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

Authors
 Sung Soo Ahn  ;  Minkyung Han  ;  Juyoung Yoo  ;  Yong-Beom Park  ;  Inkyung Jung  ;  Sang-Won Lee 
Citation
 FRONTIERS IN IMMUNOLOGY, Vol.12 : 629902, 2021-03 
Journal Title
 FRONTIERS IN IMMUNOLOGY 
Issue Date
2021-03
Keywords
anti-neutrophil cytoplasmic antibody-associated vasculitis ; incidence ; microscopic polyangiitis ; polyarteritis nodosa ; stroke ; systemic necrotizing vasculitis
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.
Files in This Item:
T202101411.pdf Download
DOI
10.3389/fimmu.2021.629902
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
Yonsei Authors
Park, Yong Beom(박용범)
Ahn, Sung Soo(안성수) ORCID logo https://orcid.org/0000-0002-9002-9880
Yoo, Juyoung(유주영) ORCID logo https://orcid.org/0000-0001-8882-1695
Lee, Sang-Won(이상원) ORCID logo https://orcid.org/0000-0002-8038-3341
Jung, Inkyung(정인경) ORCID logo https://orcid.org/0000-0003-3780-3213
Han, Minkyung(한민경) ORCID logo https://orcid.org/0000-0002-5011-5557
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182842
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