Association between plasma factor VIII level and clinical indicators and prognosis in patients with IgA nephropathy

Objective To investigate the relationship between plasma factor VIII (FVIII) level and the clinical indicators and prognosis in IgA nephropathy (IgAN) patients. Methods The clinical data of IgAN patients diagnosed from the Second Xiangya Hospital of Central South University from January 2016 to December 2016 were collected. Patients were divided into high FVIII group (FVIII>140.50%) and low FVIII group (FVIII≤140.50%) according to the time-dependent receiver operating characteristic curve analysis. The baseline clinical parameters at the time of renal biopsy between two groups of patients were compared. Taking the estimated glomerular filtration rate (eGFR) reduction ≥30% or entering end-stage renal disease (ESRD) as the endpoint event, Kaplan-Meier analysis and Cox proportional hazards models were used to explore the association between plasma FVIII level and prognosis in IgAN patients. Results A total of 93 patients were ultimately retained for this study, with a median follow-up of 35.15(33.77, 36.76) months. Twelve (12.90%) patients reached the endpoint event. The levels of serum creatinine, urea nitrogen, triglyceride, total cholesterol, plasma fibrinogen, D-dimer, 24-hour urinary protein, protein C, protein S, slope of eGFR and age in the high FVIII group were higher than those in the low FVIII group (all P<0.05). The levels of eGFR, serum albumin and follow-up time in the high FVIII group were lower than those in the low FVIII group (all P<0.05). The renal cumulative survival rate was significantly lower in the high FVIII group than that in the low FVIII group (χ2=5.635, P=0.018) according to the Kaplan-Meier analysis. After adjusting for variables such as systolic blood pressure, eGFR, urinary protein, and renal tubular atrophy/interstitial fibrosis, multivariate Cox proportional hazards models analysis showed that high level of plasma FVIII was an independent risk factor for poor prognosis in IgAN patients (HR=4.147, 95%CI 1.055-16.308, P=0.042). Conclusions The level of plasma FVIII is associated with clinical indicators and prognosis in IgAN patients. The higher level of plasma FVIII can be identified as an independent risk factor for poor prognosis in IgAN patients. Key words: Glomerulonephritis, IgA; Factor VIII; Prognosis; End-stage renal disease