Factors associated with relapse in ANCA-associated vasculitis: a single-center retrospective cohort study
TURKISH JOURNAL OF MEDICAL SCIENCES, cilt.56, sa.5, ss.1384-1396, 2026 (SCI-Expanded, Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 56 Sayı: 5
- Basım Tarihi: 2026
- Doi Numarası: 10.55730/1300-0144.6384
- Dergi Adı: TURKISH JOURNAL OF MEDICAL SCIENCES
- Derginin Tarandığı İndeksler: Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Scopus, Science Citation Index Expanded (SCI-EXPANDED), EMBASE, MEDLINE, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.1384-1396
- Ankara Üniversitesi Adresli: Evet
Özet
Abstract
Background/aim: Relapse remains common in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). We examined factors associated with relapse after remission.
Materials and methods: We retrospectively reviewed 130 adults with AAV followed between January 2015 and May 2026, all of whom achieved remission after induction therapy. Demographics, disease subtype, serology, organ involvement, baseline laboratory values, treatments, and relapse were recorded. Relapse was defined as recurrent vasculitic activity after remission requiring escalation/ modification of immunosuppressive therapy. Time from remission to first relapse was analyzed using Cox proportional hazards regression, with serious infection modeled as a time-dependent covariate. No imputation was undertaken.
Results: Median time from diagnosis to remission was 5.0 months (Q1–Q3: 2.2–7.2) and median observation after remission was 64.8 months (29.9–111.4). Seventy-two patients (55.4%) relapsed and the median time from remission to first relapse was 20.0 months (6.4–50.7). Both multivariable models were fitted on 65 patients with 32 relapse events. In Model 1, serious infection (hazard ratio [HR]: 4.82; 95% confidence interval [CI]: 2.09–11.10) and rheumatoid factor (RF) positivity (HR: 3.86; 95% CI: 1.68–8.86) were associated with higher relapse hazard. In Model 2, higher total protein was associated with lower relapse hazard (HR: 0.53 per 1 g/dL increase; 95% CI: 0.32–0.88) and RF positivity with higher hazard (HR: 2.66; 95% CI: 1.23–5.74). Low Prognostic Nutritional Index score and lower immunoglobulin G occurred in the relapse group in univariable comparisons only.
Conclusion: Relapse affected more than half of the patients who achieved remission. RF positivity showed the most consistent positive association across analyses, although precision varied and CI included the null in one sensitivity model. The serious-infection and total-protein associations were more sensitive to model specification. Given the few events per variable and the missing data, these findings are exploratory and require confirmation.