J Rheum Dis.  2022 Jul;29(3):154-161. 10.4078/jrd.2022.29.3.154.

Modified Body Mass Index at Diagnosis is a Useful Predictor of Mortality in Patients With Antineutrophil Cytoplasmic Antibody-associated Vasculitis

• Pyo JY
• Ahn SS
• Song JJ
• Park YB
• Lee SW

• KMID: 2530679
• DOI: http://doi.org/10.4078/jrd.2022.29.3.154

Abstract

Objective
We investigated whether modified body mass index (mBMI) at diagnosis could predict all-cause mortality during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).
Methods
The medical records of 203 AAV patients with BMI ≥18.5 kg/m 2 were reviewed. mBMI was calculated using an equation: mBMI=BMI (kg/m 2 )×serum albumin (g/L). All-cause mortality was considered as a poor outcome, and the follow-up duration based on all-cause mortality was defined as the period from AAV diagnosis to death for deceased patients, and the period from AAV diagnosis to the last visit for surviving patients.
Results
The median age was 59.0 years (35.5% were male). The median BMI and mBMI were 22.8 kg/m² and 813.2 kg · g/m² · L.Twenty-five patients (12.3%) died. mBMI was well correlated with age, BVAS, FFS, erythrocyte sedimentation rate and C-reactive protein at diagnosis. Deceased patients exhibited significantly lower mBMI at diagnosis compared to surviving patients. AAV patients mBMI ≤570.1 kg g/m² · L showed a significantly higher frequency of all-cause mortality (38.5% vs. 8.5%), and furthermore, exhibited a significantly higher risk for all-cause mortality than those with mBMI >570.1 kg · g/m² · L (RR 6.750). mBMI ≤570.1 kg · g/m² · L showed a significantly lower cumulative patients’ survival rate than those with mBMI >570.1 kg · g/m² · L. In the multivariable Cox hazards model analysis, either serum albumin or mBMI was significantly associated with all-cause mortality in AAV patients.
Conclusion
In conclusion, mBMI ≤570.1 kg · g/m² · L at diagnosis may be a useful predictor of all-cause mortality during followup additionally to serum albumin in AAV patients.

Keyword

Antineutrophil cytoplasmic antibody; Body mass index; Albumin; Mortality

Figure

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  Fig. 1 Comparison between surviving and deceased patients. (A) BMI at diagnosis did not differ between the two groups. (B, C) However, deceased patients exhibited significantly lower serum albumin and mBMI at diagnosis. mBMI: modified body mass index, BMI: body mass index, AAV: ANCA-associated vasculitis, ANCA: antineutrophil cytoplasmic antibody.

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  Fig. 2 (A) When the cut-offs of mBMI for all-cause mortality were obtained using the ROC curve (area 0.702, 95% CI 0.598~0.807), mBMI of 570.1 was chosen for the optimal one due to the maximised sum of sensitivity and specificity. All-cause mortality was identified more frequently in AAV patients with mBMI ≤570.1 kg · g/m2 · L than those without. (B) Furthermore, AAV patients with mBMI ≤570.1 kg · g/m2 · L exhibited a significantly higher risk for all-cause mortality than those without. mBMI: modified body mass index, ROC: the receiver operator characteristic, CI: confidence interval, AAV: ANCA-associated vasculitis, ANCA: antineutrophil cytoplasmic antibody, RR: relative risk.

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  Fig. 3 AAV patients with mBMI ≤570.1 kg · g/m2 · L showed a significantly lower cumulative patients’ survival rate than those without. AAV: ANCA-associated vasculitis, ANCA: antineutrophil cytoplasmic antibody, mBMI: modified body mass index.

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