Impact of ANCA-Associated Vasculitis on Outcomes of Hospitalizations for Goodpasture’s Syndrome in the United States: Nationwide Inpatient Sample 2003–2014
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Population
2.3. Predictor of Interest
2.4. In-Hospital Treatment and Outcome of Interest
2.5. Statistical Analysis
3. Results
3.1. Clinical Characteristics
3.2. In-Hospital Treatments
3.3. Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
- Greco, A.; Rizzo, M.I.; De Virgilio, A.; Gallo, A.; Fusconi, M.; Pagliuca, G. Goodpasture’s syndrome: A clinical update. Autoimmun. Rev. 2015, 14, 246–253. [Google Scholar] [CrossRef]
- Moroni, G.; Ponticelli, C. Rapidly progressive crescentic glomerulonephritis: Early treatment is a must. Autoimmun. Rev. 2014, 13, 723–729. [Google Scholar] [CrossRef] [PubMed]
- Gulati, K.; McAdoo, S.P. Anti-Glomerular Basement Membrane Disease. Rheum Dis. Clin. N. Am. 2018, 44, 651–673. [Google Scholar] [CrossRef] [PubMed]
- Hellmark, T.; Segelmark, M. Diagnosis and classification of Goodpasture’s disease (anti-GBM). J. Autoimmun. 2014, 48–49, 108–112. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sinico, R.A.; Radice, A.; Corace, C.; Sabadini, E.; Bollini, B. Anti-glomerular basement membrane antibodies in the diagnosis of Goodpasture syndrome: A comparison of different assays. Nephrol. Dial. Transpl. 2006, 21, 397–401. [Google Scholar] [CrossRef] [Green Version]
- Kaewput, W.; Thongprayoon, C.; Boonpheng, B.; Ungprasert, P.; Bathini, T.; Chewcharat, A. Inpatient Burden and Mortality of Goodpasture’s Syndrome in the United States: Nationwide Inpatient Sample 2003–2014. J. Clin. Med. 2020, 9, 455. [Google Scholar] [CrossRef] [Green Version]
- Rutgers, A.; Slot, M.; van Paassen, P.; van Breda Vriesman, P.; Heeringa, P.; Tervaert, J.W. Coexistence of anti-glomerular basement membrane antibodies and myeloperoxidase-ANCAs in crescentic glomerulonephritis. Am. J. Kidney Dis. 2005, 46, 253–262. [Google Scholar] [CrossRef]
- Jia, X.Y.; Hu, S.Y.; Chen, J.L.; Qu, Z.; Liu, G.; Cui, Z. The clinical and immunological features of patients with combined anti-glomerular basement membrane disease and membranous nephropathy. Kidney Int. 2014, 85, 945–952. [Google Scholar] [CrossRef] [Green Version]
- Cheungpasitporn, W.; Zacharek, C.C.; Fervenza, F.C.; Cornell, L.D.; Sethi, S.; Herrera Hernandez, L.P. Rapidly progressive glomerulonephritis due to coexistent anti-glomerular basement membrane disease and fibrillary glomerulonephritis. Clin. Kidney J. 2016, 9, 97–101. [Google Scholar] [CrossRef] [Green Version]
- File, I.; Pucsok, K.; Trinn, C.; Ujhelyi, L.; Balla, J.; Matyus, J. Clinical consequence and significance of anti-neutrophil cytoplasmic antibody positivity in anti-glomerular basement membrane disease. Orv. Hetil. 2013, 154, 1696–1701. [Google Scholar] [CrossRef]
- Holmes, D. Glomerular disease: MN linked to improved prognosis in anti-GBM disease. Nat. Rev. Nephrol. 2013, 9, 626. [Google Scholar] [CrossRef] [PubMed]
- Booth, A.; Harper, L.; Hammad, T.; Bacon, P.; Griffith, M.; Levy, J. Prospective study of TNFalpha blockade with infliximab in anti-neutrophil cytoplasmic antibody-associated systemic vasculitis. Journal of the American Society of Nephrology. Clin. J. Am. Soc. Nephrol. 2004, 15, 717–721. [Google Scholar] [CrossRef] [PubMed]
- Van Daalen, E.E.; Jennette, J.C.; McAdoo, S.P.; Pusey, C.D.; Alba, M.A.; Poulton, C.J. Predicting Outcome in Patients with Anti-GBM Glomerulonephritis. Clin. J. Am. Soc. Nephrol. 2018, 13, 63–72. [Google Scholar] [CrossRef]
- Angioi, A.; Cheungpasitporn, W.; Sethi, S.; De Vriese, A.S.; Lepori, N.; Schwab, T.R. Familial antiglomerular basement membrane disease in zero human leukocyte antigen mismatch siblings. Clin. Nephrol. 2017, 88, 277–283. [Google Scholar] [CrossRef] [PubMed]
- McAdoo, S.P.; Pusey, C.D. Anti-Glomerular Basement Membrane Disease. Clin. J. Am. Soc. Nephrol. 2017, 12, 1162–1172. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- O’Donoghue, D.J.; Short, C.D.; Brenchley, P.E.; Lawler, W.; Ballardie, F.W. Sequential development of systemic vasculitis with anti-neutrophil cytoplasmic antibodies complicating anti-glomerular basement membrane disease. Clin. Nephrol. 1989, 32, 251–255. [Google Scholar]
- Jayne, D.R.; Marshall, P.D.; Jones, S.J.; Lockwood, C.M. Autoantibodies to GBM and neutrophil cytoplasm in rapidly progressive glomerulonephritis. Kidney Int. 1990, 37, 965–970. [Google Scholar] [CrossRef] [Green Version]
- Olson, S.W.; Arbogast, C.B.; Baker, T.P.; Owshalimpur, D.; Oliver, D.K.; Abbott, K.C. Asymptomatic autoantibodies associate with future anti-glomerular basement membrane disease. J. Am. Soc. Nephrol. 2011, 22, 1946–1952. [Google Scholar] [CrossRef] [Green Version]
- Henderson, S.R.; Salama, A.D. Diagnostic and management challenges in Goodpasture’s (anti-glomerular basement membrane) disease. Nephrol. Dial. Transpl. 2018, 33, 196–202. [Google Scholar] [CrossRef] [Green Version]
- Dez, J.; Taylor, D.; Thein, H.; Yehia, M. Incidence and features of dual anti-GBM-positive and ANCA-positive patients. Nephrology 2011, 16, 725–729. [Google Scholar]
- Verburgh, C.A.; Bruijn, J.A.; Daha, M.R.; van Es, L.A. Sequential development of anti-GBM nephritis and ANCA-associated Pauci-immune glomerulonephritis. Am. J. Kidney Dis. 1999, 34, 344–348. [Google Scholar] [CrossRef]
- Hellmark, T.; Niles, J.L.; Collins, A.B.; McCluskey, R.T.; Brunmark, C. Comparison of anti-GBM antibodies in sera with or without ANCA. J. Am. Soc. Nephrol. 1997, 8, 376–385. [Google Scholar] [PubMed]
- Chen, M.; Cui, Z.; Zhao, M.H. ANCA-associated vasculitis and anti-GBM disease: The experience in China. Nephrol. Dial. Transpl. 2010, 25, 2062–2065. [Google Scholar] [CrossRef] [PubMed]
- Huart, A.; Josse, A.G.; Chauveau, D.; Korach, J.M.; Heshmati, F.; Bauvin, E. Outcomes of patients with Goodpasture syndrome: A nationwide cohort-based study from the French Society of Hemapheresis. J. Autoimmun. 2016, 73, 24–29. [Google Scholar] [CrossRef] [PubMed]
- McAdoo, S.P.; Tanna, A.; Hruskova, Z.; Holm, L.; Weiner, M.; Arulkumaran, N. Patients double-seropositive for ANCA and anti-GBM antibodies have varied renal survival, frequency of relapse, and outcomes compared to single-seropositive patients. Kidney Int. 2017, 92, 693–702. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hirayama, K.; Yamagata, K.; Kobayashi, M.; Koyama, A. Anti-glomerular basement membrane antibody disease in Japan: Part of the nationwide rapidly progressive glomerulonephritis survey in Japan. Clin. Exp. Nephrol. 2008, 12, 339–347. [Google Scholar] [CrossRef]
- Cui, Z.; Zhao, J.; Jia, X.Y.; Zhu, S.N.; Jin, Q.Z.; Cheng, X.Y. Anti-glomerular basement membrane disease: Outcomes of different therapeutic regimens in a large single-center Chinese cohort study. Medicine 2011, 90, 303–311. [Google Scholar] [CrossRef]
- Levy, J.B.; Turner, A.N.; Rees, A.J.; Pusey, C.D. Long-term outcome of anti-glomerular basement membrane antibody disease treated with plasma exchange and immunosuppression. Ann. Intern. Med. 2001, 134, 1033–1042. [Google Scholar] [CrossRef]
- Simon, N.; Coiteux, V.; Bruno, B.; Taque, S.; Charbonnier, A.; Souchet, L. Dose adaptation of the drugs used for hematopoietic stem-cell transplantation in patients with comorbidity: Obesity, chronic renal disease or hepatopathy: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bulletin du Cancer. Consensus Development Conference Practice Guideline Review. Bull. Cancer 2017, 104, S99–S105. [Google Scholar]
- Jennette, J.C.; Nachman, P.H. ANCA Glomerulonephritis and Vasculitis. Clin. J. Am. Soc. Nephrol. 2017, 12, 1680–1691. [Google Scholar] [CrossRef]
- Jefferson, J.A. Treating elderly patients with ANCA-associated vasculitis. Clin. J. Am. Soc. Nephrol. 2015, 10, 1110–1113. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Shiferaw, B.; Miro, V.; Smith, C.; Akella, J.; Chua, W.; Kim, Z. Goodpasture’s Disease: An Uncommon Disease With an Atypical Clinical Course. J. Clin. Med. Res. 2016, 8, 52–55. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Savage, C.O.; Pusey, C.D.; Bowman, C.; Rees, A.J.; Lockwood, C.M. Antiglomerular basement membrane antibody mediated disease in the British Isles 1980–1984. Br. Med. J. 1986, 292, 301–304. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Weber, M.F.; Andrassy, K.; Pullig, O.; Koderisch, J.; Netzer, K. Antineutrophil-cytoplasmic antibodies and antiglomerular basement membrane antibodies in Goodpasture’s syndrome and in Wegener’s granulomatosis. J. Am. Soc. Nephrol. 1992, 2, 1227–1234. [Google Scholar]
- Levy, J.B.; Hammad, T.; Coulthart, A.; Dougan, T.; Pusey, C.D. Clinical features and outcome of patients with both ANCA and anti-GBM antibodies. Kidney Int. 2004, 66, 1535–1540. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bosch, X.; Mirapeix, E.; Font, J.; Borrellas, X.; Rodriguez, R.; Lopez-Soto, A. Prognostic implication of anti-neutrophil cytoplasmic autoantibodies with myeloperoxidase specificity in anti-glomerular basement membrane disease. Clin. Nephrol. 1991, 36, 107–113. [Google Scholar]
- Yu, J.T.; Li, J.N.; Wang, J.; Jia, X.Y.; Cui, Z.; Zhao, M.H. Deglycosylation of myeloperoxidase uncovers its novel antigenicity. Kidney Int. 2017, 91, 1410–1419. [Google Scholar] [CrossRef]
- Yang, R.; Hellmark, T.; Zhao, J.; Cui, Z.; Segelmark, M.; Zhao, M.H. Antigen and epitope specificity of anti-glomerular basement membrane antibodies in patients with goodpasture disease with or without anti-neutrophil cytoplasmic antibodies. J. Am. Soc. Nephrol. 2007, 18, 1338–1343. [Google Scholar] [CrossRef]
- Segelmark, M.; Hellmark, T.; Wieslander, J. The prognostic significance in Goodpasture’s disease of specificity, titre and affinity of anti-glomerular-basement-membrane antibodies. Nephron. Clin. Pract. 2003, 94, c59–c68. [Google Scholar] [CrossRef]
- Alchi, B.; Griffiths, M.; Sivalingam, M.; Jayne, D.; Farrington, K. Predictors of renal and patient outcomes in anti-GBM disease: Clinicopathologic analysis of a two-centre cohort. Nephrol. Dial. Transpl. 2015, 30, 814–821. [Google Scholar] [CrossRef] [Green Version]
Characteristics | Total | Goodpasture’s Syndrome Alone | Goodpasture’s Syndrome and ANCA | p-Value |
---|---|---|---|---|
Number | 964 | 880 | 84 | |
Age (years) | 54 ± 21 | 54 ± 21 | 57 ± 19 | 0.13 |
≤39 | 27% | 28% | 20% | 0.01 |
40–49 | 9% | 10% | 6% | |
50–59 | 15% | 14% | 24% | |
60–69 | 21% | 21% | 13% | |
≥70 | 28% | 28% | 37% | |
Male | 47% | 47% | 54% | 0.23 |
Caucasian | 65% | 65% | 64% | 0.96 |
Smoking | 10% | 10% | 8% | 0.62 |
Hemoptysis | 28% | 27% | 42% | <0.01 |
Plasmapheresis | 39% | 40% | 32% | 0.18 |
Treatment | Goodpasture’s Syndrome Alone | Goodpasture’s Syndrome and ANCA |
---|---|---|
Mechanical ventilation | 18% | 25% |
Unadjusted OR | 1 (ref) | 1.50 (0.89–2.53) |
Adjusted OR | 1 (ref) | 1.48 (0.87–2.52) |
Non-invasive ventilation | 5% | 10% |
Unadjusted OR | 1 (ref) | 2.15 (0.98–4.76) |
Adjusted OR | 1 (ref) | 1.94 (0.86–4.35) |
Renal replacement therapy | 53% | 42% |
Unadjusted OR | 1 (ref) | 0.64 (0.41–1.01) |
Adjusted OR | 1 (ref) | 0.67 (0.42–1.07) |
Outcomes | Goodpasture’s Syndrome Alone | Goodpasture’s Syndrome and ANCA |
---|---|---|
Respiratory failure | 29% | 38% |
Unadjusted OR | 1 (ref) | 1.54 (0.97–2.45) |
Adjusted OR | 1 (ref) | 1.42 (0.88–2.29) |
Circulatory failure | 6% | 5% |
Unadjusted OR | 1 (ref) | 1.10 (0.42–2.84) |
Adjusted OR | 1 (ref) | 1.21 (0.46–3.17) |
Renal failure | 61% | 70% |
Unadjusted OR | 1 (ref) | 1.50 (0.92–2.44) |
Adjusted OR | 1 (ref) | 1.47 (0.89–2.43) |
Hematologic failure | 14% | 8% |
Unadjusted OR | 1 (ref) | 0.58 (0.26–1.28) |
Adjusted OR | 1 (ref) | 0.68 (0.30–1.52) |
Sepsis | 7% | 5% |
Unadjusted OR | 1 (ref) | 0.71 (0.25–2.00) |
Adjusted OR | 1 (ref) | 0.75 (0.26–2.16) |
In-hospital mortality | 8% | 7% |
Unadjusted OR | 1 (ref) | 0.92 (0.39–2.19) |
Adjusted OR | 1 (ref) | 0.71 (0.29–1.74) |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Thongprayoon, C.; Kaewput, W.; Boonpheng, B.; Ungprasert, P.; Bathini, T.; Srivali, N.; Vallabhajosyula, S.; Castaneda, J.L.; Monga, D.; Kanduri, S.R.; et al. Impact of ANCA-Associated Vasculitis on Outcomes of Hospitalizations for Goodpasture’s Syndrome in the United States: Nationwide Inpatient Sample 2003–2014. Medicina 2020, 56, 103. https://doi.org/10.3390/medicina56030103
Thongprayoon C, Kaewput W, Boonpheng B, Ungprasert P, Bathini T, Srivali N, Vallabhajosyula S, Castaneda JL, Monga D, Kanduri SR, et al. Impact of ANCA-Associated Vasculitis on Outcomes of Hospitalizations for Goodpasture’s Syndrome in the United States: Nationwide Inpatient Sample 2003–2014. Medicina. 2020; 56(3):103. https://doi.org/10.3390/medicina56030103
Chicago/Turabian StyleThongprayoon, Charat, Wisit Kaewput, Boonphiphop Boonpheng, Patompong Ungprasert, Tarun Bathini, Narat Srivali, Saraschandra Vallabhajosyula, Jorge L. Castaneda, Divya Monga, Swetha R. Kanduri, and et al. 2020. "Impact of ANCA-Associated Vasculitis on Outcomes of Hospitalizations for Goodpasture’s Syndrome in the United States: Nationwide Inpatient Sample 2003–2014" Medicina 56, no. 3: 103. https://doi.org/10.3390/medicina56030103