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Cohen A, Weerasinghe N, Lemmert K, de Malmanche T, Myint T. Diagnostic accuracy of ANCA serology in ANCA-associated vasculitis with renal involvement. Intern Med J 2024. [PMID: 38873696 DOI: 10.1111/imj.16436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/18/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Pauci-immune glomerulonephritis (GN) due to antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a common cause of crescentic GN. Despite advances in treatment, rates of mortality and progression to end-stage kidney disease remain high. Renal involvement is diagnosed by histological examination of kidney tissue. Serum ANCAs play a significant role in AAV; however, the value of serum ANCA quantification to predict renal involvement is not well-established. AIM We aimed to evaluate the diagnostic accuracy of serum ANCA titres in diagnosing AAV with renal involvement. METHODS We conducted a retrospective study of consecutive native kidney biopsies reported at our centre from 2016 to 2021. We included all adults who had both a kidney biopsy and ANCA serology. ANCA serology was tested using indirect immunofluorescence with reporting of titres. Antibodies to proteinase 3 and myeloperoxidase were measured using a chemiluminescent immunoassay. RESULTS Eight hundred and forty-eight native kidney biopsies were reported during the study period. Five hundred and seven cases were included. The biopsy prevalence of pauci-immune GN in paired samples was 41/507 (8.1%). Most of the cohort had haematuria (66.6%), proteinuria (93.4%) and/or acute kidney injury (65.0%). A positive ANCA at any titre demonstrated a sensitivity of 97.6% and a specificity of 71.2% for a diagnosis of pauci-immune GN. The area under the curve for the receiver operator characteristic was 0.93 (95% confidence interval [CI]: 0.89-0.97). A cutoff ANCA titre of 1:160 provided the optimum balance between a sensitivity of 75.6% (95% CI: 59.7%-87.6%) and a specificity of 94.0% (95% CI: 91.6%-96.0%). CONCLUSIONS ANCA titres are highly predictive of pauci-immune GN in the appropriate context. While serum ANCA quantitation may not replace renal biopsy, reporting will assist in the decision to start treatment early for patients with organ or life-threatening disease.
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Affiliation(s)
- Adrienne Cohen
- Department of Nephrology and Renal Transplant, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Nethmi Weerasinghe
- Department of Nephrology and Renal Transplant, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Karla Lemmert
- NSW Health Pathology, Immunology, Newcastle, New South Wales, Australia
| | - Theo de Malmanche
- NSW Health Pathology, Immunology, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, Newcastle University, Newcastle, New South Wales, Australia
| | - Thida Myint
- Department of Nephrology and Renal Transplant, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, Newcastle University, Newcastle, New South Wales, Australia
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Serpa Pinto L, Xavier Pires S, Silva B, Farinha F, Vasconcelos C, Araújo Correia J. Predictive Factors of Severe Behçet's disease: A Longitudinal, Prospective Cohort Followed Between 1981-2020. REUMATOLOGIA CLINICA 2022; 18:410-415. [PMID: 35940675 DOI: 10.1016/j.reumae.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/25/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Behçet's disease (BD) is a systemic vasculitis of unknown cause. The spectrum of the disease ranges from mucocutaneous manifestations to other organ diseases with relevant morbidity. Associations between disease severity and male sex, earlier age at onset, and the presence of erythema nodosum have been described. OBJECTIVES To evaluate clinical factors associated with manifestations of severe disease in a single-center cohort. METHODS A longitudinal, prospective, unicentric cohort study with patients followed in a specialized outpatient clinic between 1981 and 2020. Severe BD was defined as a Krause total clinical severity score >4 points. RESULTS We included 243 patients, of whom 31% were male, with an average follow-up time of 14.6 years. Regarding organ manifestations, all patients had mucous manifestations (N=243, 100%), 133 (55%) skin, 104 (43%) joint, 71 (29%) ocular, 48 (20%) vascular, 47 (19%) neurological, 22 (9%) gastrointestinal and 1 (0.4%) cardiac involvement by BD. One hundred fifty-six (64%) patients were classified as having severe BD. Severe BD was more frequent in men (OR=2.004, p=0.024), increasing with age (OR=1.021 per year, p=0.037), in the presence of skin manifestations (OR=4.711, p<0.001), specifically erythema nodosum (OR=8.381, p<0.001), and pseudofolliculitis (OR=2.910, p<0.001). In the multivariate model, variables independently associated with severe BD were male gender (Adjusted OR=1.961, p=0.047), erythema nodosum (Adjusted OR=8.561, p<0.001) and pseudofolliculitis (Adjusted OR=2.372, p=0.007). DISCUSSION Male gender, erythema nodosum, and pseudofolliculitis were independently associated with severe BD forms and therefore should serve as warning signs to the clinician.
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Affiliation(s)
- Luísa Serpa Pinto
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.
| | - Sara Xavier Pires
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
| | - Berta Silva
- Imunogenetics Laboratory, Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Fátima Farinha
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Carlos Vasconcelos
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - João Araújo Correia
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
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Iwafuchi Y, Morioka T, Oyama Y, Narita I. A case of smoldering antineutrophil cytoplasmic antibody-associated vasculitis development during the course of primary Sjögren's syndrome. CEN Case Rep 2022; 11:247-253. [PMID: 34787826 PMCID: PMC9061905 DOI: 10.1007/s13730-021-00663-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022] Open
Abstract
Various forms of glomerular lesions have been described in primary Sjögren's syndrome (pSjS); however, myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is rarely reported, and the disease onset and clinical course of ANCA-associated vasculitis (AAV) complicated by pSjS are not well understood. A 51-year-old woman was referred to our hospital because of mild proteinuria and microscopic hematuria. She fulfilled the classification criteria for pSjS. We performed a kidney biopsy; however, it revealed no characteristic findings for pSjS, vasculitis, or other autoimmune diseases, including systemic lupus erythematosus. After 9 months, urinalysis abnormalities worsened and renal function was slowly declining, and ANCA was found to be positive. A second kidney biopsy was performed, revealing MPO-ANCA-associated pauci-immune segmental necrotizing glomerulonephritis with crescent formation. Even though immunofluorescence microscopy did not reveal any positive findings, additional electron microscopy demonstrated the presence of mesangial electron-dense deposits in both kidney biopsies. Based on kidney biopsy results and sequential serum ANCA measurements, we considered that smoldering ANCA-associated vasculitis had developed in this patient as this can develop during the clinical course of pSjS. She responded well to steroid therapy. Serum measurement, especially perinuclear, ANCA levels can be useful in patients with pSjS to detect the onset of ANCA-associated vasculitis, even in the absence of acute renal deterioration or severe urinary abnormalities.
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Affiliation(s)
- Yoichi Iwafuchi
- Department of Internal Medicine, Koseiren Sanjo General Hospital, 5-1-62 Tsukanome, Sanjo, 955-0055, Japan.
| | - Tetsuo Morioka
- Department of Internal Medicine, Kidney Center, Shinrakuen Hospital, 3-3-11 Shindoriminami Nishi-ku, Niigata, 950-2087, Japan
| | - Yuko Oyama
- Department of Internal Medicine, Koseiren Sanjo General Hospital, 5-1-62 Tsukanome, Sanjo, 955-0055, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-754 Asahimachi-Dori, Chuo-ku, Niigata, 951-8510, Japan
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Gelzo M, Cacciapuoti S, Pinchera B, De Rosa A, Cernera G, Scialò F, Comegna M, Mormile M, Gallicchio A, Fabbrocini G, Parrella R, Corso G, Gentile I, Castaldo G. A Transient Increase in the Serum ANCAs in Patients with SARS-CoV-2 Infection: A Signal of Subclinical Vasculitis or an Epiphenomenon with No Clinical Manifestations? A Pilot Study. Viruses 2021; 13:v13091718. [PMID: 34578298 PMCID: PMC8473224 DOI: 10.3390/v13091718] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 01/04/2023] Open
Abstract
A relationship is emerging between SARS-CoV-2 infections and ANCA-associated vasculitis (AAV) because: (i) the pulmonary involvement of COVID-19 may mimic that observed in patients with AAV; (ii) the two diseases may occur together; (iii) COVID-19 may trigger AAV. However, few cases of AAV have been identified so far in COVID-19 patients. To define the frequency of ANCA autoimmunity in patients with SARS-CoV-2 infection, we analyzed the serum ANCAs and the serum PR3 and MPO antigens by immunoassays in 124 adult patients with a diagnosis of SARS-CoV-2 infection (16 were asymptomatic and 108 were hospitalized) and 48 control subjects. The serum ANCAs were significantly higher in the hospitalized patients compared with either the controls or the asymptomatic patients and increased with the progression of the COVID-19 severity. After one week of hospitalization, the values were significantly lower. In contrast, no differences emerged among the controls, asymptomatic and hospitalized patients for the PR3 and MPO serum levels. None of the patients had clinical signs of AAV with the exception of a severe pulmonary involvement. Further studies are necessary to define whether the increase in the serum ANCAs might mask subclinical vasculitis in a percentage of patients with SARS-CoV-2 infection or it is an epiphenomenon of SARS-CoV-2 infection with no clinical manifestations.
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Affiliation(s)
- Monica Gelzo
- CEINGE-Biotecnologie Avanzate, Scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Sara Cacciapuoti
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (A.G.); (G.F.); (I.G.)
| | - Biagio Pinchera
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (A.G.); (G.F.); (I.G.)
| | - Annunziata De Rosa
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, 80131 Naples, Italy; (A.D.R.); (R.P.)
| | - Gustavo Cernera
- CEINGE-Biotecnologie Avanzate, Scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Filippo Scialò
- CEINGE-Biotecnologie Avanzate, Scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Traslazionale, Università della Campania L. Vanvitelli, 80131 Naples, Italy
| | - Marika Comegna
- CEINGE-Biotecnologie Avanzate, Scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Mauro Mormile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (A.G.); (G.F.); (I.G.)
| | - Antonella Gallicchio
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (A.G.); (G.F.); (I.G.)
| | - Gabriella Fabbrocini
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (A.G.); (G.F.); (I.G.)
| | - Roberto Parrella
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, 80131 Naples, Italy; (A.D.R.); (R.P.)
| | - Gaetano Corso
- CEINGE-Biotecnologie Avanzate, Scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Clinica e Sperimentale, Università di Foggia, 71121 Foggia, Italy
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (A.G.); (G.F.); (I.G.)
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate, Scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-0813737759
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Serpa Pinto L, Xavier Pires S, Silva B, Farinha F, Vasconcelos C, Araújo Correia J. Predictive Factors of Severe Behçet's disease: A Longitudinal, Prospective Cohort Followed Between 1981-2020. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00121-2. [PMID: 34023233 DOI: 10.1016/j.reuma.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Behçet's disease (BD) is a systemic vasculitis of unknown cause. The spectrum of the disease ranges from mucocutaneous manifestations to other organ diseases with relevant morbidity. Associations between disease severity and male sex, earlier age at onset, and the presence of erythema nodosum have been described. OBJECTIVES To evaluate clinical factors associated with manifestations of severe disease in a single-center cohort. METHODS A longitudinal, prospective, unicentric cohort study with patients followed in a specialized outpatient clinic between 1981 and 2020. Severe BD was defined as a Krause total clinical severity score >4 points. RESULTS We included 243 patients, of whom 31% were male, with an average follow-up time of 14.6 years. Regarding organ manifestations, all patients had mucous manifestations (N=243, 100%), 133 (55%) skin, 104 (43%) joint, 71 (29%) ocular, 48 (20%) vascular, 47 (19%) neurological, 22 (9%) gastrointestinal and 1 (0.4%) cardiac involvement by BD. One hundred fifty-six (64%) patients were classified as having severe BD. Severe BD was more frequent in men (OR=2.004, p=0.024), increasing with age (OR=1.021 per year, p=0.037), in the presence of skin manifestations (OR=4.711, p<0.001), specifically erythema nodosum (OR=8.381, p<0.001), and pseudofolliculitis (OR=2.910, p<0.001). In the multivariate model, variables independently associated with severe BD were male gender (Adjusted OR=1.961, p=0.047), erythema nodosum (Adjusted OR=8.561, p<0.001) and pseudofolliculitis (Adjusted OR=2.372, p=0.007). DISCUSSION Male gender, erythema nodosum, and pseudofolliculitis were independently associated with severe BD forms and therefore should serve as warning signs to the clinician.
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Affiliation(s)
- Luísa Serpa Pinto
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.
| | - Sara Xavier Pires
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
| | - Berta Silva
- Imunogenetics Laboratory, Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Fátima Farinha
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Carlos Vasconcelos
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - João Araújo Correia
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
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Mollaeian A, Chan N, Aloor R, Iding JS, Arend LJ, Saeidabadi SHF, Haas CJ. ANCA-negative microscopic polyangiitis with diffuse alveolar hemorrhage masquerading as congestive heart failure. AUTOIMMUNITY HIGHLIGHTS 2021; 12:1. [PMID: 33407881 PMCID: PMC7788985 DOI: 10.1186/s13317-020-00143-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022]
Abstract
Background Microscopic polyangiitis (MPA) is a subtype of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), involving small and medium sized vessels, often affecting the kidneys and lungs. Anti-neutrophil cytoplasmic antibody (ANCA) is detected in up to 90% of cases of MPA and its detection helps guide diagnosis, however cases of ANCA-negative MPA have been reported, hence definitive diagnosis relies on tissue biopsy. Case report A 23-year-old man was evaluated for dyspnea and pleuritic chest pain, and found to have bilateral intra-alveolar opacities and hilar adenopathy. Diagnostic work up revealed positive anti-nuclear antibodies (ANA) and negative ANCA, which in the setting of a non-classical presentation, delayed diagnosis and appropriate treatment. Due to persistent symptoms and a high suspicion for autoimmune disease with pulmonary-renal syndrome, he underwent lung biopsy which revealed intra-alveolar hemorrhage and capillaritis indicative of microscopic polyangiitis (MPA). Surprisingly, kidney biopsy was not typical of classic MPA, but revealed less common features. Due to therapeutic noncompliance he was readmitted multiple times thereafter with rare complications of MPA such as acute pancreatitis and hemorrhagic pericardial effusion with tamponade. Conclusion This case serves as an important clinical reminder to consider AAV even in those with negative ANCA serologies and a high suspicion for pulmonary-renal syndrome. It also demonstrates the high morbidity in cases of diagnostic delay and inadequate treatment.
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Affiliation(s)
- Arash Mollaeian
- MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA.
| | - Nina Chan
- MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA
| | - Rohit Aloor
- MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA
| | - Jeffery S Iding
- Department of Pathology, MedStar Franklin Square Hospital, Baltimore, MD, USA
| | - Lois J Arend
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
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Oristrell J, Loureiro-Amigo J, Solans R, Valenzuela MP, Monsálvez V, Segarra A, Amengual MJ, Marín A, Feijoo C, Tolosa C. Relapse rate and renal prognosis in ANCA-associated vasculitis according to long-term ANCA patterns. Clin Exp Immunol 2020; 203:209-218. [PMID: 33020895 DOI: 10.1111/cei.13530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 01/30/2023] Open
Abstract
Long-term observation of patients with ANCA-associated vasculitis (AAV) allows the identification of different longitudinal patterns of ANCA levels during follow-up. This study aimed to characterize these patterns and to determine their prognostic significance. All ANCA determinations performed in two university hospitals during a 2-year period were retrospectively reviewed. Patients were included in the analysis if they had high titers of anti-myeloperoxidase (anti-MPO) or anti-proteinase 3 (anti-PR3) antibodies at least once, ≥ 5 serial ANCA determinations and AAV diagnosed by biopsy or American College of Rheumatology (ACR) classification criteria. Patients' time-course ANCA patterns were classified as monophasic, remitting, recurrent or persistent. Associations between ANCA patterns and prognostic variables (relapse rate and renal outcome) were analysed by univariate and multivariate statistics. A total of 99 patients [55 with microscopic polyangiitis (MPA), 36 with granulomatosis with polyangiitis (GPA) and eight with eosinophilic granulomatosis with polyangiitis (EGPA)] were included. Median follow-up was 9 years. Among patients diagnosed with MPA or GPA, recurrent or persistent ANCA patterns were associated with a higher risk of clinical relapse [hazard ratio (HR) = 3·7, 95% confidence interval (CI) = 1·5-9·1 and HR = 2·9, 95% CI = 1·1-8·0, respectively], independently of clinical diagnosis or ANCA specificity. In patients with anti-MPO antibodies, the recurrent ANCA pattern was associated with worsening renal function [odds ratio (OR) = 5·7, 95% CI = 1·2-26·0]. Recurrent or persistent ANCA patterns are associated with a higher risk of clinical relapse. A recurrent ANCA pattern was associated with worsening renal function in anti-MPO-associated vasculitis.
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Affiliation(s)
- J Oristrell
- Internal Medicine Service, Parc Tauli Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Catalonia, Spain
| | - J Loureiro-Amigo
- Internal Medicine Service, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - R Solans
- Internal Medicine Service, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - M P Valenzuela
- Nephrology Service, Parc Tauli Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Catalonia, Spain
| | - V Monsálvez
- Internal Medicine Service, Parc Tauli Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Catalonia, Spain
| | - A Segarra
- Nephrology Service, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - M J Amengual
- Immunology Service, Parc Tauli Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Catalonia, Spain
| | - A Marín
- Immunology Service, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - C Feijoo
- Internal Medicine Service, Parc Tauli Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Catalonia, Spain
| | - C Tolosa
- Internal Medicine Service, Parc Tauli Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Catalonia, Spain
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Hou X, Liu J, Wang T, Zhou J, Cui L. The performance of the chemiluminescent immunoassay for measuring serum myeloperoxidase and proteinase 3 antibodies. J Clin Lab Anal 2020; 35:e23615. [PMID: 33034910 PMCID: PMC7891508 DOI: 10.1002/jcla.23615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/30/2020] [Accepted: 09/19/2020] [Indexed: 11/12/2022] Open
Abstract
Background Enzyme‐linked immunosorbent assay (ELISA) has traditionally been used to detect myeloperoxidase (MPO) and proteinase 3 (PR3) antibodies, although it is time‐consuming and physically demanding. As a novel and highly effective immunoassay, we compared chemiluminescent immunoassay (CIA) with ELISA to verify the application value of CIA in MPO and PR3 antibodies detection. Methods By ELISA and CIA, serum levels of anti‐MPO and anti‐PR3 antibodies were measured in 63 anti‐neutrophil cytoplasmic antibody (ANCA)‐associated vasculitis (AAV) patients (AAV group), including 47 microscopic polyangiitis (MPA) patients and 16 granulomatosis with polyangiitis (GPA) patients, in addition, 68 patients in interference control group (IC group), 19 healthy subjects in healthy control group (HC group). We compared MPO and PR3 antibodies levels and positive rates measured by these two methods among groups. Relationship and coincidence rate between ELISA and CIA were investigated. Diagnostic values for clinical outcomes for MPO and PR3 antibodies were assessed by receiver operator characteristic (ROC) curve. Results In AAV patients, when detecting anti‐MPO (r = .90) and anti‐PR3 (r = .81), CIA was highly correlated with ELISA, companying with highly total (88.89%, 92.06%, respectively) and positive coincidence rates (84.78%, 77.27%, respectively). In HC group, anti‐PR3 positive rate detected by both immunoassay were 0, anti‐MPO almost were 0, which without statistically significant difference (P = .32). In IC group, the total (76.47%, 58.82, respectively) and positive coincidence rates (48.38%, 30.00%, respectively) of anti‐MPO and anti‐PR3 were the lowest, but the negative coincidence rates reached 100%. By CIA, similar to ELISA, the levels of anti‐MPO were significantly higher both in AAV patients (56.00; [4.40‐235.30]) and MPA patients (98.00; [27.90‐324.70]) compared with either IC group (3.20; [3.20‐18.55) (P < .0001) or HC group (3.20; [3.20‐3.20]) (P < .0001), yielded an area under curve (AUC) of 0.76 for AAV and 0.89 for MPA, the concentration of anti‐PR3 in GPA group (66.65; [24.43‐150.00]) was significantly higher than that in IC group (2.3; [2.3‐10.95]) (P < .0001) and HC group (2.3; [2.3‐2.3]) (P < .0001), with an AUC of 0.92. Conclusion Similar to ELISA, CIA was competent to detect MPO and PR3 antibodies in AAV patients and healthy population, thus distinguish AAV patients from IC group and HC group and effectively diagnose MPA and GPA.
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Affiliation(s)
- Xiuzhu Hou
- Department of laboratory medicine, Peking University Third Hospital, Beijing, China
| | - Jing Liu
- Department of laboratory medicine, Peking University Third Hospital, Beijing, China
| | - Tiancheng Wang
- Department of laboratory medicine, Peking University Third Hospital, Beijing, China
| | - Jiansuo Zhou
- Department of laboratory medicine, Peking University Third Hospital, Beijing, China
| | - Liyan Cui
- Department of laboratory medicine, Peking University Third Hospital, Beijing, China
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Trier NH, Houen G. Antibodies as Diagnostic Targets and as Reagents for Diagnostics. Antibodies (Basel) 2020; 9:antib9020015. [PMID: 32443407 PMCID: PMC7345923 DOI: 10.3390/antib9020015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022] Open
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