tetano
Editor, Senior Moderator
J Clin Rheumatol
. 2022 May 25.
doi: 10.1097/RHU.0000000000001855. Online ahead of print.
Antineutrophil Cytoplasmic Antibody-Associated Vasculitis and COVID-19: The Clinical Course and Prognosis of 15 Patients From a Tertiary Care Center
Burak İnce[SUP] 1 [/SUP], Murat Bektaş[SUP] 1 [/SUP], Nevzat Koca[SUP] 1 [/SUP], Besim Fazıl Ağargün[SUP] 2 [/SUP], Sibel Zarali[SUP] 2 [/SUP], Damla Yenersu Güzey[SUP] 3 [/SUP], Görkem Durak[SUP] 4 [/SUP], Yasemin Yalçinkaya[SUP] 1 [/SUP], Bahar Artim-Esen[SUP] 1 [/SUP], Ahmet Gül[SUP] 1 [/SUP], Murat İnanç[SUP] 1 [/SUP]
Affiliations
Abstract
Objective: The aim of this study was to evaluate incidence rates, prognoses, and disease-related factors associated with poor outcomes in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) who had coronavirus disease (COVID-19).
Methods: Patients with AAV were questioned for a history of COVID-19 in the outpatient setting. Cumulative clinical findings and treatment history were obtained from the patients' medical records. The clinical, laboratory, and imaging findings of inpatients with COVID-19 were recorded. The data of patients who developed symptomatic COVID-19 and/or died of the disease were used for comparison.
Results: Eighty-nine patients (47.2% female; mean age, 56 ± 12.5 years) were included. The diagnosis was granulomatosis with polyangiitis in 56 patients (62.9%) and microscopic polyangiitis in 33 (37.1%). Sixty-one (68.2%) and 21 patients (23.6%) had renal and peripheral nerve involvement, respectively. Ten patients had a history of diffuse alveolar hemorrhage. Fifteen patients (16.9%) had COVID-19, including 9 (60%) with severe pneumonia. Twelve patients (85.7%) were hospitalized, 6 (42.9%) were admitted to the intensive care unit, and 5 (35.7%) died. All deceased patients had hypogammaglobulinemia (IgG levels <700 mg/dL) during hospital admission. Symptomatic COVID-19 was associated with higher disease activity, glucocorticoid and rituximab treatments, and glomerular filtration rate <30 mL/min. A history of peripheral nerve involvement, higher organ damage scores, and hypogammaglobulinemia was associated with mortality.
Conclusions: The prognosis was poor in our patients with AAV who had COVID-19, especially those with severe multisystem involvement. Hypogammaglobulinemia was associated with mortality. Serum IgG level monitoring in patients with AAV would be beneficial during the COVID-19 pandemic.
. 2022 May 25.
doi: 10.1097/RHU.0000000000001855. Online ahead of print.
Antineutrophil Cytoplasmic Antibody-Associated Vasculitis and COVID-19: The Clinical Course and Prognosis of 15 Patients From a Tertiary Care Center
Burak İnce[SUP] 1 [/SUP], Murat Bektaş[SUP] 1 [/SUP], Nevzat Koca[SUP] 1 [/SUP], Besim Fazıl Ağargün[SUP] 2 [/SUP], Sibel Zarali[SUP] 2 [/SUP], Damla Yenersu Güzey[SUP] 3 [/SUP], Görkem Durak[SUP] 4 [/SUP], Yasemin Yalçinkaya[SUP] 1 [/SUP], Bahar Artim-Esen[SUP] 1 [/SUP], Ahmet Gül[SUP] 1 [/SUP], Murat İnanç[SUP] 1 [/SUP]
Affiliations
- PMID: 35612560
- DOI: 10.1097/RHU.0000000000001855
Abstract
Objective: The aim of this study was to evaluate incidence rates, prognoses, and disease-related factors associated with poor outcomes in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) who had coronavirus disease (COVID-19).
Methods: Patients with AAV were questioned for a history of COVID-19 in the outpatient setting. Cumulative clinical findings and treatment history were obtained from the patients' medical records. The clinical, laboratory, and imaging findings of inpatients with COVID-19 were recorded. The data of patients who developed symptomatic COVID-19 and/or died of the disease were used for comparison.
Results: Eighty-nine patients (47.2% female; mean age, 56 ± 12.5 years) were included. The diagnosis was granulomatosis with polyangiitis in 56 patients (62.9%) and microscopic polyangiitis in 33 (37.1%). Sixty-one (68.2%) and 21 patients (23.6%) had renal and peripheral nerve involvement, respectively. Ten patients had a history of diffuse alveolar hemorrhage. Fifteen patients (16.9%) had COVID-19, including 9 (60%) with severe pneumonia. Twelve patients (85.7%) were hospitalized, 6 (42.9%) were admitted to the intensive care unit, and 5 (35.7%) died. All deceased patients had hypogammaglobulinemia (IgG levels <700 mg/dL) during hospital admission. Symptomatic COVID-19 was associated with higher disease activity, glucocorticoid and rituximab treatments, and glomerular filtration rate <30 mL/min. A history of peripheral nerve involvement, higher organ damage scores, and hypogammaglobulinemia was associated with mortality.
Conclusions: The prognosis was poor in our patients with AAV who had COVID-19, especially those with severe multisystem involvement. Hypogammaglobulinemia was associated with mortality. Serum IgG level monitoring in patients with AAV would be beneficial during the COVID-19 pandemic.