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ORIGINAL RESEARCH article

Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1450153
This article is part of the Research Topic ANCA associated vasculitis treatment: outcomes and complications View all 3 articles

Identification of novel clinical subtypes in patients with microscopic polyangiitis using cluster analysis: multicenter REVEAL cohort study

Provisionally accepted
Ayana Okazaki Ayana Okazaki 1Shogo Matsuda Shogo Matsuda 1Takuya Kotani Takuya Kotani 1*Keisuke Fukui Keisuke Fukui 2Takaho Gon Takaho Gon 3Ryu Watanabe Ryu Watanabe 3Atsushi Manabe Atsushi Manabe 4Mikihito Shoji Mikihito Shoji 4Keiichiro Kadoba Keiichiro Kadoba 4Ryosuke Hiwa Ryosuke Hiwa 4Wataru Yamamoto Wataru Yamamoto 5Motomu Hashimoto Motomu Hashimoto 3Tohru Takeuchi Tohru Takeuchi 1
  • 1 Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
  • 2 Kansai University, Suita, Ōsaka, Japan
  • 3 Osaka Metropolitan University, Osaka, Japan
  • 4 Kyoto University, Kyoto, Kyōto, Japan
  • 5 Kurashiki Sweet Hospital, Kurashiki, Okayama, Japan

The final, formatted version of the article will be published soon.

    This study aimed to identify new clinical phenotypes of microscopic polyangiitis (MPA) using a principal components analysis (PCA)-based cluster analysis.Methods: A total of 189 patients with MPA between May 2005 and December 2021 were enrolled from a multicenter cohort in Japan (REVEAL cohort). Categorical PCA and cluster analysis were performed based on clinical, laboratory, and radiological findings. Clinical characteristics and outcomes, including all-cause mortality, respiratory-related mortality, end-stage renal disease (ESRD), and relapse were compared between each cluster.Results: Eleven clinical variables were transformed into four components using categorical PCA and synthetic variables were created. Additionally, a cluster analysis was performed using these variables to classify patients with MPA into subgroups.Four distinct clinical subgroups were identified: Cluster 1 included the renal involvements and diffuse alveolar haemorrhage (DAH)-dominant group (N=33). Cluster 2 comprised the elderly onset systemic inflammation group (N=75). Cluster 3 included patients in the younger-onset limited-organ disease group (N=45). Cluster 4 was comprised of an ILD-predominant group without kidney involvement (N=36). 61 patients died during follow-up, with 32 dying of respiratory-related causes.Additionally, 19 patients developed ESRD and 70 relapsed. Cluster 1 showed the worst ESRD-free survival and relapse rates, whereas Cluster 2 showed the worst overall survival and respiratory-related death-free survival rates among the four groups.Conclusions: Our study identified four unique subgroups with different MPA outcomes.Individualized treatments for each subgroup may be required to improve the prognosis of MPA.

    Keywords: The running head: clinical subtypes in MPA microscopic polyangiitis, Principal Component Analysis, Cluster analysis, prognosis, Real world evidence

    Received: 17 Jun 2024; Accepted: 30 Dec 2024.

    Copyright: © 2024 Okazaki, Matsuda, Kotani, Fukui, Gon, Watanabe, Manabe, Shoji, Kadoba, Hiwa, Yamamoto, Hashimoto and Takeuchi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Takuya Kotani, Osaka Medical and Pharmaceutical University, Takatsuki, 569-8686, Osaka, Japan

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