Wegener's Granulomatosis in the Elderly

Krafcik, Sonja S.; Covin, Randal B.; Lynch, Joseph P.; Sitrin, Robert G.

doi:10.1378/chest.109.2.430

Cited by 52 publications

(34 citation statements)

References 25 publications

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“…This is consistent with the finding that patients with MPA are older than patients with GPA and that patients with MPO/ P-ANCA are older than patients with PR3/C-ANCA (5,6,11,18,24,25). Results showing that older patients with GPA have more renal insufficiency and less upper airway symptoms (26) add to this picture. We found a higher proportion of MPO/P-ANCA positive GPA compared with two large studies in Caucasian patients.…”

Section: Discussionsupporting

confidence: 90%

Outcome and Treatment of Elderly Patients with ANCA-Associated Vasculitis

Weiner¹,

Goh

Mohammad

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives ANCA-associated vasculitis is commonly found in elderly patients, but there are few data concerning outcome and treatment in the highest age groups.Design, setting, participants, & measurements Consecutive patients (N=151) presenting between 1997 and 2009 were retrospectively included from local registries in six centers in Sweden, the United Kingdom, and the Czech Republic if diagnosed with microscopic polyangiitis or granulomatosis with polyangiitis at age $75 years during the study period. Patients were followed until 2 years from diagnosis or death. Data on survival and renal function were analyzed with respect to age, sex, ANCA specificity, renal function, C-reactive protein, comorbidities, and Birmingham Vasculitis Activity Score at diagnosis as well as treatment during the first month.Results Median follow-up was 730 days (interquartile range, 244-730). Overall 1-year survival was 71.5% and 2-year survival was 64.6%. Older age, higher creatinine, and lower Birmingham Vasculitis Activity Score were associated with higher mortality in multivariable analysis. Patients who were not treated with standard immunosuppressive therapy had significantly worse survival. Renal survival was 74.8% at 1 year. No new cases of ESRD occurred during the second year. High creatinine at diagnosis was the only significant predictor of renal survival in multivariable analysis.Conclusions ANCA-associated vasculitis is a disease with substantial mortality and morbidity among elderly patients. This study showed a better prognosis for those who received immunosuppressive treatment and those who were diagnosed before having developed advanced renal insufficiency.

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Section: Discussionsupporting

confidence: 90%

Outcome and Treatment of Elderly Patients with ANCA-Associated Vasculitis

Weiner¹,

Goh

Mohammad

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…As already reported in old people [2,[4][5][6][7], steroid and immunosuppressive treatments were effective in VS manifestations, but these treatments did not seem to influence the overall poor prognosis. The chosen therapy was adapted to each patient's status and was not directly the cause of death.…”

Section: Discussionmentioning

confidence: 56%

“…Published studies report a mortality rate of between 40 and 60% at 1-to 7-year follow-up in the elderly [2][3][4][5]. The main reported causes of death are complications due to infections and respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

“…The main reported causes of death are complications due to infections and respiratory failure. Comorbid conditions and treatment toxicity have been reported as having an influence on the risk of mortality [2,6]. Some patients may have been in remission of VS at the time of death [2].…”

Section: Discussionmentioning

confidence: 99%

“…Several other VS have been described in patients in their 50s or 60s. Three studies concerning Wegener's granulomatosis (WG) have reported a total of 56 patients over 60 years old [2][3][4]. Other authors have mentioned 43 subjects older than 70 years, from a total of 218 having a VS with glomerulonephritis [5].…”

Section: Introductionmentioning

confidence: 99%

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Vasculitis in the Very Elderly

Turcu

Bielefeld²,

Besancenot³

et al. 2002

Gerontology

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Background: Whatever may be their clinical presentation, vasculitis syndromes (VS) have a bad prognosis in the very elderly. Objective: The aim of this work was to study VS particularities in very old people. Most published studies on VS in elderly people concern patients older than 60 years; studies concerning very old patients are unusual. Methods: We studied retrospectively subjects older than 75 years with a diagnosis of VS from the Departments of Geriatrics and Internal Medicine at Dijon University Hospital. These subjects were hospitalized between January 1995 and December 1999. Data were obtained from the medical files of these patients. Several aspects were considered: type of VS, associated diseases, treatment, complications, and outcome. Results: Twelve patients, 5 men and 7 women aged 79–91 (mean age 82.3) years, were included. Primary VS was observed in half of the patients and secondary VS in the others. The initial clinical presentation was often polymorphous and unspecific; 8 of the patients died, 2 developed progressive severe functional impairment, 1 was stabilized under therapy, and 1 patient with VS secondary to infection recovered. Most patients either died quickly or progressively deteriorated from infections, malnutrition, or functional impairment. Conclusion: The health of the majority of patients (83%) deteriorated dramatically, leading to death or severe functional impairment.

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Predicting mortality in systemic Wegener's granulomatosis: A survival analysis based on 93 patients

Bligny¹,

Mahr²,

Toumelin³

et al. 2004

Arthritis & Rheumatism

139

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Objective. To determine predictors of survival of patients with systemic Wegener's granulomatosis (WG).Methods. We retrospectively studied 93 patients (median age 52 years, male/female ratio 1.7) with systemic WG. All subjects received cytotoxic drugs. Survival was evaluated as a function of the main clinical and laboratory parameters and 2 disease activity scores assessed at diagnosis. Statistical analyses used the multivariate Cox proportional hazards regression model. Results. The mean followup was 4.5 years; 25 (27%) patients died. According to univariate analysis, a pejorative prognostic value was attributed to serum creatinine >160 mole/liter (P < 0.001); age >52 years (P < 0.002); absence of ear, nose, and throat (ENT) involvement (P < 0.001); and hemoglobin <11.8 gm/dl (P ‫؍‬ 0.02). Multivariate analysis retained age >52 years (hazard ratio [HR] ‫؍‬ 3.40, P ‫؍‬ 0.04) as an independent predictor of poor outcome, whereas the presence of ENT involvement was associated with a longer survival (HR ‫؍‬ 0.31, P ‫؍‬ 0.02). Conclusion. Our results suggest that an older age and the absence of ENT involvement at diagnosis independently predict an increased risk of mortality for WG patients. These findings could indicate that the prognosis of WG might be governed by the balance between the granulomatosis as opposed to the vasculitic disease process.

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Wegener's Granulomatosis in the Elderly

Cited by 52 publications

References 25 publications

Outcome and Treatment of Elderly Patients with ANCA-Associated Vasculitis

Outcome and Treatment of Elderly Patients with ANCA-Associated Vasculitis

Vasculitis in the Very Elderly

Predicting mortality in systemic Wegener's granulomatosis: A survival analysis based on 93 patients

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