Red Blood Cell Distribution Width Can Predict Vasculitis Activity and Poor Prognosis in Granulomatosis with Polyangiitis

Overview

Journal Yonsei Med J

Specialty General Medicine

Date 2018 Feb 14

PMID 29436199

Citations 6

Authors

Ho Jae Kim

Juyoung Yoo

Seung Min Jung

Jason Jungsik Song

Yong Beom Park

Sang Won Lee

Affiliations

Soon will be listed here.

Abstract

Purpose: We investigated whether red blood cell distribution width (RDW) predicts vasculitis activity based on Birmingham vasculitis activity score (BVAS) or BVAS for granulomatosis with polyangiitis (GPA) at diagnosis and poor prognosis during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).

Materials And Methods: We reviewed the medical records of 150 patients with AAV. We defined severe GPA as BVAS for GPA ≥7 (the highest quartile). Correlation and standardised correlation coefficients were analysed by linear regression tests. The differences between groups were evaluated by Mann-Whitney test. Relative risk (RR) was assessed by chi square test and Cox hazards model.

Results: RDW was correlated only with the vasculitis activity of GPA among patients with AAV. An increase in RDW was associated with the absence of ear nose throat (ENT) manifestation, but not proteinase 3-ANCA. Significant differences were noted in cumulative refractory free survival according to RDW ≥15.4% (p=0.007) and the absence of ENT manifestation (p=0.036). Multivariate Cox hazards analysis identified RDW ≥15.4% as the only significant predictor of refractory disease in GPA (RR 17.573).

Conclusion: RDW predicts vasculitis activity in GPA, and RDW ≥15.4% at diagnosis may increase the risk of severe GPA at diagnosis and predict refractory diseases during follow-up.

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References

Yoo J, Kim H, Ahn S, Jung S, Song J, Park Y . Clinical and prognostic features of Korean patients with MPO-ANCA, PR3-ANCA and ANCA-negative vasculitis. Clin Exp Rheumatol. 2017; 35 Suppl 103(1):111-118. View

Furuta S, Chaudhry A, Arimura Y, Dobashi H, Fujimoto S, Homma S . Comparison of the Phenotype and Outcome of Granulomatosis with Polyangiitis Between UK and Japanese Cohorts. J Rheumatol. 2016; 44(2):216-222. DOI: 10.3899/jrheum.160005. View

Gayraud M, Guillevin L, Le Toumelin P, Cohen P, Lhote F, Casassus P . Long-term followup of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: analysis of four prospective trials including 278 patients. Arthritis Rheum. 2001; 44(3):666-75. DOI: 10.1002/1529-0131(200103)44:3<666::AID-ANR116>3.0.CO;2-A. View

Evans T, Jehle D . The red blood cell distribution width. J Emerg Med. 1991; 9 Suppl 1:71-4. DOI: 10.1016/0736-4679(91)90592-4. View

Bloch D, Michel B, Hunder G, McShane D, Arend W, Calabrese L . The American College of Rheumatology 1990 criteria for the classification of vasculitis. Patients and methods. Arthritis Rheum. 1990; 33(8):1068-73. DOI: 10.1002/art.1780330803. View

Jennette J, Falk R, Bacon P, Basu N, Cid M, Ferrario F . 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2012; 65(1):1-11. DOI: 10.1002/art.37715. View

Stone J, Hoffman G, Merkel P, Min Y, Uhlfelder M, Hellmann D . A disease-specific activity index for Wegener's granulomatosis: modification of the Birmingham Vasculitis Activity Score. International Network for the Study of the Systemic Vasculitides (INSSYS). Arthritis Rheum. 2001; 44(4):912-20. DOI: 10.1002/1529-0131(200104)44:4<912::AID-ANR148>3.0.CO;2-5. View

Yoo J, Kim H, Jung S, Song J, Park Y, Lee S . Birmingham vasculitis activity score of more than 9.5 at diagnosis is an independent predictor of refractory disease in granulomatosis with polyangiitis. Int J Rheum Dis. 2017; 20(10):1593-1605. DOI: 10.1111/1756-185X.13144. View

Aksoy S, Savas E, Sucu M, Kisacik B, Kul S, Zengin O . Association between red blood cell distribution width and disease activity in patients with Behçet's disease. J Int Med Res. 2015; 43(6):765-73. DOI: 10.1177/0300060515591063. View

10.

Puechal X, Pagnoux C, Perrodeau E, Hamidou M, Boffa J, Kyndt X . Long-Term Outcomes Among Participants in the WEGENT Trial of Remission-Maintenance Therapy for Granulomatosis With Polyangiitis (Wegener's) or Microscopic Polyangiitis. Arthritis Rheumatol. 2015; 68(3):690-701. DOI: 10.1002/art.39450. View

11.

Koma Y, Onishi A, Matsuoka H, Oda N, Yokota N, Matsumoto Y . Increased red blood cell distribution width associates with cancer stage and prognosis in patients with lung cancer. PLoS One. 2013; 8(11):e80240. PMC: 3823700. DOI: 10.1371/journal.pone.0080240. View

12.

de Groot K, Gross W, Herlyn K, Reinhold-Keller E . Development and validation of a disease extent index for Wegener's granulomatosis. Clin Nephrol. 2001; 55(1):31-8. View

13.

Oh Y, Ahn S, Park E, Jung S, Song J, Park Y . Birmingham vasculitis activity score at diagnosis is a significant predictor of relapse of polyarteritis nodosa. Rheumatol Int. 2017; 37(5):685-694. DOI: 10.1007/s00296-017-3706-5. View

14.

Mukhtyar C, Lee R, Brown D, Carruthers D, Dasgupta B, Dubey S . Modification and validation of the Birmingham Vasculitis Activity Score (version 3). Ann Rheum Dis. 2008; 68(12):1827-32. DOI: 10.1136/ard.2008.101279. View

15.

Miloslavsky E, Lu N, Unizony S, Choi H, Merkel P, Seo P . Myeloperoxidase-Antineutrophil Cytoplasmic Antibody (ANCA)-Positive and ANCA-Negative Patients With Granulomatosis With Polyangiitis (Wegener's): Distinct Patient Subsets. Arthritis Rheumatol. 2016; 68(12):2945-2952. PMC: 5541999. DOI: 10.1002/art.39812. View

16.

Watts R, Lane S, Hanslik T, Hauser T, Hellmich B, Koldingsnes W . Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis. 2006; 66(2):222-7. PMC: 1798520. DOI: 10.1136/ard.2006.054593. View

17.

Rodriguez-Carrio J, Alperi-Lopez M, Lopez P, Alonso-Castro S, Ballina-Garcia F, Suarez A . Red cell distribution width is associated with cardiovascular risk and disease parameters in rheumatoid arthritis. Rheumatology (Oxford). 2014; 54(4):641-6. DOI: 10.1093/rheumatology/keu345. View

18.

Leavitt R, Fauci A, Bloch D, Michel B, Hunder G, Arend W . The American College of Rheumatology 1990 criteria for the classification of Wegener's granulomatosis. Arthritis Rheum. 1990; 33(8):1101-7. DOI: 10.1002/art.1780330807. View

19.

Dabbah S, Hammerman H, Markiewicz W, Aronson D . Relation between red cell distribution width and clinical outcomes after acute myocardial infarction. Am J Cardiol. 2010; 105(3):312-7. DOI: 10.1016/j.amjcard.2009.09.027. View

20.

Guillevin L, Pagnoux C, Seror R, Mahr A, Mouthon L, Le Toumelin P . The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort. Medicine (Baltimore). 2011; 90(1):19-27. DOI: 10.1097/MD.0b013e318205a4c6. View