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. 2021 Mar 31:12:629902.
doi: 10.3389/fimmu.2021.629902. eCollection 2021.

Risk of Stroke in Systemic Necrotizing Vasculitis: A Nationwide Study Using the National Claims Database

Sung Soo Ahn  1 , Minkyung Han  2 , Juyoung Yoo  3 , Yong-Beom Park  3   4 , Inkyung Jung  5 , Sang-Won Lee  3   4
Affiliations

Risk of Stroke in Systemic Necrotizing Vasculitis: A Nationwide Study Using the National Claims Database

Sung Soo Ahn et al. Front Immunol. .

Abstract

Objective: Evidences indicate that the risk of stroke is increased in autoimmune rheumatic diseases. This study aimed to investigate the incidence of stroke in patients with systemic necrotizing vasculitis (SNV) using the national health database.

Methods: Data were obtained from the Korean National Claims database between 2010 and 2018 to identify incident SNV [anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and polyarteritis nodosa (PAN)] cases. The standardized incidence ratio (SIR) and incidence rate ratio (IRR) were calculated to estimate the risk of stroke in patients with SNV compared to the general population and among disease subgroups. Time-dependent Cox's regression analysis was performed to identify risk factors for stroke.

Results: Among 2644 incident SNV cases, 159 patients (6.0%) were affected by stroke. The overall risk of stroke was significantly higher in patients with SNV compared to the general population (SIR 8.42). Stroke event rates were the highest within the first year of SNV diagnosis (67.3%). Among disease subgroups, patients with microscopic polyangiitis (MPA) exhibited higher IRR compared to PAN (adjusted IRR 1.98). In Cox's hazard analysis, older age and MPA were associated with higher risk of stroke [hazard ratio (HR) 1.05 and 1.88], whereas the administration of cyclophosphamide, azathioprine/mizoribine, methotrexate, and statins were protective in stroke (HR 0.26, 0.34, 0.49, and 0.50, respectively).

Conclusion: A considerable number of SNV patients experienced stroke, especially in the early phase of disease. Older age and MPA diagnosis were associated with elevated risk of stroke, while the administration of immunosuppressive agents and statins was beneficial in preventing stroke.

Keywords: anti-neutrophil cytoplasmic antibody-associated vasculitis; incidence; microscopic polyangiitis; polyarteritis nodosa; stroke; systemic necrotizing vasculitis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Selection of the study population from the HIRA database. HIRA, Health Insurance and Review Agency; SNV, systemic necrotizing vasculitis; MPA, microscopic polyangiitis; GPA, granulomatosis with polyangiitis; EGPA, eosinophilic granulomatosis with polyangiitis; PAN, polyarteritis nodosa.
Figure 2
Figure 2
Age distribution of SNV patients on stroke occurrence. The incidence of stroke events was estimated by dividing age into 10-year intervals. SNV, systemic necrotizing vasculitis; MPA, microscopic polyangiitis; GPA, granulomatosis with polyangiitis; EGPA, eosinophilic granulomatosis with polyangiitis; PAN, polyarteritis nodosa.
Figure 3
Figure 3
Cumulative incidence rate of stroke according to SNV subgroups. Among the SNV subgroups, the cumulative incidence rate of stroke was found to be highest in MPA. SNV, systemic necrotizing vasculitis; MPA, microscopic polyangiitis; PAN, polyarteritis nodosa; GPA, granulomatosis with polyangiitis; EGPA, eosinophilic granulomatosis with polyangiitis.
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References

    1. Gapud EJ, Seo P, Antiochos B. ANCA-Associated Vasculitis Pathogenesis: A Commentary. Curr Rheumatol Rep (2017) 19:15. 10.1007/s11926-017-0641-0 - DOI - PubMed
    1. Gross WL, Trabandt A, Reinhold-Keller E. Diagnosis and evaluation of vasculitis. Rheumatology (2000) 39:245–52. 10.1093/rheumatology/39.3.245 - DOI - PubMed
    1. Khan I, Watts RA. Classification of ANCA-associated vasculitis. Curr Rheumatol Rep (2013) 15:383. 10.1007/s11926-013-0383-6 - DOI - PubMed
    1. Forbess L, Bannykh S. Polyarteritis nodosa. Rheum Dis Clinics North Am (2015) 41:33–46, vii. 10.1016/j.rdc.2014.09.005 - DOI - PubMed
    1. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. . 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum (2013) 65:1–11. 10.1002/art.37715 - DOI - PubMed

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