PT  - JOURNAL ARTICLE
AU  - DAN-AVI LANDAU
AU  - SAMY SCERRA
AU  - DAMIEN SENE
AU  - MATHIEU RESCHE-RIGON
AU  - DAVID SAADOUN
AU  - PATRICE CACOUB
TI  - Causes and Predictive Factors of Mortality in a Cohort of Patients with Hepatitis C Virus-related Cryoglobulinemic Vasculitis Treated with Antiviral Therapy
AID  - 10.3899/jrheum.090790
DP  - 2010 Mar 01
TA  - The Journal of Rheumatology
PG  - 615--621
VI  - 37
IP  - 3
4099  - http://www.jrheum.org/content/37/3/615.short
4100  - http://www.jrheum.org/content/37/3/615.full
SO  - J Rheumatol2010 Mar 01; 37
AB  - Objective. Hepatitis C virus (HCV)-associated mixed cryoglobulinemia (MC) vasculitis is an autoimmune disorder with significant morbidity and mortality. Renal involvement was associated with an increased mortality, and was the most common cause of death; these data were obtained before effective antiviral treatment was available. We studied causes of death and predictive factors in patients with HCV-associated MC vasculitis treated with antivirals. Methods. Case histories of 85 patients with HCV-associated MC vasculitis treated in a single center between 1990 and 2006 were retrospectively reviewed. Prognostic factors affecting mortality were studied by comparing 23 patients who died with 62 survivors, using the Cox model regression analysis. Results. The most common cause of death was infection, accounting for 34.7%, followed by endstage liver disease in 30.4% (including 4 patients with hepatocellular carcinoma), and cardiovascular disease in 17.4% of patients. Endstage renal disease accounted for only 8.7% of deaths, as did central nervous system vasculitis and nonhepatic malignancy. Increased mortality was strongly associated with immunosuppressive treatment [hazard ratio (HR) 6.51, 95% CI 2.75–15.37], cutaneous ulcers (HR 5.37, 95% CI 1.79–16.14), and renal insufficiency (HR 3.25, 95% CI 1.37–7.72). A 2 log10 decrease in HCV viral load at month 3 after starting antiviral treatment was associated with decreased mortality (HR 0.39, 95% CI 0.16–0.95). Conclusion. While renal involvement is still associated with poorer prognosis, infectious processes are now the most common cause of death in HCV cryoglobulinemia vasculitis. Immunosuppressive treatment is associated with an increased risk of death, independently from disease severity. Response to antiviral treatment is associated with significantly reduced mortality risk.