Cardiovascular, thromboembolic and renal outcomes in IgA vasculitis (Henoch-Schönlein purpura): a retrospective cohort study using routinely collected primary care data.

Tracy, Alexander, Subramanian, Anuradhaa, Adderley, Nicola J, Cockwell, Paul, Ferro, Charles, Ball, Simon, Harper, Lorraine and Nirantharakumar, Krishnarajah (2019) Cardiovascular, thromboembolic and renal outcomes in IgA vasculitis (Henoch-Schönlein purpura): a retrospective cohort study using routinely collected primary care data. Annals of the rheumatic diseases, 78 (2). pp. 261-269. ISSN 1468-2060. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using the UHB Athens login IDs

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Official URL: https://ard.bmj.com/content/78/2/261.long

Abstract

BACKGROUND

IgA vasculitis (IgAV, Henoch-Schönlein purpura) is a small-vessel vasculitis most common in children but also occurring in adults. Case series have suggested that IgAV may be associated with cardiovascular disease and venous thromboembolism, but this has not been evaluated in population-based studies. Renal disease and hypertension are possible complications of the disease with unknown incidence.

METHODS

Using a large UK primary care database, we conducted an open retrospective matched cohort study of cardiovascular, venous thrombotic and renal outcomes in adult-onset and childhood-onset IgAV. Control participants were selected at a 2:1 ratio, matched for age and sex. Adjusted HRs (aHRs) were calculated using Cox proportional hazards models.

RESULTS

2828 patients with adult-onset IgAV and 10 405 patients with childhood-onset IgAV were compared with age-matched and sex-matched controls. There was significantly increased risk of hypertension (adult-onset aHR 1.42, 95% CI 1.19 to 1.70, p < 0.001; childhood-onset aHR 1.52, 95% CI 1.22 to 1.89, p < 0.001) and stage G3-G5 chronic kidney disease (adult-onset aHR 1.54, 95% CI 1.23 to 1.93, p < 0.001; childhood-onset aHR 1.89, 95% CI 1.16 to 3.07, p=0.010). There was no evidence of association with ischaemic heart disease, cerebrovascular disease or venous thromboembolism. All-cause mortality was increased in the adult-onset IgAV cohort compared with controls (aHR 1.27, 95% CI 1.07 to 1.50, p=0.006).

CONCLUSIONS

Patients with IgAV are at increased risk of hypertension and chronic kidney disease (CKD) compared with individuals without IgAV; analysis restricted to adult-onset IgAV patients showed increased mortality. Appropriate surveillance and risk factor modification could improve long-term outcomes in these patients.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using the UHB Athens login IDs
Subjects: WB Practice of medicine
WG Cardiovascular system. Cardiology
Divisions: Clinical Support
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Depositing User: Jamie Edgar
Date Deposited: 01 Nov 2019 12:21
Last Modified: 01 Nov 2019 13:06
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2542

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