Long term outcome of patients with low level of cryoglobulin (<0.05g/L)

V. Eble (1, 2, 3, 4) , B. Legallicier (5) , P. Joly (6, 2, 3, 4) , O. Vittecoq (7, 2, 3, 4) , F. Caron (8) , F. Tamion (9) , P. Ducrotté (10, 11, 3, 12) , H. Levesque (1, 2, 3, 4) , J.-F. Ménard (13) , F. Jouen (14, 2, 3, 4) , D. Guerrot (6, 2, 3, 4) , I. Marié (1, 2, 3, 4)

1 Service de Médecine Interne [CHU Rouen]
2 Physiopathologie et biothérapies des maladies inflammatoires et autoimmunes
3 IRIB - Institute for Research and Innovation in Biomedicine
4 IFRMP 23 - Institut Fédératif de Recherches Multidisciplinaires sur les Peptides
5 Service de Néphrologie [Rouen]
6 Service de Dermatologie [Rouen]
7 Service de rhumatologie [CHU Rouen]
8 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
9 Service de soins intensifs [CHU Rouen]
10 Service d'Hépato-Gastroentérologie [CHU Rouen]
11 ADEN - Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
12 UNIROUEN UFR Santé - UNIROUEN - UFR Santé
13 Unité de biostatistiques [CHU Rouen]
14 Laboratoire d'immunologie et biothérapies [Rouen]

Objectives To date, no studies have yet assessed the characteristics of non-HCV patients with low level of cryoglobulin (≤ 0.05 g/L). The aims of the current study were thus to: 1) determine the prevalence of cryoglobulin ≤ 0.05 g/L in patients with non-HCV cryoglobulin; and 2) compare clinical features and long term outcome, including organ complications and mortality rate, between non-HCV patients with cryoglobulin level ≤ 0.05 g/L and those exhibiting cryoglobulin level > 0.05 g/L. Methods Among 6379 cryoglobulin testing, cryoglobulin was detected in 618 patients (9.69% of cases); of these 618 patients, 453 non-HCV patients were included in the study. The medical records of these patients were reviewed. Results Of the 453 non-HCV cryoglobulin-positive patients, 265 (58.6%) exhibited cryoglobulin level ≤ 0.05 g/L. We showed that patients with cryoglobulin level ≤ 0.05 g/L had: 1) less commonly: palpable purpura (p < 0.001), digital ulcers (p = 0.006), peripheral neurologic involvement (p = 0.03) and renal impairment (p = 0.03); and 2) lower median values of ESR (p < 0.001) and C-reactive protein (p = 0.001). The patients with cryoglobulin level ≤ 0.05 g/L less often experienced infections (p = 0.04) and hematological malignancies (p = 0.01); both groups did not differ regarding prevalence of connective tissue diseases and solid tumors. Mortality rate was as high as 13.6% in patients with cryoglobulin level ≤ 0.05 g/L; death was mainly due to: solid tumors (16.6%), cardiovascular complications (13.8%), hematological malignancies (11.1%), infections (8.3%), pulmonary/renal complications of cryoglobulin (8.3%) and connective tissue diseases (8.3%). Conclusion Our study shows a high prevalence of cryoglobulin level ≤ 0.05 g/L in clinical practice. Our findings further underscore that non-HCV cryoglobulin level ≤ 0.05 g/L may be responsible for severe renal and neurological complications, leading to high morbidity and mortality in these patients. Thus, our data suggest that both appropriate therapy and close follow-up may be required to improve such patients' outcome.

Keywords: Cryoglobulin; Connective tissue disease; Infection; Cancer; Diagnosis; Prognosis; Therapy

Domains: Tissues and Organs [q-bio.TO]

V. Eble, B. Legallicier, P. Joly, O. Vittecoq, F. Caron, et al.. Long term outcome of patients with low level of cryoglobulin (<0.05g/L). Autoimmunity Reviews, 2016, 15 (5), pp.440-446. ⟨10.1016/j.autrev.2016.01.012⟩. ⟨hal-02375570⟩