Sex Disparities in Clinicopathological Features and Outcomes of Patients with Myeloperoxidase-ANCA-associated Vasculitis: a Retrospective Study of 366 Cases in a Single Chinese Center

Overview

Journal Clin Exp Med

Specialty General Medicine

Date 2023 Jul 10

PMID 37428262

Authors

Ting Meng

Peng Zhu

Chanjuan Shen

Joshua D Ooi

Peter Eggenhuizen

Ya-Ou Zhou

Hui Luo

Jin-Biao Chen

Wei Lin

Qi Xiong

Yizi Gong

Rong Tang

Xiang Ao

Weisheng Peng

Zhou Xiao

Ping Xiao

Xiangcheng Xiao

Yong Zhong

Affiliations

Soon will be listed here.

Abstract

There are a few studies that reported sex disparities in clinical features, pathological features and outcomes among ANCA-associated vasculitis (AAV) patients, but studies focusing on sex-specific differences of myeloperoxidase (MPO)-AAV patients are scarce. Therefore, the purpose of this study was to analyze sex differences in clinicopathological features and outcomes of MPO-AAV. Patients diagnosed with MPO-AAV in Xiangya Hospital from January 2010 to June 2021 were included in the study and separated into female and male groups. The differences in clinical manifestations, laboratory parameters, pathological features and prognosis between the two groups were retrospectively analyzed. Three hundred and sixty-six patients were included and divided into female group (n = 176) and male group (n = 190). The age of the male group was 62.41 ± 10.49 years, significantly higher than that of the female group (58.69 ± 16.39, p = 0.011). Compared with the female group, the male group had a shorter duration of disease, higher levels of hemoglobin, eosinophil count, proteinuria, serum C4, and lower levels of serum globulin, serum IgG and serum IgM (p < 0.05). No significant differences in kidney pathological features were observed between the two groups. During a median follow-up of 37.6 months, there was no significant difference in renal survival and patient survival between the two groups, but male patients had a worse composite outcome of renal and patient survival compared with the female patients (p = 0.044). This study found that male patients with MPO-AAV had a higher age of onset, shorter duration of disease, higher levels of hemoglobin, eosinophil count, proteinuria, serum C4, and lower levels of serum globulin, serum IgG and serum IgM. Male patients fared worse than female patients in terms of the composite outcome of renal and patient survival.

References

Kitching A, Anders H, Basu N, Brouwer E, Gordon J, Jayne D . ANCA-associated vasculitis. Nat Rev Dis Primers. 2020; 6(1):71. DOI: 10.1038/s41572-020-0204-y. 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

Wallace Z, Miloslavsky E . Management of ANCA associated vasculitis. BMJ. 2020; 368:m421. DOI: 10.1136/bmj.m421. View

Hilhorst M, van Paassen P, Cohen Tervaert J . Proteinase 3-ANCA Vasculitis versus Myeloperoxidase-ANCA Vasculitis. J Am Soc Nephrol. 2015; 26(10):2314-27. PMC: 4587702. DOI: 10.1681/ASN.2014090903. View

Cornec D, Cornec-Le Gall E, Fervenza F, Specks U . ANCA-associated vasculitis - clinical utility of using ANCA specificity to classify patients. Nat Rev Rheumatol. 2016; 12(10):570-9. DOI: 10.1038/nrrheum.2016.123. View

Jayne D, Rasmussen N, Andrassy K, Bacon P, Cohen Tervaert J, Dadoniene J . A randomized trial of maintenance therapy for vasculitis associated with antineutrophil cytoplasmic autoantibodies. N Engl J Med. 2003; 349(1):36-44. DOI: 10.1056/NEJMoa020286. View

Flossmann O, Berden A, Groot K, Hagen C, Harper L, Heijl C . Long-term patient survival in ANCA-associated vasculitis. Ann Rheum Dis. 2010; 70(3):488-94. DOI: 10.1136/ard.2010.137778. View

Titeca-Beauport D, Francois A, Lobbedez T, Guerrot D, Launay D, Vrigneaud L . Early predictors of one-year mortality in patients over 65 presenting with ANCA-associated renal vasculitis: a retrospective, multicentre study. BMC Nephrol. 2018; 19(1):317. PMC: 6234782. DOI: 10.1186/s12882-018-1102-3. View

Yen C, Tian Y, Wu H, Tu K, Liu S, Lee C . High anti-neutrophil cytoplasmic antibody titers are associated with the requirement of permanent dialysis in patients with myeloperoxidase-ANCA-associated vasculitis. J Formos Med Assoc. 2019; 118(10):1408-1415. DOI: 10.1016/j.jfma.2019.05.004. View

10.

Berden A, Ferrario F, Hagen E, Jayne D, Jennette J, Joh K . Histopathologic classification of ANCA-associated glomerulonephritis. J Am Soc Nephrol. 2010; 21(10):1628-36. DOI: 10.1681/ASN.2010050477. View

11.

Bjorneklett R, Solbakken V, Bostad L, Fismen A . Exploring sex-specific differences in the presentation and outcomes of ANCA-associated vasculitis: a nationwide registry-based cohort study. Int Urol Nephrol. 2018; 50(7):1311-1318. DOI: 10.1007/s11255-018-1888-8. View

12.

Kwon H, Pyo J, Lee L, Ahn S, Song J, Park Y . Male Sex Is a Significant Predictor of All-cause Mortality in Patients with Antineutrophil Cytoplasmic Antibody-associated Vasculitis. J Korean Med Sci. 2021; 36(18):e120. PMC: 8111045. DOI: 10.3346/jkms.2021.36.e120. View

13.

Scott J, Canepa C, Buettner A, Ryan L, Moloney B, Cormican S . A cohort study to investigate sex-specific differences in ANCA-associated glomerulonephritis outcomes. Sci Rep. 2021; 11(1):13080. PMC: 8219762. DOI: 10.1038/s41598-021-92629-7. View

14.

Tampe D, Korsten P, Strobel P, Hakroush S, Tampe B . Comprehensive Analysis of Sex Differences at Disease Manifestation in ANCA-Associated Glomerulonephritis. Front Immunol. 2021; 12:736638. PMC: 8495213. DOI: 10.3389/fimmu.2021.736638. View

15.

Lacou M, Leroy M, Le Lan N, Toquet C, Espitia-Thibault A, Graveleau J . Muscle biopsy in anti-neutrophil cytoplasmic antibody-associated vasculitis: diagnostic yield depends on anti-neutrophil cytoplasmic antibody type, sex and neutrophil count. Rheumatology (Oxford). 2020; 60(2):699-707. DOI: 10.1093/rheumatology/keaa233. View

16.

Rais-Jalali G, Khajehdedi P . ANCA-associated glomerulonephritis: Relationship of main ANCA subtypes to renal outcome, age and sex of the patients. Ann Saudi Med. 2007; 19(5):413-6. DOI: 10.5144/0256-4947.1999.413. View

17.

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

18.

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

19.

Huang L, Shen C, Zhong Y, Ooi J, Zhou Y, Chen J . The association of neutrophil-to-lymphocyte ratio with all-cause mortality in Chinese patients with MPO-ANCA associated vasculitis. Clin Exp Med. 2020; 20(3):401-408. DOI: 10.1007/s10238-020-00629-0. View

20.

Lin W, Shen C, Zhong Y, Ooi J, Eggenhuizen P, Zhou Y . Glomerular Immune Deposition in MPO-ANCA Associated Glomerulonephritis Is Associated With Poor Renal Survival. Front Immunol. 2021; 12:625672. PMC: 8027492. DOI: 10.3389/fimmu.2021.625672. View