MO277THE RATIO OF NEUTROPHIL TO LYMPHOCYTE AS A POTENTIAL MARKER OF CLINICOPATHOLOGICAL ACTIVITY FOR SYSTEMIC LUPUS ERYTHEMATOSUS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Qianqian Han ◽  
Peifen Liang ◽  
Jiajia Li ◽  
Bo Liu ◽  
Rong Hu‘an’g ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Renal Involvement ◽  
Active Group ◽  
Inflammatory Factor ◽  
Systemic Lupus ◽  
Control Groups ◽  
Sledai Score ◽  
Potential Marker

Abstract Background and Aims The ratio of neutrophils to lymphocytes (NLR) is a novel inflammatory factor that is elevated in systemic lupus erythematosus (SLE) and related to disease activity. However, the relationship between NLR and renal pathological manifestations in patients with lupus nephritis (LN) has not been studied. Method In this retrospective study, 240 SLE patients were recruited. 186 patients with renal involvement and 124 LN patients underwent renal biopsy. In the meanwhile, control groups included 125 chronic kidney disease (CKD) patients and 125 healthy volunteers. Patients with SLE disease activity 2000 (SLEDAI-2K) >9 and ≤ 9 were defined as severely active and mildly active, respectively. Clinical parameters and pathological data were collected. The correlations between NLR and clinicopathological features were analyzed. Results The NLR of SLE group was significantly higher than that of the sex-age matched control groups. Patients with nephritis had higher NLR levels than those without nephritis [2.88(1.81,4.32) vs. 2.43(1.55,3.90), P=0.044; Figure 1]. Increased NLR was observed in severely active group compared to mildly active group [3.00(1.84,4.28) vs.2.36(1.61,3.51), P=0.020; Figure 1]. NLR was significantly positively related with SLEDAI score (r=0.131, P=0.043), Renal SLEDAI score (r=0.173, P=0.023), C-reactive protein (CRP; r=0.213, P=0.002), 24-hour urine protein (r=0.274, P<0.001; Figure 2A), renal activity index (AI; r=0.192, P=0.033), cellular crescents (r=0.274, P=0.006) and tubular atrophy (r=0.226, P=0.011), and negatively correlated with serum albumin (r=-0.187, P=0.004; Figure 2A). Based on the receiver operating characteristic (ROC) curve, the best NLR cut-off value to predict severe activity and cellular crescents was 2.19 and 3.16, respectively. The ability of NLR to differentiate severely active from mildly active SLE was stronger than CRP and weaker than C3 (Figure 3A). The ability of NLR to predict cellular crescents was better than C3, but not superior to SLEDAI and RSLEDAI. Interestingly, the ROC fitted by NLR and RSLEDAI had a higher AUC and sensitivity [AUC=0.75(0.66,0.84), sensitivity=82.6%, specificity=63.6%; Figure 3B]. Conclusion NLR was a non-invasive and potential inflammatory factor to evaluate clinical and renal pathological activity in patients with SLE.

scholarly journals Correlations of serum beta 2-microglobulin level with disease activity and renal involvement in patients with systemic lupus erythematosus

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Bingxin Liu ◽  
Feng Lu ◽  
Jing Lin ◽  
Hongmei Zou
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Renal Damage ◽  
Renal Involvement ◽  
Kidney Damage ◽  
Systemic Lupus ◽  
Sledai Score ◽  
Beta 2 ◽  
Beta 2 Microglobulin

Abstract Objectives To determine correlations of serum beta 2-microglobulin (β2-MG) level with disease activity and renal involvement in patients with systemic lupus erythematosus (SLE). Methods Two hundred eligible SLE patients were assigned into remission and active stage groups according to SLE disease activity index (SLEDAI) scores. They were also assigned into kidney damage and no kidney damage groups. Serum β2-MG, Scr, ALB, BUN, anti-dsDNA, complements C3, C4 and 24-h urinary total protein (UTP) were detected. Estimated glomerular filtration rate (eGFR) was calculated. Correlations of β2-MG level with SLEDAI score and eGFR were subjected to Spearman analysis. Affecting factors were explored by logistic multivariate regression analysis, and predictive values of β2-MG level for SLE, disease activity and renal damage were assessed by ROC curves. Results β2-MG, Scr, ALB, C3, C4, anti-dsDNA and UTP levels, eGFR and SLEDAI score were different between patients with different disease activities, and, except for eGFR, also between patients with different renal damage degrees (p<0.05). Serum β2-MG, Scr, ALB, C3, C4, anti-dsDNA, UTP, eGFR and SLEDAI score were independent factors for disease activity (p<0.05), and β2-MG, ALB, C3, UTP, eGFR and SLEDAI score were factors affecting renal damage (p<0.05). β2-MG level was correlated positively with SLEDAI score (r=0.877, p=0.000) and negatively with eGFR (r=−0.873, p=0.000). This level was highly valuable for predicting SLE, disease activity and renal damage. Conclusions Serum β2-MG levels in SLE patients are correlated positively with disease activity and negatively with renal involvement, being highly sensitive and specific for predicting SLE, disease activity and eGFR.

scholarly journals POS0685 MYCOPHENOLATE MOFETIL IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS: FIVE-YEARS DRUG SURVIVAL IN RENAL AND NON-RENAL INVOLVEMENT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 588.2-588
Author(s):  
G. Olivieri ◽  
F. Ceccarelli ◽  
F. Natalucci ◽  
F. R. Spinelli ◽  
C. Alessandri ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Mycophenolate Mofetil ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Treatment Duration ◽  
Retention Rate ◽  
Renal Involvement ◽  
Joint Involvement ◽  
Systemic Lupus ◽  
Median Treatment

Background:The updated EULAR recommendations for the management of systemic lupus erythematosus (SLE) underline the use of Mycophenolate Mofetil (MMF) in the treatment of different disease related manifestations (1). Several randomized controlled trials have demonstrated the efficacy of MMF in lupus nephritis (LN) patients but only case series and open-labelled trials have analyzed the use of this drug in other than LN features. Moreover, no data are available about the MMF retention rate in a real-life setting.Objectives:The present study aims at evaluating the 5-years drug retention rate (DRR) of MMF in a large monocentric SLE cohort. Secondly, we investigated the influence of MMF in disease activity changes and chronic damage progression.Methods:We performed a longitudinal study including all the SLE patients (ACR 1997 criteria) starting MMF treatment in our Lupus Clinic. Data about indications, mean dosage, duration of treatment and reasons for drug withdrawal were registered. The DRR was estimated using the Kaplan–Meier method. Disease activity and chronic damage were assessed by SLE Disease Activity Index 2000 (SLEDAI-2K) and SLICC Damage Index (SDI), respectively.Results:The present analysis included 162 SLE patients (M/F 22/140, median age at the disease diagnosis 25.5 years, IQR 13). At the beginning of MMF treatment, we registered a median age of 34 months (IQR 21) and a median disease duration of 72 months (IQR 123). The most frequent indications for prescribing MMF were LN (101 patients, 62.3%) and musculoskeletal manifestations (39, 24.1%), followed by neuropsychiatric involvement (10, 6.2%), and others disease related manifestations (12, 7.4%; in particular skin involvement, hematological features, myositis, vasculitis). MMF was administered at a mean daily dosage of 2.1±0.6 grams; no differences in dosage were found between the different indications (p=ns).At the longitudinal analysis, we registered a median treatment duration of 30 months (IQR 55). Figure 1 reported data about DRR: in particular, at 60 months follow-up we observed a DRR of 61.1% for LN patients, which was similar to that registered for patients without renal involvement (NLN) (60.5%; p=ns). Interestingly, the DRR at 60 months was higher in the subgroup of patients treated for joint involvement (75.4%), even without reaching a statistically significant difference. During the observation period, 92 patients (59.2%) discontinued MMF (median treatment duration at discontinuation 25 months, IQR 35). Interestingly, the main cause of withdrawal was the achievement of persistent remission, observed in 20 patients (21.7%), followed by loss of efficacy (19 patients, 20.5%), drug intolerance and pregnancy planning (17 patients for both reasons, 18,4%). Furthermore, our analysis confirmed MMF efficacy, as demonstrated by the significant reduction in SLEDAI-2k values after 4, 12 and 24 months of treatment (p< 0.0001 for all the time-points in comparison with baseline). In addition, MMF resulted able to control chronic damage progression, as demonstrated by the lack of significant increase in SDI values (baseline: 0.6, IQR 1; last observation: 0.93, IQR 1; p=ns).Conclusion:The evaluation of a large SLE cohort demonstrated a good retention rate for MMF. In particular, our results demonstrated that MMF is also a safe and effective drug for SLE manifestation other than LN, in particular for joint involvement. Moreover, it is able to control disease activity and to prevent the progression of chronic damage.References:[1]Fanouriakis A et al. Ann Rheum Dis. 2019 Jun;78(6):736-745.Disclosure of Interests:None declared

scholarly journals Systemic Lupus Erythematosus with and without Anti-dsDNA Antibodies: Analysis from a Large Monocentric Cohort

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Conti Fabrizio ◽  
Ceccarelli Fulvia ◽  
Perricone Carlo ◽  
Massaro Laura ◽  
Marocchi Elisa ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Clinical Laboratory ◽  
Renal Involvement ◽  
Serum Levels ◽  
Activity Measurement ◽  
Systemic Lupus ◽  
Before And After ◽  
Dsdna Antibodies

Objectives. The anti-dsDNA antibodies are a marker for Systemic Lupus Erythematosus (SLE) and 70–98% of patients test positive. We evaluated the demographic, clinical, laboratory, and therapeutical features of a monocentric SLE cohort according to the anti-dsDNA status.Methods. We identified three groups: anti-dsDNA + (persistent positivity); anti-dsDNA ± (initial positivity and subsequent negativity during disease course); anti-dsDNA − (persistent negativity). Disease activity was assessed by the European Consensus Lupus Activity Measurement (ECLAM).Results. We evaluated 393 patients (anti-dsDNA +: 62.3%; anti-dsDNA ±: 13.3%; anti-dsDNA −: 24.4%). The renal involvement was significantly more frequent in anti-dsDNA + (30.2%), compared with anti-dsDNA ± and anti-dsDNA − (21.1% and 18.7%, resp.;P=0.001). Serositis resulted significantly more frequent in anti-dsDNA − (82.3%) compared to anti-dsDNA + and anti-dsDNA ± (20.8% and 13.4%, resp.;P<0.0001). The reduction of C4 serum levels was identified significantly more frequently in anti-dsDNA + and anti-dsDNA ± (40.0% and 44.2%, resp.) compared with anti-dsDNA − (21.8%,P=0.005). We did not identify significant differences in the mean ECLAM values before and after modification of anti-dsDNA status (P=0.7).Conclusion. Anti-dsDNA status influences the clinical and immunological features of SLE patients. Nonetheless, it does not appear to affect disease activity.

Predictors of Remission and Low Disease Activity State in Systemic Lupus Erythematosus: Data from a Multiethnic, Multinational Latin American Cohort

2019 ◽  
Vol 46 (10) ◽  
pp. 1299-1308 ◽  
Author(s):  
Manuel F. Ugarte-Gil ◽  
Daniel Wojdyla ◽  
Guillermo J. Pons-Estel ◽  
Rosana Quintana ◽  
José A. Gómez-Puerta ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Maintenance Dose ◽  
Renal Involvement ◽  
Immunosuppressive Drugs ◽  
Older Age ◽  
Systemic Lupus ◽  
Low Disease Activity ◽  
Activity State

Objective.To determine the predictors of remission and low disease activity state (LDAS) in patients with systemic lupus erythematosus (SLE).Methods.Three disease activity states were defined: Remission = SLE Disease Activity Index (SLEDAI) = 0 and prednisone ≤ 5 mg/day and/or immunosuppressants (maintenance dose); LDAS = SLEDAI ≤ 4, prednisone ≤ 7.5 mg/day and/or immunosuppressants (maintenance dose); and non-optimally controlled state = SLEDAI > 4 and/or prednisone > 7.5 mg/day and/or immunosuppressants (induction dose). Antimalarials were allowed in all groups. Patients with at least 2 SLEDAI reported and not optimally controlled at entry were included in these analyses. Outcomes were remission and LDAS. Multivariable Cox regression models (stepwise selection procedure) were performed for remission and for LDAS.Results.Of 1480 patients, 902 were non-optimally controlled at entry; among them, 196 patients achieved remission (21.7%) and 314 achieved LDAS (34.8%). Variables predictive of a higher probability of remission were the absence of mucocutaneous manifestations (HR 1.571, 95% CI 1.064–2.320), absence of renal involvement (HR 1.487, 95% CI 1.067–2.073), and absence of hematologic involvement (HR 1.354, 95% CI 1.005–1.825); the use of immunosuppressive drugs before the baseline visit (HR 1.468, 95% CI 1.025–2.105); and a lower SLEDAI score at entry (HR 1.028, 95% CI 1.006–1.051 per 1-unit decrease). These variables were predictive of LDAS: older age at entry, per 5-year increase (HR 1.050, 95% CI 1.004–1.098); absence of mucocutaneous manifestations (HR 1.401, 95% CI 1.016–1.930) and renal involvement (HR 1.344, 95% CI 1.049–1.721); and lower SLEDAI score at entry (HR 1.025, 95% CI 1.009–1.042).Conclusion.Absence of mucocutaneous, renal, and hematologic involvement, use of immunosuppressive drugs, and lower disease activity early in the course of the disease were predictive of remission in patients with SLE; older age was predictive of LDAS.

scholarly journals EFFECTIVITY AND RENAL SAFETY OF CYCLOSPORINE AND METHYLPREDNISOLONE COMBINATION THERAPY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

2016 ◽  
Vol 51 (3) ◽  
pp. 156
Author(s):  
Desantika Wuryana ◽  
Bagus PP Suryana ◽  
Yulistiani Yulistiani
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Renal Function ◽  
Combination Therapy ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Side Effect ◽  
Systemic Lupus ◽  
Sledai Score ◽  
Function Tests ◽  
Renal Function Tests

Cyclosporine and methylprednisolone combination are second line therapy for moderate to severe systemic lupus erythemathosus. Some study suggest that the combination were effective to decrease of systemic lupus erythematosus disease activity. But record from the study, cyclosporine cause nephrotoxicity side effect. Therefore, this study should be considered to monitore therapy effect on disease activity and renal side effect. The aim of this study is to analyze the effect of cyclosporine and methylprednisolone combination therapy on disease activity in systemic lupus erythematosus (SLE) assessed by MEX-SLEDAI and renal side effect assessed by creatinine, ureum and proteinuria. A cohort, observational prospective study was conducted to determine the effect of cyclosporine and methylprednisolone combination therapy on disease activity of SLE and renal side effect of this combination. Patients who met criteria were given cyclosporine and methylprednisolone combination that normally renal function tests. MEX-SLEDAI score, creatinine, ureum and proteinuria were measured for fourth times (one time in one mounth), before study, 1st mounth, 2nd mounth, and 3rd mounth. The study comprised 9 patients SLE were given cyclosporine and methylprednisolone combination that normally renal function tests. All patients were female and had productive age. At 3rd mounth, there was increase patients who had MEX-SLEDAI score <2 (55,6%) and one patient (11,1%) had increase of creatinine, ureum and proteinuria. In conclusion, cyclosporine and methylprednisolone combination therapy showed the effectiveness and safety in 88,9% patients and renal dysfunction in 11,1% patients.

scholarly journals SYSTEMIC LUPUS ERYTHEMATOSUS DISEASE ACTIVITY CORRELATED WITH POSTERIOR SEGMENT MANIFESTATIONS USING MEX-SLEDAI SCORE

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Seravina Adila Izzati ◽  
Ovi Sofia ◽  
Cesarius Singgih Wahono ◽  
Nadia Artha Dewi ◽  
Ovi Sofia
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Posterior Uveitis ◽  
Posterior Segment ◽  
Cotton Wool ◽  
Systemic Lupus ◽  
Sledai Score ◽  
The Mean ◽  
Lupus Retinopathy

Introduction: Lupus retinopathy and posterior uveitis are complications due to systemic lupus erythematosus which can threaten the vision. The presence of posterior segment manifestation is suggestive of high disease activity. The aim of this study is to identify posterior segment manifestation (Lupus Retinopathy and Posterior Uveitis) in SLE patient and their correlation with SLE disease activity using The Mexican-SLEDAI (MEX-SLEDAI) score.                                                                                                                                                                Methods: This was an analytical observational study with cross-sectional design, conducted from August to October 2020 and involved 114 SLE patients in Dr. Saiful Anwar General Hospital. We calculated MEX-SLEDAI score to assess SLE disease activity. All participant that met inclusion criteria underwent ophthalmology examinations using a portable slit-lamp, head indirect ophthalmoscope, and fundus finding were documented using portable fundus imaging.   Result: Lupus retinopathy (LR) presents in 25/114 (21.9%) and posterior uveitis (PU) occurs in 2/114 (1.8%) SLE patients. The mean age of patient with LR, PU, and without retinopathy were 32.92; 37.00; and 31.08 years respectively. The posterior segment findings were hemorrhages, cotton wool spots, hard exudates, and vasculitis reflecting vascular damage. The most common manifestation found in retina was cotton wool spot. The mean of MEX-SLEDAI score of SLE patient with LR (7.200 ± 3.905) and SLE patient with PU (3.500 ± 2.121) was higher than the mean of SLE patient without LR and PU (2.871 ± 2.534). There was a significant association between LR and MEX-SLEDAI score (p=0.000). An insignificant association between PU and MEX-SLEDAI score was found (p=0.353)   Conclusion There is a significance correlation between lupus retinopathy and SLE disease activity based on MEX-SLEDAI scores. The mean of MEX-SLEDAI score in SLE patients with lupus retinopathy was higher than SLE with posterior uvetis and SLE without posterior segment manifestations.

scholarly journals The Relationship between Platelet to Lymphocyte Ratio and Platelet Indices with Disease Severity Level of Systemic Lupus Erythematosus

2021 ◽  
Vol 27 (3) ◽  
pp. 295
Author(s):  
Purbosari Lisnaedy ◽  
Umi Solekhah Intansari
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Platelet Count ◽  
Disease Activity ◽  
Disease Severity ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Platelet To Lymphocyte Ratio ◽  
Sledai Score ◽  
Platelet Indices ◽  
Very High

Systemic Lupus Erythematosus (SLE) is an episodic, chronic autoimmune inflammatory disease characterized by remission and flare phases. Laboratory parameters required to assess the severity of disease activity in SLE include platelet count and platelet indices. Several studies regarding the Platelet to Lymphocyte Ratio (PLR) and platelet indices on the severity of SLE patients remain inconsistent. This study aimed to evaluate the relationship between PLR value and platelet index with the degree of disease severity in SLE patients. This study used a retrospective analytic observational design in SLE patients from January 2016 to December 2019 at Dr. Sardjito Central Hospital. Disease severity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score. Platelet to Lymphocyte Ratio (PLR) values and platelet indices were measured with a hematology analyzer. The data were analyzed using correlation, bivariate, multiple regression tests, and the ROC curve to determine the PLR cut-off. There were 55 SLE patients with high activity (SLEDAI 11-19; n=30(54,54%)) and very high activity (SLEDAI 20; n=25(45.45%)). There was a significant correlation (p <0.05) between the PLR value, platelet count, plateletcrit, and Mean Platelet Volume (MPV) with SLEDAI scores (p <0.05), but only the MPV variable was significant as an independent variable (p=0.0357). In the ROC curve, a cut-off PLR value of 124 was obtained with a sensitivity of 68.0%, specificity of 66.7%, likelihood ratio=2.04 (AUC=0.659 with p-value=0.035) to detect very high disease activity. Based on the PLR value, platelet count and plateletcrit negatively correlated with SLEDAI score but were related to the very high degree of thrombocytopenia in disease activity. The MPV value reflected the high platelet turnover, which had a positive correlation with the SLEDAI score. Patients with a PLR value ≤124 were 2.04 times more likely to have a SLEDAI score of 20, indicating potential use as a predictor of disease activity. The PLR value and platelet indices were significantly related to the degree of SLE activity.

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