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Background <p>Frailty has gained attention as an important prognostic factor in autoimmune diseases, but its clinical impact in organ-threatening ANCA-associated vasculitis (AAV) remains poorly understood. While recent advances in treatment have improved survival outcomes in AAV, maintaining quality of life (QOL) remains a challenge. This study investigated the impact of frailty on prognosis in elderly patients with severe AAV.</p> Methods <p>We retrospectively analyzed 23 newly diagnosed AAV patients with renal involvement. Frailty was assessed using the Clinical Frailty Scale (CFS). Patients were divided into robust and frail groups based on pre-AAV onset CFS scores. We compared clinical characteristics, treatment, outcomes, and CFS progression between groups. We also investigated predictors of serious adverse events (SAEs).</p> Results <p>No significant difference in age was observed between the robust and frail groups. The frequency of rituximab, intravenous cyclophosphamide, and avacopan use was comparable between groups. Two deaths occurred during the 6-month follow-up period, both in the frail group. Serious adverse events (SAEs) occurred significantly more frequently in frail patients (66.7% vs. 9.1%, p &lt; 0.01). Survival time analysis demonstrated a markedly higher SAE risk in the frail group (log-rank: p &lt; 0.01, HR: 6.07). Patients who developed SAEs experienced progressive deterioration of frailty, whereas those who did not developed stable or improved frailty.</p> Conclusion <p>In organ‑threatening AAV, frailty may be associated with an increased risk of severe adverse events and functional decline. These exploratory findings suggest a potential role for frailty assessment in initial risk stratification.</p>

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Impact of frailty on prognosis in elderly patients with organ-threatening ANCA-associated vasculitis

  • 期刊论文

  • 发表日期：

    2026年6月19日

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  • Kenta Taito,
  • Seiji Hashimoto,
  • Kaoruko Fukushima,
  • Keitaro Ogawa,
  • Kanako Yatabe,
  • Ayano Izawa,
  • Yui Ohta,
  • Shiho Matsuno,
  • Masatoshi Oka,
  • Noriyuki Suzuki,
  • Takashi Takei,
  • Mitsuyo Itabashi

摘要

Background

Frailty has gained attention as an important prognostic factor in autoimmune diseases, but its clinical impact in organ-threatening ANCA-associated vasculitis (AAV) remains poorly understood. While recent advances in treatment have improved survival outcomes in AAV, maintaining quality of life (QOL) remains a challenge. This study investigated the impact of frailty on prognosis in elderly patients with severe AAV.

Methods

We retrospectively analyzed 23 newly diagnosed AAV patients with renal involvement. Frailty was assessed using the Clinical Frailty Scale (CFS). Patients were divided into robust and frail groups based on pre-AAV onset CFS scores. We compared clinical characteristics, treatment, outcomes, and CFS progression between groups. We also investigated predictors of serious adverse events (SAEs).

Results

No significant difference in age was observed between the robust and frail groups. The frequency of rituximab, intravenous cyclophosphamide, and avacopan use was comparable between groups. Two deaths occurred during the 6-month follow-up period, both in the frail group. Serious adverse events (SAEs) occurred significantly more frequently in frail patients (66.7% vs. 9.1%, p < 0.01). Survival time analysis demonstrated a markedly higher SAE risk in the frail group (log-rank: p < 0.01, HR: 6.07). Patients who developed SAEs experienced progressive deterioration of frailty, whereas those who did not developed stable or improved frailty.

Conclusion

In organ‑threatening AAV, frailty may be associated with an increased risk of severe adverse events and functional decline. These exploratory findings suggest a potential role for frailty assessment in initial risk stratification.