#3424 Renal Outcomes in the Elderly With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis: A New Prediction Model

Abstract

Background and Aims Antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) is a type of necrotizing small vessel inflammatory disease, including alveolar hemorrhage and rapidly progressive glomerulonephritis. Elderly patients with antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) commonly experience renal impairment and poor prognosis. Based on the cohort of inpatients with AAV in Peking Union Medical College Hospital, this study aimed to analyze the clinical manifestations, diagnosis and treatment characteristics of elderly patients compared with non-elderly patients, and establish a risk scoring system for predicting composite renal outcomes in patients with AAV in elderly patients. Method This retrospective observational study included all AAV patients hospitalized in a single-center tertiary hospital in China between January 2013 and April 2022. Patients aged ≥ 65 years were defined as elderly and randomly divided into development and validation cohorts (2:1). Logistic regression analysis was performed in the development cohort to analyze risk factors. The scoring system was established accordingly and further validated in the validation cohort. Results A total of 1203 patients were enrolled in the study, among whom the elderly group accounted for 36% with a mean age of 71.4 ± 0.3 years. The elderly group had a worse prognosis, a higher mortality rate (8.9% vs. 3.5%, P < 0.001), a higher rate of end-stage renal disease (17.6% vs. 10.2%, P < 0.001), and worsening renal function (7.4% vs. 4.5%, P = 0.04). Logistic regression showed that age > 75 years, chronic heart disease, elevated serum creatine, and D-dimer values were risk factors for poor prognosis in patients with AAV. The development and validation cohorts in AAV patients produced area under the curve values of 0.823 (0.784–0.862) and 0.833 (0.777–0.888), respectively (Figure 1). When the risk score was ≥ 2 points, the risk of acquiring composite renal outcomes increased significantly with a sensitivity and specificity of 75.0% and 79.9%, respectively. Conclusion We established risk-scoring systems based on baseline clinical characteristics to predict composite renal outcomes in patients with AAV. Our results suggest that more attention should be paid to elderly patients who have severe renal impairment and active inflammation.