The Systemic Necrotizing Vasculitis Damage Index (SNVDI) was developed to evaluate permanent damage caused by scarring in patients with a systemic vasculitis like polyarteritis nodosa or the Churg Strauss syndrome. The authors are from the Wellesley Hospital in Toronto.
Criteria for injury
(1) non-reversible change
(2) not related to active disease
(3) occurring after the onset of the vasculitis
Systems involved:
(1) ocular
(2) pulmonary
(3) cardiovascular
(4) peripheral vascular
(5) gastrointestinal
(6) gonads
(7) renal
(8) skin
(9) neurological
(10) malignancy
(11) diabetes mellitus
(12) musculoskeletal
System |
Finding |
Points if Present |
---|---|---|
ocular (either eye) |
cataract or cataract surgery |
1 |
|
retinal change > 6 months |
1 |
|
acute irreversible visual loss |
2 |
pulmonary |
pulmonary fibrosis |
1 |
|
pulmonary infarction |
1 |
|
pulmonary function test abnormality for > 6 months |
1 |
cardiovascular |
angina > 6 months, OR coronary artery bypass |
1 |
|
myocardial infarction |
1 |
|
additional myocardial infarction(s) |
1 |
|
cardiomyopathy |
1 |
|
valvular disease with murmur > 3/6 |
1 |
|
arrhythmia > 6 months |
1 |
peripheral vascular |
hypertension > 6 months, requiring therapy |
1 |
|
claudication > 6 months |
1 |
|
tissue loss (pulp space, digit, limb, gangrene, amputation) |
1 |
|
venous thrombosis with swelling, ulceration or venous stasis |
1 |
|
peripheral vascular repair |
1 |
gastrointestinal |
infarction or resection of bowel below duodenum |
2 |
|
infarction of spleen, liver, gallbladder, or appendix |
1 |
|
mesenteric insufficiency > 6 months |
1 |
|
upper gastrointestinal tract peptic ulcer disease > 6 months |
1 |
gonads |
premature gonadal failure |
1 |
renal |
creatinine clearance < 50% for > 6 months OR dialysis OR transplant |
2 |
skin |
scarring |
1 |
neurological |
fixed motor neuropathy |
2 |
|
fixed sensory neuropathy |
1 |
|
fixed cranial neuropathy |
2 |
|
major seizures requiring therapy |
2 |
|
cerebral vascular accident |
2 |
|
cognitive impairment > 6 months |
2 |
malignancy |
|
2 |
diabetes |
|
1 |
musculoskeletal |
osteoporosis with fracture or vertebral collapse |
1 |
|
avascular necrosis |
1 |
|
osteomyelitis |
1 |
where:
• A pulmonary function test abnormality includes either diffusing capacity for carbon monoxide < 70%, OR ratio FEV1 to FVC < 75%.
• Cardiomyopathy involves echocardiographic demonstration of ventricular dysfunction.
• The reduction in creatinine clearance may be estimated or measured.
• Cognitive impairment involves a memory deficit; difficulty with calculation, concentration, spoken language, written language, or performance level; dementia; delirium.
SNV damage index =
= SUM(points for all of the findings present)
Interpretation:
• minimum score: 0
• maximum score: 44
• The higher the score, the greater the permanent damage caused by the vasculitis.
Purpose: To evaluate permanent damage from scarring in a patient with a systemic vasculitis using the Systemic Necrotizing Vasculitis Damage Index (SNVDI).
Specialty: Immunology/Rheumatology
Objective: severity, prognosis, stage, disease progression
ICD-10: M31,