title: Predictors of treatment resistance and relapse in antineutrophil cytoplasmic antibody-associated vasculitis: a study of 439 cases in a single Chinese center.
abstract: OBJECTIVE
  Treatment resistance and relapse in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are major challenges for physicians. The aim of this study was to assess the risk factors for treatment resistance and relapse in a single-center cohort of Chinese patients with AAV.
  
  
  METHODS
  Four hundred thirty-nine consecutive patients with AAV were recruited for inclusion in this study. The value of various clinical and pathologic parameters for the prediction of treatment resistance and relapse was analyzed.
  
  
  RESULTS
  Treatment resistance occurred in 47 (10.7%) of 439 patients and was independently associated with a higher serum creatinine level (odds ratio [OR] 1.087, 95% confidence interval [95% CI] 1.001-1.180, P = 0.047), a higher erythrocyte sedimentation rate (OR 1.009, 95% CI 1.001-1.018, P = 0.025), therapy with corticosteroids plus cyclophosphamide (OR 0.115, 95% CI 0.051-0.256, P = 0.000), and the presence of muscle pain (OR 0.249, 95% CI 0.083-0.747, P = 0.013). Relapse occurred in 128 (32.7%) of 392 patients in whom remission was achieved and was independently associated with lung involvement (hazard ratio [HR] 1.768, 95% CI 1.088-2.872, P = 0.021) and a lower serum creatinine level (HR 0.925, 95% CI 0.872-0.981, P = 0.009).
  
  
  CONCLUSIONS
  In Chinese patients with AAV, lung involvement and lower serum creatinine levels were independently associated with an increased risk of relapse. Elevated serum creatinine levels were associated with treatment resistance.
authors.affiliation: Peking University First Hospital and Peking University, Beijing, China.
authors.forename: Zhi-Ying
authors.initials: ZY
authors.lastname: Li
authors.forename: Dong-Yuan
authors.initials: DY
authors.lastname: Chang
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Zhao
authors.forename: Min
authors.initials: M
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D044466:Asian People; D001799:Blood Sedimentation; D015267:Churg-Strauss Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D003404:Creatinine / Q000097:blood; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D003404:Creatinine