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Ocular manifestations in ANCA-associated vasculitis: a comprehensive analysis from Chinese medical centers

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Abstract

Introduction

This study aimed to explore ocular manifestations in ANCA-associated vasculitis (AAV), focusing on granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA), and microscopic polyangiitis (MPA) and to examine the associations with laboratory parameters and other systemic manifestations.

Methods

This retrospective study reviewed data from 533 AAV patients across two major Chinese medical centers from January 2016 to November 2023. Data including diagnosis, cranial manifestations of disease, ocular complications, and laboratory parameters were analyzed. Univariate and multivariable logistic regression analyses assessed associations across disease manifestations. Machine learning models were also utilized to predict the risk of retinal/eye involvement in AAV patients.

Results

Among 533 patients (210 GPA, 217 MPA, 99 EGPA, and 7 unclassified AAV), ocular complications were observed in 20.64% of them, with a distribution of 36.67% in GPA, 7.37% in MPA, and 18.18% in EGPA. The most common ocular manifestations included scleritis and retro-orbital mass/dacryocystitis, which were notably prevalent in GPA patients. Retinal involvement was observed in 9.09% of EGPA cases. The machine learning models yielded that eosinophil percentage (EOS%), high-sensitivity C-reactive protein (hsCRP), and CD4 + T cell/CD8 + T cell ratio (T4/T8) can predict retinal involvement. Furthermore, the white blood cell, EOS%, APTT, IgA, hsCRP, PR3-ANCA, and T4/T8 can predict eye involvement.

Conclusion

Ocular manifestations are a prevalent complication across all forms of AAV. Predictive models developed through machine learning offer promising tools for early intervention and tailored patient care. This necessitates a multidisciplinary approach, integrating rheumatology and ophthalmology expertise for optimal patient outcomes.

Key Points

• This study provides new insights into the ocular manifestations of ANCA-associated vasculitis across different subtypes, revealing a notable prevalence of ocular complications.

• A machine learning model is built to predict eye/retinal involvement, enhancing early diagnostic capabilities.

• The findings could guide more systematic ocular screenings in ANCA-associated vasculitis patients and influence treatment protocols.

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Fig. 1
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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank staff members from the First Affiliated Hospital of Chongqing Medical University and Peking Union Medical College Hospital for their assistance with the information collection.

Funding

This study was supported by the National Natural Science Foundation of China (No. 82271112).

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Authors and Affiliations

  1. Department of Ophthalmology, Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Shulin Liu & Mei Xu

  2. Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Bei**g, China

    **nyu Zhao, **gyuan Yang, Wenfei Zhang & Youxin Chen

Authors
  1. Shulin Liu
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  2. Mei Xu
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  3. **nyu Zhao
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  4. **gyuan Yang
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  5. Wenfei Zhang
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Contributions

Shulin Liu designed the study, analyzed the data, and drafted the article. Mei Xu, **nyu Zhao, **gyuan Yang, and Wenfei Zhang collected and organized the data. Youxin Chen provided funds for the research, supervised the study, and guided the writing of article. All authors read and approved the final manuscript.

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Correspondence to Youxin Chen.

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Liu, S., Xu, M., Zhao, X. et al. Ocular manifestations in ANCA-associated vasculitis: a comprehensive analysis from Chinese medical centers. Clin Rheumatol (2024). https://doi.org/10.1007/s10067-024-07034-y

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