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Association between biopsies for anti-neutrophil cytoplasmic antibody-associated vasculitis and prognosis: a retrospective cohort study

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Abstract

Objectives

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic vasculitis with unknown aetiology. Although biopsies are helpful for diagnosing AAV, whether they improve the outcomes of AAV patients remains unknown. The objective of this study was to elucidate the association between biopsies and prognosis.

Method

This retrospective cohort study analysed health care records that were routinely collected at 190 hospitals in Japan from April 2005 to March 2019. Patients who were 18 years or older and hospitalized for AAV were eligible for inclusion. The primary outcome was the composite outcome of death and renal replacement therapy (RRT) during the first admission. We compared the outcome between the biopsy group and the no-biopsy group. The chi-square test was performed as a univariable analysis, and logistic regression analysis was performed as a multivariable analysis.

Results

Three hundred and eighty-six patients were assessed in this study. One hundred fifty-four (39.9%) patients underwent biopsy, and 232 (60.1%) patients did not undergo biopsy during the first admission with AAV. In univariable analysis, the composite outcome of death and RRT were observed in 7 (4.5%) patients in the biopsy group and 25 (10.8%) patients in the no-biopsy group (OR 0.39 [95% CI 0.17, 0.94], P = 0.01). The result was consistent in the multivariable analysis (OR 0.31 [95% CI 0.12, 0.79], P = 0.01) after adjusting for potential confounders.

Conclusions

We showed that patients who underwent biopsy had a better prognosis in the composite outcome of mortality and RRT during admission using a Japanese healthcare record database.

Key Points

• This is the first study to elucidate the association between undergoing biopsy and prognosis.

• Patients undergoing biopsy had a better prognosis in the composite outcome of mortality and RRT.

• The proportion of patients who received transfusions was not significantly different between the two groups.

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References

  1. Pagnoux C (2016) Updates in ANCA-associated vasculitis. Eur J Rheumatol 3(3):122–133. https://doi.org/10.5152/eurjrheum.2015.0043

    Article  PubMed  PubMed Central  Google Scholar 

  2. Koyama A, Yamagata K, Makino H, Arimura Y, Wada T, Nitta K et al (2009) A nationwide survey of rapidly progressive glomerulonephritis in Japan: etiology, prognosis and treatment diversity. Clin Exp Nephrol 13(6):633–650. https://doi.org/10.1007/s10157-009-0201-7

    Article  PubMed  Google Scholar 

  3. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F et al (2013) 2012 Revised International Chapel Hill consensus conference nomenclature of vasculitides. In: Arthritis and rheumatism. Instituto Nacional de Enfermedades Respiratorias 1:1–11. https://doi.org/10.1002/art.37715

  4. La Guillevin L (2012) granulomatose éosinophilique avec polyangéite (syndrome de Churg et Strauss). Vol. 41. Presse Med 41:1004–13. https://doi.org/10.1016/j.lpm.2012.07.008

    Article  Google Scholar 

  5. Comarmond C, Pagnoux C, Khellaf M, Cordier JF, Hamidou M, Viallard JF et al (2013) Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): clinical characteristics and long-term followup of the 383 patients enrolled in the French Vasculitis Study Group cohort. Arthritis Rheum 65(1):270–281. https://doi.org/10.1002/art.37721

    Article  PubMed  Google Scholar 

  6. Watts RA, Mahr A, Mohammad AJ, Gatenby P, Basu N, Flores-Suárez LF (2015) Classification, epidemiology and clinical subgrouping of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Nephrol Dial Transplant 30:i14-22. https://doi.org/10.1093/ndt/gfv022

    Article  CAS  PubMed  Google Scholar 

  7. Fujimoto S, Uezono S, Hisanaga S, Fukudome K, Kobayashi S, Suzuki K et al (2006) Incidence of ANCA-associated primary renal vasculitis in the Miyazaki Prefecture: the first population-based, retrospective, epidemiologic survey in Japan. Clin J Am Soc Nephrol 1(5):1016–1022. https://doi.org/10.2215/CJN.01461005

    Article  PubMed  Google Scholar 

  8. Mohammad AJ, Weiner M, Sjöwall C, Johansson ME, Bengtsson AA, Ståhl-Hallengren C et al (2015) Incidence and disease severity of anti-neutrophil cytoplasmic antibody-associated nephritis are higher than in lupus nephritis in Sweden. Nephrol Dial Transplant 30:i23-30. https://doi.org/10.1093/ndt/gfu396

    Article  CAS  PubMed  Google Scholar 

  9. Mohammad AJ, Jacobsson LTH, Westman KWA, Sturfelt G, Segelmark M (2009) Incidence and survival rates in Wegener’s granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome and polyarteritis nodosa. Rheumatology 48(12):1560–1565. https://doi.org/10.1093/rheumatology/kep304

    Article  PubMed  Google Scholar 

  10. Mohammad AJ, Segelmark M (2014) Antineutrophil cytoplasmic antibody (ANCA) a population-based study showing better renal prognosis for proteinase 3. J Rheumatol 41(7):2020. https://doi.org/10.3899/jrheum.131038

    Article  Google Scholar 

  11. Watts RA, Scott DGI, Jayne DRW, Ito-Ihara T, Muso E, Fujimoto S et al (2008) Renal vasculitis in Japan and the UK - are there differences in epidemiology and clinical phenotype? Nephrol Dial Transplant 23(12):3928–3931. https://doi.org/10.1093/ndt/gfn354

    Article  PubMed  Google Scholar 

  12. Thompson G, Klecka M, Roden AC, Specks U, Cartin-Ceba R (2016) Biopsy-proven pulmonary capillaritis: a retrospective study of aetiologies including an in-depth look at isolated pulmonary capillaritis. Respirology 21(4):734–738. https://doi.org/10.1111/resp.12738

    Article  PubMed  Google Scholar 

  13. Berden AE, Ferrario F, Hagen EC, Jayne DR, Jennette JC, Joh K et al (2010) Histopathologic classification of ANCA-associated glomerulonephritis. J Am Soc Nephrol 21:1628–1636. https://doi.org/10.1681/ASN.2010050477

    Article  PubMed  Google Scholar 

  14. Corapi KM, Chen JLT, Balk EM, Gordon CE (2012) Bleeding complications of native kidney biopsy: a systematic review and meta-analysis. Am J Kidney Dis 60(1):62–73. https://doi.org/10.1053/j.ajkd.2012.02.330

    Article  PubMed  Google Scholar 

  15. Ravaglia C, Bonifazi M, Wells AU, Tomassetti S, Gurioli C, Piciucchi S et al (2016) Safety and diagnostic yield of transbronchial lung cryobiopsy in diffuse parenchymal lung diseases: a comparative study versus video-assisted thoracoscopic lung biopsy and a systematic review of the literature. Respiration 91(3):215–227. https://doi.org/10.1159/000444089

    Article  PubMed  Google Scholar 

  16. Yates M, Watts RA, Bajema IM, Cid MC, Crestani B, Hauser T et al (2016) EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheum Dis 75(9):1583–1594. https://doi.org/10.1136/annrheumdis-2016-209133

    Article  CAS  PubMed  Google Scholar 

  17. Mukhtyar C, Guillevin L, Cid MC, Dasgupta B, De Groot K, Gross W et al (2009) EULAR recommendations for the management of primary small and medium vessel vasculitis. Ann Rheum Dis 68(3):310–317. https://doi.org/10.1136/ard.2008.088096

    Article  CAS  PubMed  Google Scholar 

  18. Travis WD, Hoffman GS, Leavitt RY, Pass HI, Fauci AS (1991) Surgical pathology of the lung in Wegener’s granulomatosis: review of 87 open lung biopsies from 67 patients. Am J Surg Pathol 15(4):315–33. https://doi.org/10.1097/00000478-199104000-00001

    Article  CAS  PubMed  Google Scholar 

  19. Devaney KO, Ferlito A, Hunter BC, Devaney SL, Rinaldo A (1998) Wegener’s granulomatosis of the head and neck. Ann Otol Rhinol Laryngol. 107(5 I):439–45. https://doi.org/10.1177/000348949810700515

    Article  PubMed  Google Scholar 

  20. Devaney KO, Travis WD, Hoffman G, Leavitt R, Lebovics R, Fauci AS (1990) Interpretation of head and neck biopsies in Wegener’s granulomatosis. A pathologic study of 126 biopsies in 70 patients. Am J Surg Pathol. 14(6):555–64. https://doi.org/10.1097/00000478-199006000-00006

    Article  CAS  PubMed  Google Scholar 

  21. Schnabel A, Holl-Ulrich K, Dalhoff K, Reuter M, Gross WL (1997) Efficacy of transbronchial biopsy in pulmonary vaculitides. Eur Respir J 10(12):2738–2743. https://doi.org/10.1183/09031936.97.10122738

    Article  CAS  PubMed  Google Scholar 

  22. Aasarød K, Bostad L, Hammerstrøm J, Jørstad S, Iversen BM (2001) Renal histopathology and clinical course in 94 patients with Wegener’s granulomatosis. Nephrol Dial Transplant 16(5):953–960. https://doi.org/10.1093/ndt/16.5.953

    Article  PubMed  Google Scholar 

  23. Takeuchi M, Ogura M, Minoura T, Inagaki N, Kawakami K (2020) Comparative effectiveness of sodium-glucose cotransporter-2 inhibitors versus other classes of glucose-lowering medications on renal outcome in type 2 diabetes. Mayo Clin Proc 95:265–273. https://doi.org/10.1016/j.mayocp.2019.12.004

    Article  CAS  PubMed  Google Scholar 

  24. Ide K, Fujiwara T, Shimada N, Tokumasu H (2021) Influence of acetaminophen on renal function: a longitudinal descriptive study using a real-world database. Int Urol Nephrol 53(1):129–135. https://doi.org/10.1007/s11255-020-02596-7

    Article  CAS  PubMed  Google Scholar 

  25. Manja V, AlBashir S, Guyatt G (2017) Criteria for use of composite end points for competing risks—a systematic survey of the literature with recommendations. J Clin Epidemiol 82:4–11. https://doi.org/10.1016/j.jclinepi.2016.12.001

    Article  PubMed  Google Scholar 

  26. Friedman DJ, Piccini JP, Wang T, Zheng J, Malaisrie SC, Holmes DR et al (2018) Association between left atrial appendage occlusion and readmission for thromboembolism among patients with atrial fibrillation undergoing concomitant cardiac surgery. JAMA - J Am Med Assoc 319(4):365–374. https://doi.org/10.1001/jama.2017.20125

    Article  Google Scholar 

  27. Di Angelantonio E (2018) Body mass index as a measure of global adiposity. Arch Cardiovasc Dis 111(3):141–143. https://doi.org/10.1016/j.acvd.2018.02.002

    Article  PubMed  Google Scholar 

  28. Wang Y, Huang X, Cai J, Xie L, Wang W, Tang S et al (2016) Clinicopathologic characteristics and outcomes of lupus nephritis with antineutrophil cytoplasmic antibody: a retrospective study. Med (United States) 95(4):e2580. https://doi.org/10.1097/MD.0000000000002580

    Article  CAS  Google Scholar 

  29. Moon JS, Ahn SS, Park YB, Lee SK, Lee SW (2018) C-reactive protein to serum albumin ratio is an independent predictor of all-cause mortality in patients with ANCA-associated vasculitis. Yonsei Med J 59(7):865–871. https://doi.org/10.3349/ymj.2018.59.7.865

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Özçelik G, Hafize &, Sönmez E, Şahin S, Özağarı A, Meral, et al (2019) Clinical and histopathological prognostic factors affecting the renal outcomes in childhood ANCA-associated vasculitis. Pediatr Nephrol 34:847–54. https://doi.org/10.1007/s00467-018-4162-5

  31. Harigai M, Nagasaka K, Amano K, Bando M, Dobashi H, Kawakami T et al (2019) 2017 Clinical practice guidelines of the Japan Research Committee of the Ministry of Health, Labour, and Welfare for intractable vasculitis for the management of ANCA-associated vasculitis. Mod Rheumatol 29(1):20–30. https://doi.org/10.1080/14397595.2018.1500437

    Article  PubMed  Google Scholar 

  32. Arimura Y, Harigai M, Maruyama S, Homma S (2018) Anca Kanren Kekkanen Gaidorain 2017. Nippon Naika Gakkai Zasshi 107(4):741–745. https://doi.org/10.2169/naika.107.741

    Article  Google Scholar 

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Acknowledgements

We acknowledge HCEI, which provided data to us.

Funding

This work was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (grant number 20H03941).

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Authors and Affiliations

  1. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan

    Hiroyuki Hashimoto, Masato Takeuchi & Koji Kawakami

Authors
  1. Hiroyuki Hashimoto
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  2. Masato Takeuchi
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  3. Koji Kawakami
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Contributions

HH conducted the analysis and wrote the first draft of the manuscript. MT commented on the analysis and redrafted the manuscript. KK advised on the analysis and study design. HH and MT contributed to the study conception and design. HH contributed to the analysis and interpretation of data. The first draft was written by HH, and all authors commented and revised the draft. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Masato Takeuchi.

Ethics declarations

Ethics approval

This study was approved by the Institutional Review Board at Kyoto University. We performed this study in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. This study did not need individual consent because the data were anonymized.

Competing interests

Koji Kawakami has received research funds from Eisai Co. Ltd.; Kyowa Kirin Co. Ltd.; Sumitomo Dainippon Pharma Co. Ltd.; Pfizer Inc.; Stella Pharma Corporation; CMIC Co. Ltd.; Suntory Beverage & Food Ltd.; Mitsubishi Corporation, and Real World Data Co. Ltd.; consulting fees from LEBER Inc.; JMDC Inc.; Shin Nippon Biomedical Laboratories Ltd.; Kaken Pharmaceutical Co. Ltd.; and Advanced Medical Care Inc.; executive compensation from Cancer Intelligence Care Systems; Inc.; honorarium from Mitsubishi Chemical Holdings Corporation, Mitsubishi Corporation, and Pharma Business Academy; and holds stock in Real World Data Co. Ltd. Other authors declare no competing interests.

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Hashimoto, H., Takeuchi, M. & Kawakami, K. Association between biopsies for anti-neutrophil cytoplasmic antibody-associated vasculitis and prognosis: a retrospective cohort study. Clin Rheumatol 41, 541–548 (2022). https://doi.org/10.1007/s10067-021-05889-z

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  • DOI: https://doi.org/10.1007/s10067-021-05889-z

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