Underperformance of clinical risk scores in identifying vascular ultrasound-based high cardiovascular risk in systemic lupus erythematosus

2020 ◽  
Vol 28 (3) ◽  
pp. 346-352
Author(s):  
George C Drosos ◽  
George Konstantonis ◽  
Petros P Sfikakis ◽  
Maria G Tektonidou
Keyword(s):  
Systemic Lupus Erythematosus ◽  
High Risk ◽  
Lupus Erythematosus ◽  
Risk Scores ◽  
P Value ◽  
Atherosclerotic Plaques ◽  
Systemic Lupus ◽  
Cvd Risk ◽  
Risk Models ◽  
Clinical Risk

Abstract Aims The aim of this study was to assess the performance of eight clinical risk prediction scores to identify individuals with systemic lupus erythematosus (SLE) at high cardiovascular disease (CVD) risk, as defined by the presence of atherosclerotic plaques. Methods CVD risk was estimated in 210 eligible SLE patients without prior CVD or diabetes mellitus (female: 93.3%, mean age: 44.8 ± 12 years) using five generic (Systematic Coronary Risk Evaluation (SCORE), Framingham Risk Score (FRS), Pooled Cohort Risk Equations (ASCVD), Globorisk, Prospective Cardiovascular Münster Study risk calculator (PROCAM)) and three ‘SLE-adapted’ (modified-SCORE, modified-FRS, QRESEARCH risk estimator, version 3 (QRISK3)) CVD risk scores, as well as ultrasound examination of the carotid and femoral arteries. Calibration, discrimination and classification measures to identify high CVD risk based on the presence of atherosclerotic plaques were assessed for all risk models. CVD risk reclassification was applied for all scores by incorporating ultrasound results. Results Moderate calibration (p-value range from 0.38 to 0.63) and discrimination (area under the curve 0.73–0.84), and low-to-moderate sensitivity (8.3–71.4%) and classification ability (Matthews correlation coefficient (MCC) 0.25–0.47) were observed for all risk models to identify patients with plaques at any arterial site as high-risk. MCC was improved for modified-FRS versus FRS (0.43 vs 0.36), but not for modified-SCORE versus SCORE (0.25 vs 0.25). Based on plaque presence, CVD risk was upgraded to high-risk in 10%, 16.1%, 20.5%, 21.5%, 24%, 28.2% and 28.6% of cases classified as non-high-risk by QRISK3, modified-FRS, Globorisk, FRS/PROCAM, ASCVD, modified-SCORE and SCORE, respectively. Conclusions Most of the five generic and three ‘SLE-adapted’ clinical risk scores underestimated high CVD risk defined by atherosclerotic plaque presence in patients with SLE.

Underperformance of clinical risk scores in identifying vascular ultrasound-based high cardiovascular risk in systemic lupus erythematosus

2020 ◽  
pp. 204748732090665 ◽  
Author(s):  
George C Drosos ◽  
George Konstantonis ◽  
Petros P Sfikakis ◽  
Maria G Tektonidou
Keyword(s):  
Systemic Lupus Erythematosus ◽  
High Risk ◽  
Lupus Erythematosus ◽  
Risk Scores ◽  
P Value ◽  
Atherosclerotic Plaques ◽  
Systemic Lupus ◽  
Cvd Risk ◽  
Risk Models ◽  
Clinical Risk

Aims The aim of this study was to assess the performance of eight clinical risk prediction scores to identify individuals with systemic lupus erythematosus (SLE) at high cardiovascular disease (CVD) risk, as defined by the presence of atherosclerotic plaques. Methods CVD risk was estimated in 210 eligible SLE patients without prior CVD or diabetes mellitus (female: 93.3%, mean age: 44.8 ± 12 years) using five generic (Systematic Coronary Risk Evaluation (SCORE), Framingham Risk Score (FRS), Pooled Cohort Risk Equations (ASCVD), Globorisk, Prospective Cardiovascular Münster Study risk calculator (PROCAM)) and three ‘SLE-adapted’ (modified-SCORE, modified-FRS, QRESEARCH risk estimator, version 3 (QRISK3)) CVD risk scores, as well as ultrasound examination of the carotid and femoral arteries. Calibration, discrimination and classification measures to identify high CVD risk based on the presence of atherosclerotic plaques were assessed for all risk models. CVD risk reclassification was applied for all scores by incorporating ultrasound results. Results Moderate calibration ( p-value range from 0.38 to 0.63) and discrimination (area under the curve 0.73–0.84), and low-to-moderate sensitivity (8.3–71.4%) and classification ability (Matthews correlation coefficient (MCC) 0.25–0.47) were observed for all risk models to identify patients with plaques at any arterial site as high-risk. MCC was improved for modified-FRS versus FRS (0.43 vs 0.36), but not for modified-SCORE versus SCORE (0.25 vs 0.25). Based on plaque presence, CVD risk was upgraded to high-risk in 10%, 16.1%, 20.5%, 21.5%, 24%, 28.2% and 28.6% of cases classified as non-high-risk by QRISK3, modified-FRS, Globorisk, FRS/PROCAM, ASCVD, modified-SCORE and SCORE, respectively. Conclusions Most of the five generic and three ‘SLE-adapted’ clinical risk scores underestimated high CVD risk defined by atherosclerotic plaque presence in patients with SLE.

scholarly journals Identification of 38 novel loci for systemic lupus erythematosus and genetic heterogeneity between ancestral groups

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Yong-Fei Wang ◽  
Yan Zhang ◽  
Zhiming Lin ◽  
Huoru Zhang ◽  
Ting-You Wang ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Genome Wide Association Study ◽  
Age Of Onset ◽  
Treatment Options ◽  
Human Leukocyte ◽  
Risk Scores ◽  
Systemic Lupus ◽  
Disease Manifestation ◽  
A Genome

AbstractSystemic lupus erythematosus (SLE), a worldwide autoimmune disease with high heritability, shows differences in prevalence, severity and age of onset among different ancestral groups. Previous genetic studies have focused more on European populations, which appear to be the least affected. Consequently, the genetic variations that underlie the commonalities, differences and treatment options in SLE among ancestral groups have not been well elucidated. To address this, we undertake a genome-wide association study, increasing the sample size of Chinese populations to the level of existing European studies. Thirty-eight novel SLE-associated loci and incomplete sharing of genetic architecture are identified. In addition to the human leukocyte antigen (HLA) region, nine disease loci show clear ancestral differences and implicate antibody production as a potential mechanism for differences in disease manifestation. Polygenic risk scores perform significantly better when trained on ancestry-matched data sets. These analyses help to reveal the genetic basis for disparities in SLE among ancestral groups.

scholarly journals Hubungan Derajat Aktivitas Penyakit Lupus Eritematosus Sistemik Berdasarkan Skor Mex-Sledai Dengan Kejadian Anemia Pada Penderita Lupus Eritematosus Sistemik Di Komunitas Odapus Lampung

2021 ◽  
Vol 3 (2) ◽  
pp. 192-202
Author(s):  
Rina Kirwiastiny ◽  
Ringgo Alfarisi ◽  
Hidayat Hidayat ◽  
Ageel Al-Aziz Marjaen
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Chronic Disease ◽  
Lupus Erythematosus ◽  
Deficiency Anemia ◽  
P Value ◽  
Systemic Lupus Erythematous ◽  
Systemic Lupus ◽  
Immune Disease ◽  
Cross Sectional ◽  
Sledai Score

ABSTRACT : RELATIONSHIP OF SYSTEMIC LUPUS ERYTHEMATOSUS ACTIVITIES BASED ON MEX-SLEDAI SCORE WITH INCIDENCE OF ANEMIA IN SYSTEMIC LUPUS ERYTHEMATOUS PATIENTS IN THE ODAPUS LAMPUNG COMMUNITY, 2020Background : Systemic Lupus Erytematosus (SLE) is a complex autoimmune disease characterized by the presence of autoantibodies against the cell nucleus and involving many organ systems in the body. Anemia in LES patients varies between chronic disease anemia, hemolytic anemia, blood loss, renal insufficiency, infection, myelodysplasia, and aplastic anemia. What often occurs in LES anemia is due to erythropoesis suppression due to chronic inflammation. Anemia in LES patients is an immune or non-immune disease. Anemia is a non-immune disease is anemia in chronic disease, iron deficiency anemia, sideroblastic anemia, anemia in kidney disease, anemia indicated by drugs, and anemia secondary to other diseases (eg sickle cell anemia).Research purposes : This study was to determine the degree of activity of systemic lupus erythematosus based on max-sledai and hemoglobin levels in systemic lupus erythematous patients in the ODAPUS Lampung community in 2020.Methode :The analytical observational method was used using a cross sectional approach. The research subjects were 30 respondents who used the total sampling technique from members of the ODAPUS Lampung community by conducting MEX-SLEDAI interviews and blood sampling conducted from November 2019 to February 2020. Statistical test used Fisher exact test.Results: From 30 study subjects, disease activity based on MEX-SLEDAI was above the average of 21 patients (70%). And the results of blood tests were 18 patients (60%) who were not anemia and 12 patients (40%) had anemia.Conclusion     : There was a significant relationship between the degree of activity of Systemic Lupus Erythematosus based on the MEX-SLEDAI score and the incidence of anemia with p value = 0.024 meaning the p value ≤ 0.05. Keywords      : LES; Incidence of Anemia; MEX-SLEDAI    INTISARI : HUBUNGAN DERAJAT AKTIVITAS PENYAKIT LUPUS ERITEMATOSUS SISTEMIK BERDASARKAN SKOR  MEXSLEDAI DENGAN KEJADIAN ANEMIA PADA PENDERITA LUPUS ERITEMATOUS SISTEMIK DI KOMUNITAS ODAPUS LAMPUNG  Latar belakang : Systemic Lupus Erytematosus (SLE) merupakan penyakit autoimun yang kompleks ditandai oleh adanya autoantibodi terhadap inti sel dan melibatkan banyak sistem organ dalam tubuh. Anemia pada pasien LES bervariasi antara anemia penyakit kronis, anemia hemolitik, kehilangan darah, insufisiensi ginjal, infeksi, mielodisplasia, dan anemia aplastik. Yang sering terjadi anemia pada LES disebabkan supresi eritropoesis karena inflamasi yang kronis.  Anemia pada pasien LES merupakan penyakit imun atau non-imun. Anemia merupakan penyakit non-imun adalah anemia pada penyakit kronik ,anemia defisiensi besi, anemia sideroblastik, anemia pada penyakit ginjal, anemia indikasi obat, dan anemia sekunder terhadap penyakit lain ( misalnya anemia sel sabit ).Tujuan Penelitian : Penelitian ini untuk mengetahui hubungan drajat aktivitas penyakit lupus eritematosus sistemik berdasarkan max-sledai dengan kadar hemoglobin pada penderita lupus eritematous sistemik di komunitas ODAPUS lampung tahun 2020.Metode : Digunakan metode observasional analitik menggunakan pendekatan cross sectional. Subjek penelitian sebanyak 30 responden yang menggunakan teknik total sampling dari anggota komunitas ODAPUS Lampung dengan melakukan wawancara MEX-SLEDAI dan pengambilan sampel darah yang dilakukan pada bulan November 2019 s/d Februari 2020. Uji statistic menggunakan Fisher exact test.Hasil : Dari 30 subjek penelitian didapatkan aktifitas penyakit berdasarkan MEX-SLEDAI di atas rata – rata sebanyak 21 pasien (70%). Dan hasil peneriksaan darah yaitu 18 pasien (60%) yang Tidak anemia dan yang mengalami Anemia ada 12 pasien (40%).Kesimpulan   : Terdapat hubungan bermakna antara derajat aktivitas penyakit Lupus Eritematosus Sistemik berdasarkan skor MEX-SLEDAI dengan Kejadian Anemia dengan p value =0.024 berarti nilai p value ≤ 0.05. Kata Kunci     : LES; Kejadian Anemia; MEX-SLEDAI

Hubungan Aktifitas Penyakit SLE (Systemic Lupus Erythematosus) Berdasarkan Mex-Sledai Scoring Terhadap Depresi Di Komunitas Odapus Kota Bandar Lampung

2021 ◽  
Vol 1 (4) ◽  
pp. 370-382
Author(s):  
Rina Kriswiastiny ◽  
Festy Ladyani Mustofa ◽  
Syuhada Syuhada ◽  
Reychan Gustiawan Putra
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Health Sector ◽  
Point Of View ◽  
P Value ◽  
Systemic Lupus Erythematosus Disease ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Cross Sectional Design

ABSTRACT: RELATIONSHIP OF SLE (SYSTEMIC LUPUS ERYTHEMATOSUS) ACTIVITIES BASED ON MEX-SLEDAI SCORING ON DEPRESSION IN ODAPUS COMMUNITIES BANDAR LAMPUNG Background: Depression is a clinical manifestation that can occur in patients with SLE and it is suspected that the level of SLE disease activity can affect these events (Nery, et al. 2007). Ironically, this section is a part that is often overlooked by many people, including the health sector. In fact, by understanding this point of view, cross-scientific collaborative treatment such as the Internal and Psychiatry Fields can be done to improve the treatment and quality of life of patients.Objective: To determine the relationship between SLE (Systemic lupus Erythematosus) disease activity based on MEX-SLEDAI Scoring against depression in the Odapus Community, Bandar Lampung City 2020.Methodology: The type of research used in this study is correlative analytic with cross-sectional design. The sample used in this study were patients with SLE (Systemic lupus Erythematosus) based on MEX-SLEDAI Scoring for depression in the Odapus Community, Bandar Lampung City 2020. Data analysis used the Spearman test.Results: In the activity variable SLE and depression, the P value = 0.001 (P <0.05) with a correlation value of r = 0.490 was obtained.Conclusion: There is a relationship between SLE (Systemic lupus Erythematosus) disease activity based on MEX-SLEDAI Scoring against depression in Odapus Community, Bandar Lampung City 2020 with moderate correlation strength. Keywords: Lupus, Depression, MEX-Sledai  INTISARI: HUBUNGAN AKTIFITAS PENYAKIT SLE (SYSTEMIC LUPUS ERYTHEMATOSUS)  BERDASARKAN MEX-SLEDAI SCORING TERHADAP DEPRESI DI KOMUNITAS ODAPUS KOTA BANDAR LAMPUNGLatar Belakang: Depresi merupakan manifestasi klinis yang dapat muncul pada penderita SLE dan diduga tingkat aktivitas penyakit SLE dapat mempengaruhi kejadian-kejadian tersebut (Nery, dkk. 2007). Ironisnya, bagian ini merupakan bagian yang sering luput diperhatikan oleh banyak orang, termasuk bidang kesehatan. Padahal, dengan memahami sudut pandang ini, pengobatan kolaboratif lintas keilmuan seperti Bidang Interna dengan Bidang Psikiatri dapat dilakukan untuk meningkatkan pengobatan dan kualitas hidup pasien.Tujuan: Untuk mengetahui hubungan aktifitas penyakit SLE (Systemic lupus Erythematosus) berdasarkan MEX-SLEDAI Scoring terhadap depresi di Komunitas Odapus Kota Bandar Lampung 2020.Metodologi: Jenis penelitian yang digunakan dalam penelitian ini adalah analitik korelatif dengan desain cross sectional. Sampel yang digunakan pada penelitian ini adalah penderita penyakit SLE (Systemic lupus Erythematosus) berdasarkan MEX-SLEDAI Scoring terhadap depresi di Komunitas Odapus Kota Bandar Lampung 2020. Analisa data menggunakan Uji Spearman.Hasil: Pada variabel aktifitas penyakit SLE dan depresi diperoleh nilai P value = 0,001 (P<0,05) dengan nilai korelasi r = 0,490.Kesimpulan: Terdapat hubungan aktifitas penyakit SLE (Systemic lupus Erythematosus) berdasarkan MEX-SLEDAI Scoring terhadap depresi di Komunitas Odapus Kota Bandar Lampung 2020 dengan kekuatan korelasi sedang.Kata Kunci     : Lupus, Depresi, MEX-Sledai

The Relationships of High-Sensitivity C-Reactive Protein and Homocysteine Levels With Disease Activity, Damage Accrual, and Cardiovascular Risk in Systemic Lupus Erythematosus

2019 ◽  
Vol 22 (2) ◽  
pp. 169-177 ◽  
Author(s):  
Gabriela Pocovi-Gerardino ◽  
Maria Correa-Rodríguez ◽  
José-Luis Callejas Rubio ◽  
Raquel Ríos Fernández ◽  
María Martín Amada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
High Sensitivity ◽  
Cvd Risk Factors ◽  
Systemic Lupus ◽  
Cvd Risk ◽  
Damage Accrual ◽  
Hs Crp

Chronic inflammation coupled with cardiovascular disease (CVD) risk factors influences the progression of atherosclerosis in systemic lupus erythematosus (SLE). High-sensitivity C-reactive protein (hs-CRP) and homocysteine (Hcy) are associated with the risk of CVD in the general population, but their associations with CV risk and disease activity in SLE are unclear. In this cross-sectional study ( N = 139 SLE patients, mean age = 45.27 ± 13.18 years), we investigated associations between hs-CRP and Hcy levels and disease activity, damage accrual, and CVD risk in SLE. Disease activity and damage accrual were measured with the SLE Activity Index 2000 (SLEDAI-2K), the Systemic Lupus Erythematosus International Collaborating Clinics Group/American College of Rheumatology damage index (SDI), and anti-double-stranded DNA antibodies (anti-dsDNA). CVD risk factors of obesity, diabetes mellitus, hypertension, blood lipids, and ankle–brachial index were collected. Linear regression analysis and one-way analysis of variance were used to analyze relationships of hs-CRP and Hcy with SLE activity, damage accrual, and CVD risk factors. Results: hs-CRP correlated significantly with SLEDAI-2K ( p = .036), SDI ( p = .00), anti-dsDNA titers ( p = .034), diabetes ( p = .005), and obesity ( p = .027). hs-CRP and Hcy correlated with triglyceride (TG) levels ( p = .032 and p < .001, respectively), TG/high-density lipoprotein cholesterol index ( p = .020 and p = .001, respectively), and atherogenic index of plasma ( p = .006 and p = .016, respectively). hs-CRP levels >3 mg/L correlated with SDI score ( p = .012) and several CVD risk factors. Discussion: Findings suggest SLE patients with elevated hs-CRP and/or Hcy have a higher prevalence of CVD risk factors.

scholarly journals Hepatitis C virus antibodies in high risk juvenile onset systemic lupus erythematosus

2016 ◽  
Vol 56 (3) ◽  
pp. 235-239
Author(s):  
Nádia E. Aikawa ◽  
Ana P. Nascimento ◽  
André L.S. Hayata ◽  
Eloisa Bonfá ◽  
Cláudia Goldenstein-Schainberg
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
High Risk ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Juvenile Onset ◽  
Onset Systemic Lupus Erythematosus

scholarly journals Alpha-Chlorofatty Acid and Coronary Artery or Aorta Calcium Scores in Women with Systemic Lupus Erythematosus. A Pilot Study

2014 ◽  
Vol 41 (9) ◽  
pp. 1834-1842 ◽  
Author(s):  
Mary A. Mahieu ◽  
Camelia P. Guild ◽  
Carolyn J. Albert ◽  
George T. Kondos ◽  
James J. Carr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Coronary Artery ◽  
Lupus Erythematosus ◽  
Pilot Project ◽  
Myeloperoxidase Activity ◽  
Systemic Lupus ◽  
Cvd Risk

Objective.Alpha-chlorofatty acid (α-ClFA) is one product of myeloperoxidase activity in vivo during atherogenesis and may be a biomarker for cardiovascular disease (CVD). We investigated if serum α-ClFA is associated with subclinical CVD as measured by coronary artery and aorta calcium scores (CAC and AC, respectively) in women with and without systemic lupus erythematosus (SLE).Methods.This pilot project analyzed baseline data from 173 women with SLE and 186 women without SLE participating in a 5-year longitudinal investigation of the Study of Lupus Vascular and Bone Long-term Endpoints (SOLVABLE). Data collection included demographic information, CVD and SLE risk factors, and laboratory assessments. Alpha-ClFA was measured in stored serum by liquid chromatography-mass spectrometry. CAC and AC were measured by computed tomography. Outcome measures were CAC and AC present (CAC > 0 or AC > 0) versus absent (CAC = 0 or AC = 0). Associations between risk factors and CAC or AC were tested with descriptive statistics and multivariate analyses.Results.Women with SLE had higher α-ClFA levels than women without SLE (42.0 fmol/25 µl ± 37.3 vs 34.5 fmol/25 µl ± 21.9; p = 0.020). In analyses including individual CVD risk factors, having SLE was independently associated with the presence of CAC (OR 3.42, 95% CI 1.72 to 6.78) but not AC. Alpha-ClFA was not associated with the presence of CAC or AC in patients with SLE.Conclusion.SLE, but not serum α-ClFA, was associated with the presence of CAC in this pilot project.

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