Vasculitis: 265. Cryoglobulinemic Vasculitis Secondary to Hepatitis C Infection: Is Prediction of Disease Severity Feasible?

BACKGROUND: Chronic Hepatitis C virus (HCV) infection can sometimes be causative of vasculitis. We assessed the incidence, clinical spectrum and management of cryoglobulinemic vasculitis (CGV) secondary to HCV infection in a tertiary teaching hospital. METHODS: We included 246 consecutive patients with chronic HCV infection admitted to our hospital between 01/01/2004 and 31/12/2008. In those with cryoglobulinemic vasculitis we assessed the duration of infection (more or less than 36 months), clinical features, biologic, immunologic and inflammatory status (estimated GFR - MDRD, complement level, ESR, CRP), viral load, Histological Activity Index (HAI) and disease activity (assessed with the Birmingham Vasculitis Activity Score (VAS) 2003; severe vasculitis was defined as VAS>12). RESULTS: Of the 246 chronic HCV infection patients, 16 had CGV; 9 had a duration of the disease > 36 months (mean duration 37.4 months, SD plus or minus 11, range = 7-68 months). Eleven of all the 16 patients had cutaneous involvement, 12 neurologic involvement, 7 renal dysfunction, 4 joint involvement and 1 had antiphospholipid syndrome. In 12 (75%) patients ESR was > 25 mm/h, 11 (69%) had abnormal levels of CRP and 6 (38%) had low complement levels. The HAI was > 9 in 12 patients, and the mean VAS2003 was 12 (SD plus or minus 2; range = 6-21) Severe vasculitis was associated with duration of infection > 36 months (p = .03; r = .55), renal involvement (p = .036; r = .83), lower levels of complement (p = .044; r = .78) and viral load < 800.000 IU/ml (p = .041; r = .62). Four patients died in spite of intensive treatment (1 cerebral vasculitis, 2 severe infections and 1 acute hepatic failure). CONCLUSIONS: Whereas the occurrence and severity of vasculitis secondary to HCV infection remain impossible to predict accurately, in our patients, results of simple 'routine' tests appear to have genuine associations with disease severity. This finding - if confirmed prospectively in larger studies - may be the first step towards the development of a clinical prediction tool that has the potential to guide treatment. Disclosure statement: The authors have declared no conflicts of interest.