Demographic, Clinical, and Immunologic Correlates among a Cohort of 50 Cocaine Users Demonstrating Antineutrophil Cytoplasmic Antibodies

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Table 1.

Demographic features of CLAAS cohort versus all cocaine users.

Characteristics	CLAAS, n = 50	Cocaine+, n = 2740	Univariate		Multivariate
Characteristics	CLAAS, n = 50	Cocaine+, n = 2740	OR (95% CI)	p¹	OR (95% CI)	p²
Age³, yrs, median (min, max)	46 (21, 63)	45 (18, 85)	NA	0.6373⁴	NA	NA
Sex, female	28 (56)	895 (32.7)	2.62 (1.49–4.61)	0.0005	3.15 (1.74–5.69)	0.0001
Vital status, alive⁵	35 (70)	2511 (91.64)	0.21 (0.11–0.40)	< 0.0001	0.20 (0.11–0.38)	< 0.0001
Race, self-identified
White	30 (60)	1335 (48.7)	1.58 (0.89–2.79)	0.1139	1.55 (0.86–2.79)	0.149
Black/African American	10 (20)	1083 (39.53)	0.38 (0.19–0.77)	0.0051	0.37 (0.18–0.77)	0.007
Nonwhite/nonblack	10 (20)	322 (11.75)	1.82 (0.90–3.68)	0.090	1.92 (0.94–3.92)	0.074
Hispanic and Mexican/Mexican American	4 (8)	35 (1.28)	6.72 (2.29–19.70)	< 0.0001	8.46 (2.71–26.47)	0.0002
Native American/Alaska Native	4 (8)	134 (4.89)	1.69 (0.60–4.77)	0.315	4.46 (1.51–13.17)	0.007
Asian	1 (2)	NA	NA	NA	NA	NA
Other/Unknown	1 (2)	NA	NA	NA	NA	NA

Values are n (%) unless otherwise specified.
↵1 Chi-square test, 2-sided (except where otherwise indicated).
↵2 Logistic regression analysis, controlling for age, sex, vital status, and race.
↵3 Age at first positive cocaine test result.
↵4 Mann-Whitney U test, 2-sided.
↵5 As of March 2018. CLAAS: cocaine/levamisole-associated autoimmunity syndrome; NA: not assessed.

Table 2.

Comparison of ANCA-associated antibodies: CLAAS versus all ANCA+ individuals.

Anti-MPO/PR3 Status		CLAAS, n = 50	ANCA+, n = 97	OR (95% CI)	p¹
Anti-MPO	Anti-PR3	CLAAS, n = 50	ANCA+, n = 97	OR (95% CI)	p¹
–	–	17 (34.0)	38 (39.2)	0.80 (0.40–1.63)	0.592
+	+	13 (26.0)	1 (1.0)	33.73 (4.26–267.2)	< 0.0001
–	+	9 (18.0)	26 (26.8)	0.60 (0.26–1.40)	0.308
+	–	11 (22.0)	33 (34.0)	0.55 (0.24–1.21)	0.183

Values are n (%) unless otherwise specified.
↵1 Fisher’s exact test, 2-sided. CLAAS: cocaine/levamisole-associated autoimmunity syndrome; ANCA: antineutrophil cytoplasmic antibodies; MPO: myeloperoxidase; PR3: proteinase 3.

Table 3.

Clinical and demographic features of CLAAS cohort.

Features	N (%)
Clinical features
Hematologic (any)	46 (92)
Anemia	42 (84)
Leukopenia	33 (66)
Neutropenia	23 (46)
Renal	39 (78)
Dermatologic (any)	29 (58)
Purpura/ulcers	21 (42)
MSK	20 (40)
ENT	5 (10)
Pulmonary	2 (4)
Laboratory features
Antiphospholipid antibody (any)	19/28 (68)
Anticardiolipin IgM	18/28 (64)
Anticardiolipin IgG	5/28 (18)
Anti-β₂ glycoprotein IgM	9/24 (38)
Anti-β₂ glycoprotein IgG	3/28 (11)
Lupus inhibitor	15/19 (79)
Evidence of HCV exposure	32/48 (67)
HCV viremia	23/49 (47)
Evidence of HIV infection	3/47 (6)
Low C3 or C4	15/33 (45)
Cryoglobulinemia	8/28 (29)
RF	8/33 (24)
ANA	11/48 (23)
Levamisole detected in urine	14/36 (39)

CLAAS: cocaine/levamisole-associated autoimmunity syndrome; MSK: musculoskeletal; HCV: hepatitis C virus; HIV: human immunodeficiency virus; RF: rheumatoid factor; ANA: antinuclear antibody; IgM: immunoglobulin M.

Table 4.

Select demographic, clinical, and immunologic correlates within CLAAS cohort.

Outcome	Predictor	Univariate¹	Covariable	Multivariate²
Outcome	Predictor	OR (95% CI)	p	Multivariate²	OR (95% CI)	p
Vital status (alive)	P-ANCA	7.94 (2.01–31.36)	0.0036	Race³	5.76 (1.25–26.58)	0.025
Vital status (alive)	C-ANCA	0.04 (0.01–0.42)	0.0018	Race³	0.06 (0.01–0.66)	0.022
Purpura/ulcers	Anti-MPO	5.56 (1.62–19.03)	0.0092	NA	NA	NA
MSK	Anti-MPO	7.00 (1.95–25.14)	0.0034	ANCA-IF pattern⁴	4.24 (1.04–17.20)	0.044

↵1 Fisher’s exact test, 2-tailed.
↵2 Logistic regression analysis controlling for listed covariables.
↵3 White vs others; Black/African American vs others.
↵4 P-ANCA vs C-ANCA vs A-ANCA. CLAAS: cocaine/levamisole-associated autoimmunity syndrome; ANCA: antineutrophil antibodies; P-ANCA: perinuclear ANCA; C-ANCA: cytoplasmic; MSK: musculoskeletal; IF: immunofluorescence; NA: not assessed.