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Smoking linked to renal involvement in immunoglobulin A vasculitis
Among patients with immunoglobulin A vasculitis, smoking is associated with renal involvement, while generalized purpura and pretreatment neutrophil-to-lymphocyte ratio predict both gastrointestinal and renal symptoms, according to findings published in Arthritis Research & Therapy.
“GI involvement with a severe hemorrhage or bowel perforation represents the major risk of mortality in acute adult [immunoglobulin A vasculitis (IgAV)], and renal involvement is associated with an increased risk of progression to chronic kidney failure,” Alojzija Hoevar, MD, PhD, of the University Medical Center Ljubljana, in Slovenia, and colleagues wrote. “Nevertheless, the predictors of visceral involvement in acute adult IgAV have not been extensively studied.”
To examine the predictors of gastrointestinal or renal involvement in adults with IgAV, Hoevar and colleagues conducted a prospective study of patients with histologically proven cases, diagnosed between January 2013 and July 2019, who received treatment at the University Medical Center Ljubljana. The researchers identified 214 new adult cases of IgAV during the 79-month observation period.
All identified patients underwent detailed clinical evaluation, including history of smoking, potential disease triggers, infection and medication use within a month prior to an IgAV episode, as well as an extensive laboratory workup. Hoevar and colleagues used multiple logistic regression analysis to examine the role of these parameters as predictors of gastrointestinal and renal involvement.
According to the researchers, gastrointestinal involvement occurred in 27.1% of included patients, with 38.8% developing renal involvement and 12.1% of cases experiencing each concurrently. Following the multivariate logistic regression analysis, the researchers identified generalized purpura (OR = 6.74; 95% CI, 3.18-14.31), a pretreatment neutrophil-to-lymphocyte ratio (NLR) of more than 3.5 (OR = 2.78; 95% CI, 1.34-5.75), and elevated serum IgA levels (OR = 0.4; 95% CI, 0.2-0.79) as factors associated with gastrointestinal symptoms.
Current smoking (OR = 3.23; 95% CI, 1.5-6.98), generalized purpura (OR = 1.98; 95% CI, 1.08-3.61), elevated serum IgA (OR = 2.25; 95% CI, 1.21-4.18), an NLRof more than3.5 (OR = 1.96; 95% CI, 1.02-3.77), and increasing age (1.02; 95% CI, 1.01-1.04) were associated with renal complications.
“Gastrointestinal or renal involvement in adult IgAV could be predicted by smoking status, distribution of skin lesions and the neutrophil to lymphocyte ratio,” Hoevar and colleagues wrote. “The presented findings could help physicians identify the patients at risk who need vigilant monitoring during the acute phase of the disease.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.