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Diagnostic outcome and indications for testing in patients with positive ANCA at a Canadian tertiary care centre

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Abstract

Introduction/objective

With widespread availability of anti-neutrophil cytoplasmic antibody (ANCA) testing, interpreting positive results has become increasingly challenging. Here, we conducted a retrospective study to evaluate indications for testing and diagnosis of patients with positive ANCA.

Methods

Positive ANCA tests (immunofluorescence or immunoassay) performed between April 2014 and March 2015 were identified using the Ottawa Hospital (TOH) laboratory information system. TOH electronic records of subjects with positive ANCA were reviewed.

Results

96 patients had first-time positive ANCA in the study year. The indications for testing were suspicion for: AAV in 22 patients (23%), unspecified vasculitis in 24(25%), an inflammatory condition in 46(48%), and unknown in 4(4%). Twenty-eight patients (29% of first-time positives) were diagnosed with AAV, corresponding to 16(72%), 8(33%), 4(9%), and 0 patients tested for these indications, respectively; 49(51%) of patients had other inflammatory or infectious etiologies, and non-inflammatory diagnoses accounted for the remaining 19(20%). One hundred and forty-four repeat ANCAs were performed with life-time mean of 4.4 re-tests per patient (range 0–44). Routine monitoring accounted for 86(72%) of all repeat tests. Management was changed following 34% of all re-tests performed for changed clinical status and 1% of re-tests conducted routinely.

Conclusion

Few patients who start with low clinical suspicion for AAV and have positive ANCA are subsequently diagnosed with AAV. Serial ANCA testing is common but is not supported by clear evidence, and rarely leads to change in management. Clarification of guidelines on effective ANCA ordering may reduce hospital laboratory costs.

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Authors and Affiliations

  1. Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Cyrus Chehroudi, Ronald A. Booth & Nataliya Milman

  2. Division of Biochemistry, The Ottawa Hospital, Ottawa, ON, Canada

    Ronald A. Booth

  3. Division of Rheumatology, The Ottawa Hospital, Riverside Campus, 1967 Riverside Drive, Box 37, Ottawa, ON, K1H 7W9, Canada

    Nataliya Milman

  4. Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada

    Nataliya Milman

Authors
  1. Cyrus Chehroudi
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  2. Ronald A. Booth
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  3. Nataliya Milman
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Contributions

CC, RAB, and NM wrote the manuscript. CC and RAB extracted the data. CC and NM performed the data analysis. All authors approved the final manuscript prior to submission.

Corresponding author

Correspondence to Nataliya Milman.

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Ethical approval

Cyrus Chehroudi, Ronald Booth, and Nataliya Milman declare that they have no conflicts of interest related to this study. This study was approved by the Ottawa Hospital’s Research Ethics Board on April 8, 2015 (Ethics Approval Protocol no. 20150233-01H) with waive of informed consent as this was a retrospective chart review. Data collection was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Chehroudi, C., Booth, R.A. & Milman, N. Diagnostic outcome and indications for testing in patients with positive ANCA at a Canadian tertiary care centre. Rheumatol Int 38, 641–647 (2018). https://doi.org/10.1007/s00296-017-3905-0

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  • DOI: https://doi.org/10.1007/s00296-017-3905-0

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