10.1002/art.39562.