Incorporation of patient-reported outcomes in the clinical risk score to improve relapse prediction in ANCA-associated vasculitis.

Abstract

Objectives: To evaluate whether integration of patient-reported outcomes (PROs), particularly the 36-item short form health survey (SF-36), with the French Vasculitis Study Group relapse score (FRS) improves relapse prediction in patients with microscopic polyangiitis (MPA) or granulomatosis with polyangiitis (GPA).

Methods: This retrospective cohort study included 98 patients with MPA or GPA whose baseline and first-year follow-up SF-36 data were available. The predictive accuracy of the FRS, baseline SF-36 physical component summary (PCS) and mental component summary (MCS), and first-year cumulative SF-36 PCS and MCS for relapse was evaluated using receiver operating characteristic curve analysis. The area under the curve (AUC) with 95% confidence interval (CI) was estimated for each variable. A combination of FRS and PRO with higher accuracy was developed using multivariable Cox regression incorporating variables significantly associated with relapse.

Results: During a median follow-up of 50.9 months, 28 patients (28.6%) experienced relapse. The FRS (AUC=0.666, 95% CI=0.552-0.780, p=0.010) and first-year cumulative SF-36 PCS (AUC=0.629, 95% CI=0.503-0.755, p=0.047) significantly predicted relapse, whereas baseline SF-36 PCS and MCS and first-year cumulative SF-36 MCS did not. A combination of the FRS and first-year cumulative SF-36 PCS demonstrated improved predictive performance (AUC=0.727, 95% CI=0.623-0.830, p<0.001).

Conclusions: The first-year cumulative SF-36 PCS was independently associated with relapse in patients with MPA or GPA, and its integration with the FRS improved relapse risk prediction. These findings support a multidimensional approach incorporating both clinical and patient-reported data to better stratify relapse risk and inform treatment planning in MPA or GPA.