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BackgroundAccuracy of diagnosis and prompt therapeutic intervention are the mainstay in patients with ANCA-associated vasculitis(AAV) suffering from life-threatening complications [1].However, there is no definition of therapeutic window in vital AAV, nor its impact on patient outcome regarding length of hospital stay, intensive care unit(ICU) admission or survival.ObjectivesThe aim of the study is to analyze the process of care from the perspective of time management in vital organ involvement AAV patients and to identify potential risk factors for ICU admission.MethodsA retrospective multicenter study identified AAV patients with life-threatening organ involvement, defined as alveolar hemorrhage, rapidly progressive renal failure, myocarditis and cerebral granuloma. Demographic data was collected. Key time frames were recorded, namely the interval from acute symptom onset to hospital presentation, days until imaging(plain X-ray, cardiac ultrasound, CT-scan), time to therapeutic intervention with corticosteroids or biologic/non-biologic immunosuppression(cyclophosphamide or rituximab) and to renal replacement therapy(RRT) or plasmapheresis. Time to ICU admission, hospital length-of-stay, Birmingham Vasculitis Activity Score(BVAS) were also noted. Statistical analysis was performed using SPSS and Chi-square and Pearson correlation tests were applied.Results66 patients with AAV were enrolled, out of which 17 fulfilled inclusion criteria. Mean age in the study group was 58.6±11.1 years old,10 patients(58.8%) were females and 7 (41.2%) males.11(64.7%) patients were c-ANCA positive, while 6 (35.3%) had p-ANCA and all were diagnosed with AAV prior to life-threatening event. Two patients had COVID-19 triggered AAV.In the study group, the most frequent critical organ suffering was rapidly progressive renal failure(12), followed by alveolar hemorrhages(10), 2 cerebral granulomas and one acute myocarditis. Three patients(17.6%) had more than one vital manifestation. Ten patients(58.8%) had more than three additional non-organ-threatening manifestations. Mean interval from AAV diagnosis to emergency admission was 30.1± 61.1 days, median 3 and from severe episode onset to hospitalization 1.65±0.18 days, median 1. There was only one death in the study group. Three patients were admitted in the ICU in 0.59±1.5 days following hospital presentation and required either RRT or plasma exchange within 2.66 days. Imaging examination was performed unanimously the day upon hospital admission. All patients received corticosteroids in the first 5.95±14.3 days, while immunosuppression was given to 13(76.5%) patients within 11.5±15.5 days from hospitalization.12 patients(70.5%) suffered from associated infections. Mean BVAS(13.6±6.76) correlated to ICU admission(p 0.013, r 0.58).Patients in ICU revealed higher BVAS(22±9.53) versus non-ICU(11.8±4.76).Hospital length of stay was 14.7±10.7 days(median 14) and showed no relationship to the type of severe organ involvement. The need for ICU caring was dominant in males(p 0.05) and confirmed in patients with proteinuria(p 0.012) and at least two major organ damage.ConclusionThis study shows that severity risk factors for potential ICU admission for life-threatening AAV appear to be male gender, proteinuria and the number of affected organs.Moreover, BVAS should be considered a useful tool to predict patients' risk for intensive care management since a higher score indicates a more aggressive disease.However, time to investigational or therapeutic intervention did not correlate to patient outcome in AAV.References[1]Geetha, D., Seo, P. (2011). Life-Threatening Presentations of ANCA-Associated Vasculitis. In: Khamashta, M., Ramos-Casals, M. (eds) Autoimmune Diseases. Springer, London. https://doi.org/10.1007/978-0-85729-358-9_8Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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Background: High levels of tumor necrosis factor (TNF), a key proinfamma-tory cytokine, is associated with SARS-CoV-2 infection. In rheumatoid arthritis patients with SARS-CoV-2 infection, anti TNF therapy reduces not only TNF but other cytokines responsible for high morbidity and mortality. The severe systemic infammation in COVID-19 causes respiratory symptoms, fever, fatigue, neurological and gastrointestinal manifestations. Objectives: We followed the evolution of SARS-CoV-2 infection in rheumatoid arthritis patients who received anti TNF blockers. Methods: Our study included 95 rheumatoid arthritis patients who were diagnosed with SARS CoV-2 infection through a positive RT-PCR-SARS-CoV2 test. 21 patients were men and 74 were women. Mean age was 58 ±11,5. 24 patients received monotheraphy with anti TNF blockers (Adalimumab/Infiximab), 48 received TNF blockers in combination with Methotrexate (10 mg per week) and 23 received TNF blockers in combination with Lefunomide (20 mg per day). We followed serum ferritin, C reactive protein and D-dimer in all patients. 59 patients were vaccinated with two doses of Pfzer-BioNtech (64.1 %). The study group was analyzed from 30th December 2021 to 1st of January 2022. From 95 patients, 35 (36,8%) were hospitalized and 60 received ambulatory care. Results: Our patients with COVID-19 presented with asimptomatic forms, forms with mild symptoms and complicated forms that required hospitaliza-tion. No patients had died. Milder forms were associated with the use of TNF blockers and Methotrexate and patients with monotherapy-TNF blockers. They presented with mild symptoms (fever, arthralgia, odynophagia, dysgeu-sia/ageusia, anosmia). Hospitalization rate in patients who received mono-theraphy with TNF blockers was 29,1%, 31,2% in patients who received TNF blockers and Methotrexate and 56,5% in patients with TNF blockers and Lefunomide (69,3%). Factors associated with higher odds of hospitalization included older age (p=0,001), active disease (p=0,02), obesity (p=0,005), pulmonary chronic disease (p=0,02), diabetes (p=0,001) and concomitent dose of Lefunomide (p=0,0006). Female sex was associated with milder forms of the disease. Patients with high levels of D-dimer had a higher odd of hospital-ization (p<0,001). Strong positive correlation was observed between elevated D-dimers and hospitalization odds. Conclusion: TNF blockers in monotheraphy or associated with Methotrexate were correlated with lower odds of hospitalization and milder forms of COVID-19. No signifcant difference of hospitalization odd was observed between vaccinated and unvaccinated patients.