1-Year Mortality Rate in AAV Found Higher in Men Than in Women
Chinese study, meta-analysis suggest possible predictor of patients' prognosis
Men with ANCA-associated vasculitis (AAV) have a 1.54 times higher risk of dying within one year than female patients, a new study finds.
According to authors, “this [finding] may provide a reliable predictor for clinicians to judge the prognosis and select active treatment for patients with AAV.”
The report, “Relationship Between Gender and 1-Year Mortality in ANCA-Associated Vasculitis Patients: A Single-Center Retrospective Analysis and Meta-Analysis,” was published in the journal Frontiers in Medicine.
AAV is a group of autoimmune diseases characterized by inflammation and damage to small blood vessels in the body. Inflammation in AAV is usually caused by the production of self-reactive antibodies called ANCAs.
Researchers have estimated that patients with AAV who do not receive treatment have a one-year mortality rate of up to 80%. In fact, even with intensive treatment, AAV patients still have a 2.7 times increased risk of death compared with people from the general population.
Among white AAV patients, men reportedly have an increased risk of death and a higher mortality rate within 28 days of hospitalization compared with women. However, other analyses failed to demonstrate a link between sex and AAV prognosis.
The number of studies evaluating the relationship between sex and one-year mortality of AAV patients is low, and data specifically from mainland China are lacking.
As such, the team first sought to assess the survival outcomes of people with AAV in China and then carried out an analysis of data from several previously published studies, also known as a meta-analysis.
“To the best of our knowledge, this study was the first one to explore the relationship between gender and 1-year mortality of AAV in the population of China,” the authors wrote. “We hoped to find some correlation between gender and 1-year mortality in patients with AAV to provide a predictive index for clinicians.”
Mortality risk and sex
Their first analysis included data from 84 patients diagnosed in the Second Xiangya Hospital of Central South University between January 2014 to December 2019. Among these patients, 33 were women and 51 were men. Patients had an average age of 56.6 years and a disease course of five months.
Most patients (85.7%) had microscopic polyangiitis (MPA), while others had granulomatosis with polyangiitis (GPA, 9.5%), or eosinophilic granulomatosis with polyangiitis (EGPA, 4.8%). MPA, GPA, and EGPA are three types of AAV.
One year after diagnosis, 70 patients were still alive, and 14 (12 men and two women) had died.
Statistical analysis revealed that male sex was an independent risk factor for death within one year in AAV patients. Likewise, lab findings, including high levels of creatinine — a marker of kidney dysfunction — and platelets in the blood, were also identified as risk factors.
Next, data from seven articles (including the current study) covering sex-related differences in AAV prognosis after one year were combined and analyzed. All were carried out up to July 2021; three were from Asia and four from Europe.
The analysis included a total of 1,136 people with AAV. More than half of the patients (51.32%) were male. A total of 210 patients died, and more than half of these (60%) were male.
Study findings showed that male patients had a 1.54 times higher risk of dying within one year compared with females.
“Significant sex-specific differences were found in patients with AAV in Southern China. Male, elevated [serum creatinine], … [and platelet counts] … were poor short-term prognostic factors for patients with AAV in the retrospective study. Among them, we clarified that male sex was a risk factor for 1-year mortality in patients with AAV by further meta-analysis,” the researchers wrote.
“Clinicians should pay more attention to the mortality risk of male patients with AAV in the early stage, and intensive and careful management should be taken,” they wrote.
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