1. Characteristics and risk factors for poor outcome in patients with systemic vasculitis involving the gastrointestinal tract
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Romain Paule, François Maurier, Laurent Perard, Julien Charpentier, Françoise Sarrot-Reynauld, Cécile-Audrey Durel, Ségolène Gendreau, Pierre-Louis Carron, Jean-Emmanuel Kahn, Maxime Samson, Tiphaine Goulenok, Arsène Mekinian, Charlotte Bernigaud, Loïc Guillevin, Jean-Christophe Lega, Benjamin Terrier, Thomas Pires, Raphaël Porcher, Wendy Jourde, Adrien Mirouse, Romain Sonneville, Alexandra Audemard-Verger, L. Frumholtz, Jean-Benoît Arlet, Xavier Puéchal, Nathalie Tieulie, Antoine Gaillet, Eric Hachulla, Elisabeth Diot, B. Thoreau, Saskia Ingen-Housz-Oro, Aurélie Hummel, Service de médecine interne et centre de référence des maladies rares [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Equipe 5 : METHODS - Méthodes de l’évaluation thérapeutique des maladies chroniques (CRESS - U1153), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), Centre d'épidémiologie Clinique [Hôtel-Dieu], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Hôtel Dieu, Hôpital Foch [Suresnes], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Service de Dermatologie [AP-HP Hôpital Saint-Louis], Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre hospitalier Saint Joseph - Saint Luc [Lyon], Service de Médecine Interne (SOC 1 et SOC 2) [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital Ambroise Paré [AP-HP], Hôpital Cochin [AP-HP], Hôpital Claude Huriez [Lille], CHU Lille, CHU Necker - Enfants Malades [AP-HP], CHU Bordeaux [Bordeaux], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), CHU Grenoble, CHU Nice [Cimiez], and Hôpital Cimiez [Nice] (CHU)
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medicine.medical_specialty ,Gastrointestinal Diseases ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Risk Factors ,Melena ,law ,Internal medicine ,Necrotizing Vasculitis ,medicine ,Clinical endpoint ,Humans ,030212 general & internal medicine ,Retrospective Studies ,030203 arthritis & rheumatology ,Polyarteritis nodosa ,business.industry ,Systemic Vasculitis ,medicine.disease ,Intensive care unit ,Polyarteritis Nodosa ,Gastrointestinal Tract ,Anesthesiology and Pain Medicine ,IgA vasculitis ,medicine.symptom ,business ,Vasculitis ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,Systemic vasculitis - Abstract
Background Gastrointestinal (GI) involvement was described to be a poor prognostic factor in systemic necrotizing vasculitis. Its prognostic significance may vary according to clinical presentation and vasculitis subtype. Aims This study investigated risk-factors associated to poor outcome in GI-involvement of vasculitis. Methods Patients with systemic vasculitis as defined by the 2012 Chapel Hill Consensus Conference and presenting with GI involvement were retrospectively included. Baseline characteristics, treatments and outcome were recorded. Primary endpoint was a composite of admission to intensive care unit (ICU), emergency surgical procedure, or death. Results Two hundred and thirteen patients were included. Vasculitis were distributed as follows: 41% IgA vasculitis, 27% ANCA-associated vasculitis, 17% polyarteritis nodosa (PAN), and 15% other vasculitis. Eighty-three (39%) patients fulfilled the composite primary endpoint within 6 months. Predictive factors associated with the primary endpoint included PAN subtype (OR 3.08, 95% CI 1.29–7.34), performance status (OR 1.40, 1.05–1.87), use of morphine (OR 2.51, 0.87–7.24), abdominal guarding (OR 3.08, 1.01–9.37), ileus (OR 2.29, 0.98–5.32), melena (OR 2.74, 1.17–6.42), increased leukocytes (per G/L, OR 1.05, 1.00–1.10), low hemoglobin (per g/dL, OR 0.80, 0.71–0.91) and increased CRP (log mg/L, OR 1.21, 0.94–1.56). A risk prediction model for the achievement of primary endpoint had a very good performance [C-statistics 0.853 (0.810 to 0.895], and for overall survival as well. Conclusions Vasculitis presenting with GI involvement have a poor outcome in more than one third of cases. An easy-to-use risk prediction model had a very good performance to predict the admission to ICU, emergency surgical procedure, or death.
- Published
- 2021