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Low serum complement 3 level is associated with severe ANCA-associated vasculitis at diagnosis

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Abstract

Objectives

We investigated whether low serum C3 level can cross-sectionally estimate severe antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in immunosuppressive drug-naïve patients at diagnosis.

Methods

We retrospectively reviewed the medical records of 139 patients with AAV, who were first classified as AAV at Severance Hospital. We obtained clinical and laboratory data including serum complement 3 (C3) level and calculated Birmingham vasculitis activity score (BVAS) at diagnosis. We stratified AAV patients into three groups according to the tertile of BVAS and defined the lower limit of the highest tertile as the cutoff for severe AAV (BVAS at diagnosis ≥ 16) at diagnosis. Low serum C3 level was defined as C3 < 90 mg/dL. The odds ratio (OR) was assessed using the multivariable logistic regression.

Results

The mean age at diagnosis was 56.3 years and 41 patients were men (29.5%). The mean initial BVAS was 12.8. The mean serum C3 and C4 levels were 110.6 and 26.8 mg/dL. Thirty-one patients (22.3%) exhibited low serum C3 level at diagnosis. In the multivariable analysis, serum C3 level at diagnosis < 90 mg/dL (OR 2.963) exhibited the significant association with severe AAV at diagnosis. Patients with low serum C3 level exhibited a significantly high relative risk (RR) for severe AAV at diagnosis compared to those without (RR 3.600). Patients with low serum C3 level at diagnosis exhibited poor renal prognosis than those without.

Conclusion

Low serum C3 level can estimate severe AAV and predict poor renal outcome in immunosuppressive drug-naïve patients at diagnosis.

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Funding

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2017R1D1A1B03029050) and a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health and Welfare, Republic of Korea (HI14C1324).

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Authors and Affiliations

  1. Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hyeok Choi & Youhyun Kim

  2. Division of Rheumatology, Department of Internal Medicine, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Seung Min Jung, Jason Jungsik Song, Yong-Beom Park & Sang-Won Lee

  3. Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea

    Jason Jungsik Song, Yong-Beom Park & Sang-Won Lee

Authors
  1. Hyeok Choi
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  2. Youhyun Kim
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  6. Sang-Won Lee
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Contributions

All authors contributed to the study concept, design, acquisition, and interpretation of data. HC, YHK, and SWL performed the statistical analysis. HC, YHK, YBP, and SWL drafted and revised manuscript. All authors have read and approved the manuscript for publication.

Corresponding author

Correspondence to Sang-Won Lee.

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Conflict of interest

The authors declare no competing interests.

Ethical approval

This study was approved by the institutional Review Board of Severance Hospital (4-2017-0673).

Informed consent

The patient’s written informed consent was waived by the approving IRB, as this was a retrospective study.

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Choi, H., Kim, Y., Jung, S.M. et al. Low serum complement 3 level is associated with severe ANCA-associated vasculitis at diagnosis. Clin Exp Nephrol 23, 223–230 (2019). https://doi.org/10.1007/s10157-018-1634-7

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  • DOI: https://doi.org/10.1007/s10157-018-1634-7

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