J Rheum Dis.  2024 Jul;31(3):151-159. 10.4078/jrd.2024.0001.

The monocyte-to-high-density lipoprotein-cholesterol ratio at diagnosis is associated with cerebrovascular accident during follow-up in patients with antineutrophil cytoplasmic antibody-associated vasculitis

• Ha JW
• Ahn SS
• Song JJ
• Park YB
• Lee SW

• KMID: 2557384
• DOI: http://doi.org/10.4078/jrd.2024.0001

Abstract

Objective
In this study, the association between the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) at diagnosis and poor outcomes of atherosclerosis-related antineutrophil cytoplasmic antibody-associated vasculitis (AAV) during follow-up in patients with AAV was investigated.
Methods
This retrospective study included 138 patients diagnosed with AAV. Their comprehensive medical records were meticulously reviewed. All-cause mortality, cerebrovascular accident (CVA), and acute coronary syndrome (ACS) were evaluated as atherosclerosis-related poor outcomes of AAV. MHR was obtained by dividing monocyte counts (/mm³ ) by high-density lipoprotein cholesterol (mg/dL) levels.
Results
The median age of the 138 patients was 58.3 years with 44 being male (31.9%). Among the 138 patients, 11 (8.0%) died, and 11 (8.0%) and 9 (6.5%) had CVA, and ACS, respectively. MHR at diagnosis was significantly correlated with the Birmingham vasculitis activity score, erythrocyte sedimentation rate, and C-reactive protein at diagnosis. Among the three poor outcomes of AAV, only CVA during follow-up was significantly associated with MHR at diagnosis, and thus, only CVA was considered an atherosclerosis-related poor outcome of AAV. In the multivariable Cox hazards model analysis, MHR (hazard ratio [HR]: 1.195) and serum albumin (HR: 0.203) at diagnosis were independently associated with CVA during follow-up. Additionally, patients with MHR at diagnosis ≥3.0 exhibited a significantly higher risk for CVA and lower cumulative CVA-free survival rate than those with MHR at diagnosis <3.0.
Conclusion
This study is the first to demonstrate clinical implications of MHR suggesting that MHR at diagnosis is significantly and independently associated with CVA during follow-up in patients with AAV.

Keyword

Monocytes; High density lipoprotein cholesterol; Stroke; Antineutrophil cytoplasmic antibody; Vasculitis

Figure

• 

  Figure 1 Correlation analysis. MHR at diagnosis is significantly correlated with the cross-sectional BVAS, ESR, and CRP levels. MHR: monocyte-to-high-density lipoprotein-cholesterol ratio, BVAS: Birmingham vasculitis activity score, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein.

• 

  Figure 2 Relative risk. Patients with MHR at diagnosis ≥3.0 exhibits a significantly higher risk of CVA than those with MHR at diagnosis <3.0. MHR: monocyte-to-high-density lipoprotein-cholesterol ratio, CVA: cerebrovascular accident, CI: confidence interval.

• 

  Figure 3 Comparison of cumulative survival rates. Patients with MHR at diagnosis ≥3.0 exhibits a significantly lower cumulative CVA-free survival rate than those with MHR at diagnosis <3.0. MHR: monocyte-to-high-density lipoprotein-cholesterol ratio, CVA: cerebrovascular accident.

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