Prognostic factors in systemic necrotizing vasculitis of the polyarteritis nodosa group--a review of 45 cases.

OBJECTIVE

To evaluate the prognostic importance for mortality of age, fever, hypertension, and involvement of renal, cardiac, neural, pulmonary, gastrointestinal and cutaneous systems as well as elevated transaminases, thrombocytosis, leukocytosis, anemia, smoking status, comorbid diseases and disease severity, in 45 patients with systemic necrotizing vasculitis (SNV) identified by histological, radiological, and clinical criteria.

METHODS

Kaplan-Meier nonparametric survival functions and Cox proportional hazards regression models were used.

RESULTS

Twenty-four deaths were observed during the 5 year mean followup period. Five year survival was 58%. Comorbidity and severity of involvement were not predictive of mortality. Multivariable survival analysis showed that cardiac or renal involvement was associated with a relative risk of dying of 2.91 (95% CI: 1.25, 6.77). Elevated serum transaminase demonstrated a trend to having a protective effect [relative risk of 0.14 (95% CI: 0.02, 1.07)]. No other variable was an independent predictor of fatality. No cohort effect could be documented following the introduction of cytotoxic drugs in the treatment of SNV.

CONCLUSION

SNV remains associated with a high mortality due largely to renal or cardiac involvement.