Clinical Predictors of Outcome in Buergerâ€™s Disease using BVAS and DEI.Tak Scoring Systems OC08-OC10
Dr. Debashish Danda,
Professor and Head, Department of Clinical Immunology and Rheumatology,
Christian Medical College,Vellore-632004, Tamil Nadu, India.
Introduction: Buergerâ€™s disease is an unclassifiable vasculitis of the small and medium-sized distal arteries and superficial veins. BVAS (Birmingham Vasculitis Activity Score) is a validated disease activity index for vasculitis of different types. DEI.Tak (Disease Extent Index. Takayasuâ€™s arteritis) scoring system is a validated disease extent Index used for Takayasu arteritis.
Aim: The aim of this study was to assess outcome in patients with Buergerâ€™s disease using various clinical features, laboratory parameters, BVAS and DEI.Tak scoring system.
Materials and Methods: Case records of 136 patients diagnosed with Buergerâ€™s disease in our hospital between August 1996 and July 2006 were studied retrospectively. Various clinical features (smoking history, claudication pain, loss of pulse), laboratory parameters, treatment modalities and outcome measures were recorded in a defined proforma. BVAS and DEI.Tak scoring was done using the data from medical records documented during the patientsâ€™ last visit to the hospital. Outcome of any patient requiring amputation was considered as bad outcome. Others, who could be managed by antiplatelet drugs, sympathectomy and revascularization procedures without any amputation were classified within the good outcome subset. Statistical analysis was done using Chi-square test and Non parametric MannWhitney test was performed to correlate outcome with all the recorded parameters including those embedded in BVAS and DEI.Tak scoring systems.
Results: Sixty eight patients were in each group, namely the good outcome and bad outcome subsets. The mean BVAS score were 10.29Â±1.26 and 10.88Â±2.57 and mean DEI.Tak score were 5.29Â±1.75 and 7.93Â±2.43 and these scores were observed to be significantly different (p=0.038, p=0.014 respectively) among the good outcome subsets and bad outcome patients with respectively. Proportion of patients with claudication pain and absent upper limb pulse were observed significantly higher in the bad outcome group.
Conclusion: Buergerâ€™s disease with higher DEI.Tak score has significantly higher risk of bad outcome. DEI.Tak score can be used as an important predictor of outcome in Buergerâ€™s disease.