Objectives To evaluate whether the first-year cumulative vascular damage index (VDI) could serve as an independent predictor of relapse in patients with granulomatosis with polyangiitis (GPA). Methods We retrospectively analysed 39 patients with GPA enrolled in a single-centre cohort. The first-year cumulative VDI was calculated as the area under the curve (AUC) of VDI scores during the first year using the trapezoidal rule. The earliest VDI, defined as the first VDI recorded ≥ 3 months after AAV diagnosis or AAV symptom onset, was also assessed as a contextual reference. Relapse was defined as the recurrence or new onset of vasculitic manifestations after ≥ 3 months of remission. The predictive accuracy for relapse was assessed using receiver operating characteristic (ROC) curves. Multivariable Cox proportional hazard models were performed to assess whether the first-year cumulative VDI is independently associated with the risk of relapse. Results During a median follow-up of 40.6 (13.9–64.7) months, relapse occurred in 18 (46.2%) patients. The first-year cumulative VDI (AUC = 0.817) showed a significant predictive value for relapse, with a numerically higher accuracy than the earliest VDI (AUC = 0.734), although the difference was not statistically significant (p = 0.272). In the multivariable Cox model, the first-year cumulative VDI was significantly associated with relapse risk (adjusted hazard ratio [HR] = 6.536, 95% confidence interval [CI] = 1.746–24.460, p = 0.005), whereas the earliest VDI was not (adjusted HR = 1.358, 95% CI = 0.976–1.889, p = 0.070). Conclusion The first-year cumulative VDI independently predicts relapse in GPA, and outperformed early single time-point damage assessment. Our findings suggest that early cumulative damage evaluation may improve relapse risk stratification.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="justify" colname="c1" colnum="1" /> <colspec align="justify" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> Key Points • We assessed whether VDI can predict relapse in patients with GPA. • The first-year cumulative VDI was found to independently predict relapse in GPA. • Early cumulative damage evaluation may improve relapse risk stratification. </entry> </row> </tbody> </tgroup> </Table>

Association of the first-year cumulative vascular damage index with relapse risk in granulomatosis with polyangiitis: a retrospective cohort analysis

期刊论文
发表日期：

2026年7月27日

查看全文

Oh Chan Kwon,
Jang Woo Ha,
Yong-Beom Park,
Sang-Won Lee

摘要

Objectives

To evaluate whether the first-year cumulative vascular damage index (VDI) could serve as an independent predictor of relapse in patients with granulomatosis with polyangiitis (GPA).

Methods

We retrospectively analysed 39 patients with GPA enrolled in a single-centre cohort. The first-year cumulative VDI was calculated as the area under the curve (AUC) of VDI scores during the first year using the trapezoidal rule. The earliest VDI, defined as the first VDI recorded ≥ 3 months after AAV diagnosis or AAV symptom onset, was also assessed as a contextual reference. Relapse was defined as the recurrence or new onset of vasculitic manifestations after ≥ 3 months of remission. The predictive accuracy for relapse was assessed using receiver operating characteristic (ROC) curves. Multivariable Cox proportional hazard models were performed to assess whether the first-year cumulative VDI is independently associated with the risk of relapse.

Results

During a median follow-up of 40.6 (13.9–64.7) months, relapse occurred in 18 (46.2%) patients. The first-year cumulative VDI (AUC = 0.817) showed a significant predictive value for relapse, with a numerically higher accuracy than the earliest VDI (AUC = 0.734), although the difference was not statistically significant (p = 0.272). In the multivariable Cox model, the first-year cumulative VDI was significantly associated with relapse risk (adjusted hazard ratio [HR] = 6.536, 95% confidence interval [CI] = 1.746–24.460, p = 0.005), whereas the earliest VDI was not (adjusted HR = 1.358, 95% CI = 0.976–1.889, p = 0.070).

Conclusion

The first-year cumulative VDI independently predicts relapse in GPA, and outperformed early single time-point damage assessment. Our findings suggest that early cumulative damage evaluation may improve relapse risk stratification.

Key Points

• We assessed whether VDI can predict relapse in patients with GPA.

• The first-year cumulative VDI was found to independently predict relapse in GPA.

• Early cumulative damage evaluation may improve relapse risk stratification.