Incorporation of patient-reported outcomes in the clinical risk score to improve relapse prediction in ANCA-associated vasculitis.

OBJECTIVES

To evaluate whether integration of patient-reported outcomes (PROs), particularly the 36-item short form health survey (SF-36), with the French Vasculitis Study Group relapse score (FRS) improves relapse prediction in patients with microscopic polyangiitis (MPA) or granulomatosis with polyangiitis (GPA).

METHODS

This retrospective cohort study included 98 patients with MPA or GPA whose baseline and first-year follow-up SF-36 data were available. The predictive accuracy of the FRS, baseline SF-36 physical component summary (PCS) and mental component summary (MCS), and first-year cumulative SF-36 PCS and MCS for relapse was evaluated using receiver operating characteristic curve analysis. The area under the curve (AUC) with 95% confidence interval (CI) was estimated for each variable. A combination of FRS and PRO with higher accuracy was developed using multivariable Cox regression incorporating variables significantly associated with relapse.

RESULTS

During a median follow-up of 50.9 months, 28 patients (28.6%) experienced relapse. The FRS (AUC=0.666, 95% CI=0.552-0.780, p=0.010) and first-year cumulative SF-36 PCS (AUC=0.629, 95% CI=0.503-0.755, p=0.047) significantly predicted relapse, whereas baseline SF-36 PCS and MCS and first-year cumulative SF-36 MCS did not. A combination of the FRS and first-year cumulative SF-36 PCS demonstrated improved predictive performance (AUC=0.727, 95% CI=0.623-0.830, p<0.001).

CONCLUSIONS

The first-year cumulative SF-36 PCS was independently associated with relapse in patients with MPA or GPA, and its integration with the FRS improved relapse risk prediction. These findings support a multidimensional approach incorporating both clinical and patient-reported data to better stratify relapse risk and inform treatment planning in MPA or GPA.