Clinical association of health-related quality of life and mortality in an antineutrophil cytoplasmic antibody-associated vasculitis cohort

Abstract

Objectives: To evaluate the association between health-related quality of life (HRQoL) and mortality in patients

with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).

Methods: We searched patients with AAV assessed for HRQoL at initial diagnosis using Short Form 36 (SF-36).

Relationships between SF-36 physical component summary (PCS) and mental component summary (MCS) scales

and variables were estimated using Pearson’s correlation analysis. Contal’s and O’Quigley’s methods were used

to determine optimal SF-36 PCS cut-off for predicting all-cause mortality. The Cox proportional hazards model

and inverse probability of treatment weighting (IPTW) analysis were used to ascertain prognostic implications of

SF-36 scales and mortality.

Results: The median SF-36 PCS and MCS values of the 189 patients were 47.5 and 53.3, respectively, and 21

(11.1%) patients (microscopic polyangiitis [MPA], n=15; granulomatosis with polyangiitis [GPA], n=6) died

during follow-up. SF-36 PCS was significantly but weakly associated with Birmingham Vasculitis Activity Score,

Five-factor score, erythrocyte sedimentation rate (ESR), and C-reactive protein. However, SF-36 MCS was not

associated with ESR. In the multivariable Cox analysis, a decrease of SF-36 PCS score by one unit indicated a

higher death risk (hazard ratio [HR]: 1.030; 95% confidence interval [CI]: 1.007, 1.052; p=0.041), which was

not for SF-36 MCS. IPTW analysis in a subgroup of MPA and GPA patients revealed increased patient mortality

with SF-36 PCS <53.75 independently (HR: 3.249; 95% CI: 1.169, 9.033; p=0.024).

Conclusion: Poor baseline physical functioning associated with premature death in patients with MPA and GPA.

HRQoL assessment during initial diagnosis may provide clinical insights for this population.