Clinical characteristics and risk factors of infections in patients with systemic lupus erythematosus

Abstract Background Systemic lupus erythematosus (SLE) is a chronic and complex multi-system autoimmune disorder. Higher risks of hematological malignancies (HM) were observed in SLE patients, which was associated with higher mortality. The mechanism and risk factors of HM oncogenesis in SLE patients are still under investigation. The aim of this study was to explore clinical characteristics, risk factors, and prognosis of SLE patients with or without HM in the Chinese population. Methods A retrospective, case-controlled study was conducted in 72 SLE patients between January 2013 and December 2020. Clinical and laboratory data were collected and compared between the two groups of patients with HM and those without HM. Logistic regression analysis was performed to determine risk factors of HM oncogenesis. The survival rate was estimated by Kaplan-Meier methods and Cox proportional hazards regression analysis. Results Among 72 SLE patients in this study, fifteen complicated with HM and 57 without HM were identified. The incidence rate of HM was approximately 0.24% with elevated standardized incidence ratios of lymphoma and leukemia (27.559 and 12.708, respectively). Patients with HM were older when diagnosed with SLE, with a higher frequency of infection and splenomegaly, lower levels of hemoglobin and high-density lipoprotein compared with those without HM. Fewer patients with HM expressed positive anti-dsDNA antibody (26.7% vs 66.7%, P = 0.005) or received hydroxychloroquine treatment (40.0% vs 86.0%, P = 0.001). Older age at SLE diagnosis (OR=1.122, 95% CI: 1.037–1.214) was regarded as an independent risk factor of HM oncogenesis. Female (RR= 0.219, 95% CI: 0.070–0.681) and hydroxychloroquine (RR= 0.281, 95% CI: 0.094–0.845) were protective factors of mortality in SLE patients. Conclusions SLE patients with an older age are at an increased risk of HM carcinogenesis. The prognosis of male patients with SLE tends to be poorer whether complicated with HM. The association of antinuclear antibody spectrum, medication, and HM oncogenesis in SLE needs further investigation.

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Hematological Malignancies in Systemic Lupus Erythematosus: Clinical Characteristics, Risk Factors and Prognosis – a Case-control Study

10.21203/rs.3.rs-313607/v1 ◽

2021 ◽

Author(s):

Yuqi Zhang ◽

Wei Li ◽

Panpan Zhang ◽

Jinyan Guo ◽

Jinlei Sun ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Incidence Rate ◽

Lupus Erythematosus ◽

Clinical Characteristics ◽

Hematological Malignancies ◽

Lower Percentage ◽

Systemic Lupus ◽

Dsdna Antibody

Abstract Background: Systemic lupus erythematosus (SLE) is a chronic and complex multi-system autoimmune disorder. Higher risks of malignancy were observed in SLE patients, which was associated with higher mortality. We aimed to explore clinical characteristics, risk factors and prognosis between SLE patients with or without hematological malignancies (HM) in Chinese population.Methods: We retrospectively collected patients from our hospital with a diagnosis of SLE from January 2013 to December 2020. Clinical and laboratory data were collected and disease activity was evaluated according to systemic lupus erythematosus disease activity index-2000 (SLEDAI-2K). Logistic regression analysis was performed to predict risk factors. The survival rate was estimated by Kaplan-Meier and Cox proportional hazards regression analysis.Results: The study enrolled 15 SLE patients with HM as the case group and 57 without HM as the control group for analysis. The incidence rate of HM was approximately 0.24% with elevated standard incidence rate of lymphoma and leukemia (27.559 and 12.708, respectively). Patients with HM were at a higher age at the diagnosis of SLE, with a higher frequency of infection, splenomegaly and a lower level of hemoglobin compared with patients without HM. SLEDAI-2K was comparable between the two groups at the diagnosis of SLE (P = 0.184). Lower percentage of patients with HM expressed positive anti-dsDNA antibody (26.7% vs 66.7%，P = 0.005 ) or had ever been treated with hydroxychloroquine (40.0% vs 86.0%, P = 0.001). Higher age (OR 1.098, P = 0.004), infection (OR 5.759, P = 0.041) and lower hemoglobin (OR 0.954, P = 0.021) were risk factors for SLE patients to develop with HM. Female (RR 0.219, P = 0.009) and hydroxychloroquine (RR 0.281, P = 0.024) were protective factors from mortality. Conclusions: SLE patients are more prone to be complicated with HM, especially for those at a higher age, suffering with infection or anemia. The prognosis of male patients with SLE tends to be poorer whether complicated with HM. The association between antinuclear antibody spectrum and SLE complicated with HM needs further investigation.

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