Characteristics, prognosis, and outcomes of cutaneous ischemia and gangrene in systemic necrotizing vasculitides: A retrospective multicenter study

Lega, Jean‐Christophe; Séror, Raphaèle; Fassier, Thomas; Aumaître, O.; Quéré, I.; Pourrat, Jacques; Gilson, B.; Sparsa, A.; Wahl, Denis; Jeunne, Claire Le; Decaux, Olivier; Mouthon, Luc; Mahr, Alfred; Cohen, Pascal; Guillevin, Loı̈c; Pagnoux, Christian

doi:10.1016/j.semarthrit.2013.09.001

Cited by 14 publications

(8 citation statements)

References 38 publications

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“…Although Lega et al 16 reported that skin involvement was a risk factor for mortality, this phenomenon was not observed in our study. Skin involvement was not frequently observed in our patient group.…”

Section: Survival Function Censoredcontrasting

confidence: 86%

Predictive factors of mortality in granulomatosis with polyangiitis: A single-center study

Tufan

Tekkarismaz

2021

Arch Rheumatol

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Objectives:The aim of this study was to identify predictors of mortality in granulomatosis with polyangiitis (GPA) patients and to seek the ways of improving survival in GPA patients. Patients and methods: Between January 2005 and June 2020, a total of 60 patients (26 males, 34 females; median age: 49 years; range, 19 to 75 years) who were diagnosed with GPA were retrospectively analyzed. Demographic, clinical, laboratory, and radiological findings of all patients were recorded. Survival rates were analyzed using the Kaplan-Meier plot. Results: The median follow-up was 36 months, and 10 (16.7%) patients died during the study period. Univariate analysis showed that the prognostic values were attributed to high serum creatinine levels (>2.1 mg/dL; p=0.01), proteinuria (p=0.01), dialysis-requiring renal damage at the time of diagnosis (p=0.01) or at any time during follow-up (p=0.01), low lymphocyte levels (p=0.01), hypoalbuminemia (p=0.04), absence of upper respiratory tract involvement (p=0.01), presence of lung involvement with cavitary lesions (p=0.01), high Birmingham Vascular Activity Score (p=0.02), and history of serious infection (p=0.01). In the multivariate analysis, the presence of renal damage requiring dialysis at any time during follow-up (relative risk [95% confidence interval]: 21 [4.1-18.3]; p=0.01) was found to be an independent predictor of mortality. Immunosuppressive drugs exerted no effect on mortality, and the most common causes of death were infections (50%). Conclusion:The presence of dialysis-requiring renal damage is the most important risk factor for mortality in GPA patients. These patients should be followed more closely and carefully to improve survival.

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Section: Survival Function Censoredcontrasting

confidence: 86%

Predictive factors of mortality in granulomatosis with polyangiitis: A single-center study

Tufan

Tekkarismaz

2021

Arch Rheumatol

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“…By contrast, we did not find heart involvement as a predictor for relapse. In a study which was done by Lega et al, unlike ours, skin involvement was shown to be a risk factor of relapse [44]. By contrast, Outh et al found that relapse frequency was less in patients with skin involvement.…”

Section: Discussioncontrasting

confidence: 54%

Predictors of relapse in granulomatosis with polyangiitis: a multi-center study

Safari

Alesaeidi²,

Pakzad³

et al. 2022

Egypt Rheumatol Rehabil

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Background Granulomatosis with polyangiitis (GPA) is a rare systemic vasculitis. Its severity ranges from indolent disease to fulminant that may cause death. With treatment, remission is seen in more than 80% of cases, although relapse is still common. There have been studies showing that there may be factors to predict relapse in GPA. Based on relapses, the decision to start treatment and/or to monitor the patients more closely is made. Therefore, predicting the relapse of GPA can be effective in controlling the disease. Our aim was to investigate possible factors for relapse in GPA. We recruited 254 patients diagnosed with GPA who were under treatment at Alzahra hospital affiliated to Isfahan University of Medical Sciences (from 2013 to 2020) and Amir Alam Hospital affiliated to Tehran University of Medical Sciences (from 2020 to 2022) to plan a retrospective study. Chi-squared or Fisher’s exact tests were performed to compare categorical variables, while the Mann–Whitney U test was used to compare continuous variables. Results Analysis of our patients (aged 20–80,122 females) showed that 147 patients (57.9%) experienced relapse. Mean age in relapse group was 43.8 ± 16.6 and in no-relapse group was 45.6 ± 15.1 (P > 0.05). Among many potential predictors, we observed in multivariate analysis that positive PR3-ANCA (proteinase 3-antineutrophilic cytoplasmic antibodies) (P = 0.007, OR:2.62,CI:1.29–5.31),nose manifestations (P = 0.004, OR 3.00, CI 1.43–6.26), mucosal membranes involvement (P = 0.009, OR 4.21, CI 1.43–12.38), and gastrointestinal tract (GI) complications (P = 0.03, OR 5.64, CI 1.14–27.90) were significant predictors of GPA relapse. Conclusion Among clinical and laboratory features we studied, positive PR3-ANCA, nose manifestations, mucosal membranes involvement, and GI complications were independent predictors of relapse in patients with GPA.

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“…Roderau et al [7] reported that relapse frequency was lower in patients with skin involvement. In another study, the presence of cutaneous ischemia, which indicates skin involvement, has been shown to increase the risk of relapse [18]. By contrast, only five of our patients displayed skin involvement, indicating that skin involvement is not a risk factor for relapse.…”

Section: Risk Factors Influencing the Relapse Rate In Gpamentioning

confidence: 41%

Factors affecting relapse in patients with Granulomatosis Polyangiitis: a single-center retrospective cohort study

Tufan¹,

Tekkarismaz²,

Yücel³

2021

Turk J Med Sci

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Background and aim This study aimed to determine the frequency of relapse, the risk factors for relapse, and the correlation of relapse with immunosuppressive regimens in patients with granulomatosis polyangiitis (GPA). Materials and methods The demographic characteristics, the clinical, laboratory, and radiological findings, the immunosuppressive treatment regimens, and the remission and relapse rates of 50 patients with GPA were obtained retrospectively from medical records. Results : The mean relapse-free survival rates at years 1, 3, and 5 were 82%, 60%, and 50%, respectively. Increased relapse rates were observed in patients who had cavitary lung lesions (52.2% vs. 22.2%, p = 0.04) and in those who had elevated serum creatinine levels (1.8 vs. 0.9, p = 0.00). The patients received two different types of remission induction therapies; 36% of them received the combination therapy involving cyclophosphamide (CYC) and rituximab (RTX), and 62% received CYC alone. Relapse was observed in 22.3% of the patients who received the combination remission induction therapy and in 61.3% of the patients who received CYC alone (P = 0.003). Conclusion An increased risk of relapse was observed in patients who had cavitary lung lesions and in those who had elevated serum creatinine levels. The combined use of RTX and CYC for the remission therapy in GPA reduced the relapse rates compared with the use of CYC alone

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Characteristics, prognosis, and outcomes of cutaneous ischemia and gangrene in systemic necrotizing vasculitides: A retrospective multicenter study

Cited by 14 publications

References 38 publications

Predictive factors of mortality in granulomatosis with polyangiitis: A single-center study

Predictive factors of mortality in granulomatosis with polyangiitis: A single-center study

Predictors of relapse in granulomatosis with polyangiitis: a multi-center study

Factors affecting relapse in patients with Granulomatosis Polyangiitis: a single-center retrospective cohort study

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