POS0339 PREDICTORS OF DEATH IN PATIENTS DIAGNOSED WITH GIANT CELL ARTERITIS IN WESTERN NORWAY 1972-2012
Authors: L. K. Brekke, B. T. Svanes Fevang, J. Assmus
Journal: Annals of the Rheumatic Diseases (2021)

Background: Giant cell arteritis (GCA) is the most common systemic vasculitis in adults, and the number of incident cases worldwide is projected to increase [1]. Evidence as to whether or not GCA confers a mortality risk is conflicting, and many studies have been limited by inadequate or lacking adjustment for confounders. Objectives: To investigate possible predictors of death in a large and well characterized Norwegian cohort of GCA-patients. Methods: This is a hospital-based retrospective cohort study including patients diagnosed with GCA during 1972-2012. Patients were identified through computerized hospital records using the International Classification of Diseases coding system. Clinical information was extracted from patients’ medical journals. Further details about the inclusion process have been published previously [2]. Information on time of death was obtained from the Norwegian Cause of Death Registry. We investigated predicting factors using Cox regression. Selected variables were first analyzed in univariate and block regression models (block 1: clinical features including histology, block 2: laboratory and treatment factors, block 3: demographic and traditional risk factors). Variables included in the final multivariate model were selected on the following basis: P-value &lt;0.1 in univariate or block regression or otherwise deemed clinically significant. Results: 881 patients were included of which 626 (71.1%) were females. Mean age was 73 years (SD 9). 490 patients (55.6%) died during the study period (1 January 1972 – 31 December 2012). Characteristics and mortality for the GCA-cohort compared to matched controls have been published previously [3]. Within the GCA-cohort we found that presenting with visual disturbance (any) or scalp necrosis was associated with increased risk of death in univariate analysis (Figure 1). However, in multivariate analysis the traditional risk factors (age, smoking, hypertension and previous cardiovascular disease) were more strongly associated with risk of death. Among laboratory parameters only Hemoglobin (Hb) levels were significantly associated with risk of death with increasing Hb-levels indicating decreased risk. Neither temporal artery biopsy result nor initial or maximal (before first tapering) Prednisolone dose were found to be associated with risk of death. Results from univariate and the final multivariate models are presented in Figure 1. Figure 1. Conclusion: In our large cohort of GCA-patients the risk of death was found to be predominantly predicted by age (HR 2.81) and traditional risk factors (smoking (HR 1.61), hypertension (HR 1.48) and previous cardiovascular disease (HR 1.26)). Visual disturbance (HR 1.40), visual loss in particular (HR 2.37), and scalp necrosis (HR 3.42) were found to be the clinical features most associated with risk of death. However, we note that our material lacked information about extra-cranial (large vessel) vasculitis, which may also carry increased risk of death. References: [1]De Smit E, Palmer AJ, Hewitt AW. Projected worldwide disease burden from giant cell arteritis by 2050. J Rheumatol 2015;42:119-25. [2]Brekke LK, Diamantopoulos AP, Fevang BTS, Assmus J, Esperø E, Gjesdal CG. Incidence of giant cell arteritis in Western Norway 1972-2012: a retrospective cohort study. Arthritis Res Ther. 2017;19(1):278. [3]Brekke LK, Fevang BTS, Diamantopoulos AP, Assmus J, Esperø E, Gjesdal CG. Survival and death causes of patients with giant cell arteritis in Western Norway 1972-2012: a retrospective cohort study. Arthritis Res Ther. 2019;21(1):154. Disclosure of Interests: Lene Kristin Brekke Grant/research support from: Unrestricted research grant from MSD, Bjørg Tilde Svanes Fevang Consultant of: Been part of advisory board for Lilly, Jörg Assmus: None declared