Chest
Volume 109, Issue 2, February 1996, Pages 430-437
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Clinical Investigations: Vascular
Wegener's Granulomatosis in the Elderly

https://doi.org/10.1378/chest.109.2.430Get rights and content

Study objective

To determine if elderly patients with Wegener's granulomatosis (WG) exhibit distinctive clinical features or outcomes compared with patients whose conditions were diagnosed at younger ages.

Setting

University medical center.

Patients

Thirty-three patients with WG diagnosed when 60 years old or older and 34 patients with WG diagnosed at age younger than 60 years, identified by record review of all WG patients seen over an 11-year period.

Results

The prevalence of specific clinical features, progression to end-stage renal disease, mortality rate, and infectious and noninfectious complications of therapy were examined. The prevalence of upper respiratory tract involvement (rhinitis, sinusitis, otitis, epistaxis) and hemoptysis were significantly less common as initial manifestations in the elderly patients, although pulmonary infiltrates were seen more commonly during the course of their disease. Renal insufficiency was more common at the time of diagnosis in the elderly patients (64% vs 35%; p<0.05). Most notably, CNS involvement was 4.5-fold more common in elderly patients (27% vs 6%; p=0.02). The overall incidence of infectious and noninfectious complications of therapy was similar between the groups, although the mortality rate was markedly higher in the elderly patients (54% vs 19%; p<0.01). Almost all deaths were due to overwhelming infection.

Conclusions

Elderly patients with WG present with distinctive clinical features, particularly a relatively low incidence of upper respiratory tract complaints and a high incidence of CNS involvement. The mortality risk from infectious complications of WG is substantially higher in elderly patients, although this cannot be attributed directly to adverse affects of therapy.

Section snippets

MATERIALS AND METHODS

A computerized search was performed to identify all patients diagnosed as having WG seen at the University of Michigan Medical Center from January 1983 to February 1994. The elderly group was defined as patients diagnosed as having WG when they were 60 years old or older, and the comparison group consisted of all patients with WG diagnosed at younger than 60 years of age. In keeping with previous studies, inclusion criteria consisted of the following: (1) clinical evidence of inflammatory

Patient Characteristics

Sixty-seven patients were included in the study. Thirty-three of the patients were 60 years old or older, and the remaining 34 patients comprised the younger comparison group. As shown in Table 1, the mean age of the entire population was 52.4 years, while the mean age of the elderly group was 68.4 years (range, 60 to 79 years) and 36.9 years in the control group (range, 9 to 58 years). There was a similar distribution of men and women in both groups.

As expected, the elderly patients had more

DISCUSSION

Overall, our patient population with WG was somewhat older than in previous series, as the mean age was 52.4 years, and half of the patients were diagnosed at age 60 years or older. By contrast, the mean age of 158 patients followed at the National Institutes of Health was 41 years.2 This discrepancy may be due to institution-specific referral patterns, but should not relate to patient selection, since our entry criteria were identical to those used previously. In any case, the elderly

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    Supported by SCOR research grant 1P50-HL46487.

    revision accepted July 29.

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