AB0281 MORTALITY PREDICTORS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A SINGLE TERTIARY CENTER REFERRAL EXPERIENCE

Background:Systemic Lupus Erythematosus (SLE) is a heterogeneous chronic multisystemic disease that has an increased risk of requiring inpatient management with higher morbidity and mortality rates.The most frequent causes of mortality are a high disease activity, infections, and cardiovascular diseases.Objectives:To determine the predictors of mortality in patients diagnosed with SLE.Methods:A longitudinal, descriptive, observational study was performed from March 2017-March 2020 at the University Hospital of the Autonomous University of Nuevo León, México, including patients with a diagnosis of SLE according to the ACR-EULAR 2012/2019 criteria.Descriptive statistics were used for demographic variables. Associations between mortality and clinical variables were determined using binary logistic regression analysis; a p <0.05 was considered statistically significant. The SPSS program version 20 was used.Results:One-hundred and eighty-six patients with SLE diagnosis who fulfilled ACR-EULAR 2012/2019 criteria were included, 161 (86.6%) were women; the mean age was 35.8 (SD 15.41) years. The main chief complaints were dyspnea 31 (16.7%), fever in 28 (15.1%), renal involvement in 21 (11.29%), and arthritis in 19 (10.22%) patients.Of the 186 patients, 34 (18.3%) had a readmission, 13 (7%) required intensive care unit management, 68 (36.6%) had some type of infection and 22 (11.8%) died. Factors associated with mortality are shown in table 1.Patients receiving steroids and immunosuppression previous to hospitalization were 73 (39.2%) and 92 (49.5%) respectively.Conclusion:Infections remain the leading cause of death in SLE patients. Factors that predispose to infections are a chronic use of steroids and immunosuppression as well as high activity of disease.References:[1]Wu X-Y, Yang M, Xie Y-S, Xiao W-G, Lin J, Zhou B, et al. Causes of death in hospitalized patients with systemic lupus erythematosus: a 10-year multicenter nationwide Chinese cohort. Clin Rheumatol. enero de 2019;38(1):107-15.Table 1.Association between clinical and therapeutic factors with mortality in SLE patients.Factors associated with mortalityUnivariadoMultivariadoβ (95 % IC)β (95 % IC)□Age0.93 (0.96-1.02)0.98 (0.96-1.02)Use of mechanical ventilation3.83 (1.07-13.4)*3.07 (0.59-16.04)Previous use of steroids3.92 (1.51-10.15)*2.04 (0.58-7.35)Previous use of immunosupression4.04 (1.42-11.45)*2.85 (0.71-11.48)Infection3.57 (1.41-9.01)*3.25 (1.19-8.86)*p <0.05 *Disclosure of Interests:None declared

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264 Damage accrual in swedish systemic lupus erythematosus: secondary sjögrens syndrome is among the factors associated with increased risk

10.1136/lupus-2019-lsm.264 ◽

2019 ◽

Author(s):

Martina Frodlund ◽

Sarah Reid ◽

Jonas Wetterö ◽

Örjan Dahlström ◽

Christopher Sjöwall ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Factors Associated ◽

Sjogrens Syndrome ◽

Increased Risk ◽

Damage Accrual

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Dry Eye Indexes Estimated by Keratograph 5M of Systemic Lupus Erythematosus Patients without Secondary Sjögren’s Syndrome Correlate with Lupus Activity

Journal of Ophthalmology ◽

10.1155/2019/8509089 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

An Wang ◽

Zhengyu Gu ◽

Rongfeng Liao ◽

Zongwen Shuai

Keyword(s):

Systemic Lupus Erythematosus ◽

Logistic Regression ◽

Regression Analysis ◽

Dry Eye ◽

Lupus Erythematosus ◽

Ocular Surface ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Systemic Lupus ◽

Multiple Factor

Purpose. To investigate the incidence, severity, and influencing factors of dry eye in systemic lupus erythematosus (SLE) patients without secondary Sjögren’s syndrome (sSS). Methods. A total of 78 patients who were diagnosed with systemic lupus erythematosus and met inclusion criteria were selected as the study subjects in this cross-sectional study. Tear meniscus height (TMH) and noninvasive Keratograph tear breakup time (NIKBUT) including NIKBUT-first and NIKBUT-average of the subjects were measured using a noninvasive ocular analyzer, the Keratograph 5M (Oculus, Wetzlar, Germany). Symptoms related to dry eye were assessed using the Ocular Surface Disease Index (OSDI). The severity of SLE was evaluated by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). Results of the levels of 4 serum antibodies were collected from the patients’ medical records. Correlations between SLEDAI and various ocular surface parameters were analyzed, and multiple-factor binary logistic regression analysis was conducted. Results. In the study subjects, mean TMH was 0.22 mm, mean NIKBUT-first was 9.12 s, and mean OSDI was 13.14. The subjects (19 eyes) whose NIKBUT-average was < 10 s and OSDI was ≥ 13 accounted for 24.36% of all the included patients. SLEDAI showed a statistically significant correlation with TMH (r = −0.233, p=0.040), NIKBUT-first (r = −0.254, p=0.025), NIKBUT-average (r = −0.343, p=0.002), and OSDI (r = 0.256, p=0.024). According to multiple-factor binary logistic regression analysis, SLEDAI could be considered as a risk factor of the incidence of dry eye in SLE patients without sSS. Conclusions. One-fourth of the SLE patients without sSS suffered from dry eye, and the severity of dry eye correlated with the activity of SLE.

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Causes and factors related to hospitalizations in patients with systemic lupus erythematosus: analysis of a 20-year period (1995–2015) from a single referral centre in Catalonia

Lupus ◽

10.1177/0961203319861685 ◽

2019 ◽

Vol 28 (9) ◽

pp. 1158-1166 ◽

Cited By ~ 10

Author(s):

G Pires da Rosa ◽

M Fontecha Ortega ◽

A Teixeira ◽

G Espinosa ◽

R Cervera

Keyword(s):

Systemic Lupus Erythematosus ◽

Antiphospholipid Syndrome ◽

Lupus Erythematosus ◽

Renal Involvement ◽

Diagnostic Procedures ◽

Outpatient Setting ◽

University Hospital ◽

Systemic Lupus ◽

Predicting Factors ◽

Predicting Factor

Introduction Although extensively characterized in the outpatient setting, systemic lupus erythematosus (SLE) in the hospitalization wards is still scarcely portrayed, particularly in the perspective of its evolution over the years. Methods Retrospective analysis of SLE patients hospitalized in the Department of Autoimmune Diseases of a university hospital during a 20-year period (1995–2015), describing hospitalization characteristics, causes and predictors of outcome. Results A total of 814 hospitalizations concerning 339 patients were analysed. The main causes of admission were flare (40.2%), infection (19.2%), diagnostic procedures (18.8%) and thrombotic events (5.4%). Therapy with cyclophosphamide (odds ratio (OR) 1.908, p = 0.047) was associated with admission due to infection, while antimalarials displayed a protective effect (OR 0.649, p = 0.024). Nearly 3.9% of patients required admission to an intensive care unit, with associated antiphospholipid syndrome (OR 7.385, p = 0.04) standing as a predicting factor for this outcome. Readmission at 30 days occurred in 5.8% of patients, with thrombocytopenia (OR 6.007, p = 0.002) and renal involvement (OR 3.362, p = 0.032) featuring as predicting factors. Eight patients died, with antiphospholipid syndrome (OR 26.814, p = 0.02) and thrombocytopenia (OR 31.523, p = 0.01) being associated with mortality. There was no significant variation in patients' demographics or admission causes across the 20-year period, except for a decrease in admissions due to thrombotic and musculoskeletal causes. Recently, an increase in the use of mycophenolate mofetil and lower doses of glucocorticoids were noted. Conclusion While demographics of SLE hospitalizations have not markedly changed over the past 20 years, changes in therapy patterns were observed. Thrombocytopenia, antiphospholipid syndrome and renal involvement featured as predictors of poor outcome.

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Lymphopaenia, Anti-Ro/Anti-RNP Autoantibodies, Renal Involvement and Cyclophosphamide Use Correlate with Increased Risk of Herpes Zoster in Patients with Systemic Lupus Erythematosus

Acta Dermato Venereologica ◽

10.2340/00015555-1454 ◽

2013 ◽

Vol 93 (3) ◽

pp. 314-318 ◽

Cited By ~ 14

Author(s):

S Hu ◽

C Lin ◽

Y Lu ◽

G Chen ◽

H Yu ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Herpes Zoster ◽

Lupus Erythematosus ◽

Renal Involvement ◽

Systemic Lupus ◽

Increased Risk

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Differences in the Clinical Manifestations and Mortality of Systemic Lupus Erythematosus Onset in Children and Adults: A Systematic Review and Meta-Analysis

International Archives of Allergy and Immunology ◽

10.1159/000518321 ◽

2021 ◽

pp. 1-11

Author(s):

Xiaolan Huang ◽

Nan Jia ◽

Fei Xiao ◽

Chunrong Sun ◽

Jia Zhu ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Mortality Risk ◽

Lupus Erythematosus ◽

Meta Analysis ◽

Renal Involvement ◽

Clinical Manifestations ◽

Cochrane Library ◽

Neurological Involvement ◽

Systemic Lupus ◽

Increased Risk

Introduction: The aim of this study was to assess the differences between childhood-onset and adult-onset systemic lupus erythematosus (cSLE and aSLE) for clinical manifestations and mortality using a meta-analytic approach. Methods: The PubMed, EMBASE, and the Cochrane library were searched for eligible studies published between January 1982 and March 2021. The odds ratio (OR) with 95% confidence interval was used to calculate the pooled effect estimates using the random-effects model. Results: Thirty-four studies involving 21,946 SLE patients were included. cSLE was associated with an increased risk of malar rash (OR: 1.64; p < 0.001), ulcers/mucocutaneous involvement (OR: 1.22; p = 0.039), general neurological involvement (OR: 1.52; p < 0.001), seizures (OR: 1.92; p < 0.001), general renal involvement (OR: 2.08; p < 0.001), proteinuria (OR: 1.35; p = 0.015), urinary cellular casts (OR: 1.67; p = 0.047), fever (OR: 2.31; p < 0.001), anemia (OR: 1.91; p < 0.001), thrombocytopenia (OR: 1.41; p < 0.001), leucopenia (OR: 1.57; p = 0.017), lymphadenopathy (OR: 2.40; p < 0.001), and cutaneous vasculitis (OR: 1.72; p = 0.001) as compared with aSLE. Moreover, cSLE versus aSLE was associated with a reduced risk of articular manifestations (OR: 0.63; p = 0.001), pulmonary involvement (OR: 0.54; p = 0.001), and pleuritis (OR: 0.61; p < 0.001). There were no significant differences between cSLE and aSLE for mortality risk (OR: 1.20; p = 0.203). Conclusion: We found that certain clinical manifestations of SLE are different in cSLE and aSLE. Moreover, the mortality risk of cSLE and aSLE was not significantly different.

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Systemic lupus erythematosus in Spanish males: a study of the Spanish Rheumatology Society Lupus Registry (RELESSER) cohort

Lupus ◽

10.1177/0961203316673728 ◽

2016 ◽

Vol 26 (7) ◽

pp. 698-706 ◽

Cited By ~ 21

Author(s):

A Riveros Frutos ◽

I Casas ◽

I Rúa-Figueroa ◽

F J López-Longo ◽

J Calvo-Alén ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Symptom Onset ◽

Lupus Erythematosus ◽

Renal Involvement ◽

Age At Diagnosis ◽

Systemic Lupus ◽

Female Ratio ◽

Cardiovascular Comorbidities ◽

Increased Risk ◽

Male Patients

Objective The objective of this study was to describe the demographic, clinical, and immunological manifestations of systemic lupus erythematosus (SLE) in male patients. Methods A cross-sectional, multicenter study was carried out of 3651 patients (353 men, 9.7%, and 3298 women, 90.2%) diagnosed with SLE, included in the Spanish Rheumatology Society SLE Registry (RELESSER). Results Mean ages (18–92 years) of symptom onset were 37 (SD 17) years (men) and 32 (SD 14) years (women). Male/female ratio was 1/9. Age of onset of symptoms and age at diagnosis were higher in men than in women ( p < 0.001). Males were diagnosed earlier than females (p = 0.04) and had more cardiovascular comorbidities ( p < 0.001). Two hundred and thirty-six males (68%) with SLE required hospitalization in comparison with 1713 females (53%) ( p < 0.001). During follow-up, 208 patients died: 30 men (9.3%) and 178 women (5.9%) ( p = 0.02). As regards clinical manifestations, loss of weight ( p = 0.01), lymphadenopathies ( p = 0.02), and splenomegaly ( p = 0.02) were more common in male patients. Female patients were more likely to have inflammatory rash, alopecia, and arthritis ( p < 0.05). As for lung involvement, men with SLE had more pleural fibrosis ( p < 0.001) and pulmonary embolism ( p = 0.01). However, Raynaud’s phenomenon was more common in women (35%) than in men (23.7%) ( p < 0.001); lupus nephritis was more common in men, being present in 155 (44.8%) of males versus 933 (29%) of females ( p < 0.001). Multivariate analysis showed that SLE patients with a high Charlson index (more than 3 points) and age > 50 years had a higher mortality (odds ratios 3.6 and 2.1, respectively). Furthermore, SLE patients who developed pulmonary hemorrhage, pulmonary hypertension, psychiatric involvement, complement deficiency, and hemophagocytic syndrome also had higher mortality, regardless of gender. Conclusion Patients with SLE over the age of 50 years have an increased risk of mortality. In Caucasians, age at diagnosis and symptom onset is higher in men than in women. The diagnostic delay is shorter in men. Male SLE patients present more cardiovascular comorbidities, and also more serositis, adenopathies, splenomegaly, renal involvement, convulsion, thrombosis, and lupus anticoagulant positivity than women.

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Factors associated with development and mortality of pulmonary hypertension in systemic lupus erythematosus patients

Lupus ◽

10.1177/0961203318788163 ◽

2018 ◽

Vol 27 (11) ◽

pp. 1769-1777 ◽

Cited By ~ 3

Author(s):

J S Kim ◽

D Kim ◽

Y B Joo ◽

S Won ◽

J Lee ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Pulmonary Hypertension ◽

Lupus Erythematosus ◽

Multivariable Analysis ◽

Systemic Lupus ◽

Factors Associated ◽

Tertiary Center ◽

A Prospective Study ◽

Significant Factors

Objectives This study aims to identify the factors associated with the development and mortality of pulmonary hypertension (PH) in systemic lupus erythematosus (SLE) patients. Methods We conducted a prospective study of SLE patients in a single tertiary center. PH was defined as a systolic pulmonary arterial pressure ≥30 mmHg on transthoracic echocardiography. We assessed potential associated factors contributing to the development and mortality of PH in SLE patients. Results Of 1110 patients with SLE, 48 patients were identified to have PH. Multivariable analysis indicated that pleuritis or pericarditis (odds ratio (OR) = 4.62), anti-RNP antibody (OR = 2.42), interstitial lung disease (ILD) (OR = 8.34) and cerebro-cardiovascular disease (OR = 13.37) were independently associated with the development of PH in SLE. Subgroup analysis among patients with PH demonstrated that there were no statistically significant factors associated with PH mortality in SLE. Conclusions The prevalence of PH was 4.3% in our cohort. There were significant associations with pleuritis or pericarditis, anti-RNP antibody, ILD, and cerebro-cardiovascular disease in SLE, which may contribute to the development of PH. However, there were no statistically significant factors associated with PH mortality in SLE.

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A comparative study between the disease characteristics in adult-onset and childhood-onset systemic lupus erythematosus in Egyptian patients attending a large university hospital

Lupus ◽

10.1177/0961203320972778 ◽

2020 ◽

pp. 096120332097277

Author(s):

Kamal El-Garf ◽

Ayman El-Garf ◽

Rasha Gheith ◽

Shaimaa Badran ◽

Samia Salah ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Renal Involvement ◽

Disease Onset ◽

University Hospital ◽

Adult Onset ◽

Childhood Onset ◽

Systemic Lupus ◽

Significant Difference ◽

Onset Systemic Lupus Erythematosus

Introduction Disease features and laboratory abnormalities differ among adult-onset and childhood-onset systemic lupus erythematosus (aSLE and cSLE). Socioeconomic status both independent of, and in combination with, ethnicity influences the disease phenotype and outcome. Objective To compare the various disease features among patients with cSLE and aSLE in a limited monetary income Egyptian cohort attending a large free-of-charge university hospital. Patients and methods: Retrospective analysis of the medical records of 714 SLE patients attending Cairo University Hospitals from January 2000 to December 2019. Of them 602 (400 with aSLE and 202 with cSLE) were enrolled in the study. Results The mean age of disease onset was 28.27 ± 10.55 among aSLE patients compared to 12.88 ± 4.26 years among cSLE patients. Disease duration was 12.03 ± 5.05 and 4.14 ± 3.18 years in aSLE and cSLE, respectively. Female to male ratio was 15:1 among patients with aSLE, as compared to 2.67:1 among cSLE (<0.001). Arthritis (69%), oral ulcers (48.5%), neuropsychiatric (18.3%) and thrombotic manifestations of antiphospholipid syndrome (12%) were significantly more frequent in aSLE. On the other hand, renal (67.8%), serositis (49.6%), fever (49%), lymphopenia (40.6%), hemolytic anemia (38.6%), and discoid lupus (13.4%) were significantly more frequent in cSLE. Weight loss, malar rash, photosensitivity, thrombocytopenia, leucopenia and lymphadenopathy were not significantly different between the two groups. Hypocomplementemia, proteinuria, urinary sediments, hematuria were significantly more frequent in cSLE. For those patients with renal involvement, who underwent renal biopsy (58.3% in aSLE and 63.5% in cSLE), there was no significant difference with regard to the different histopathological classes. Anti-Smith, anti-cardiolipin antibodies and rheumatoid factor were significantly more frequent among aSLE patients, while anti-La antibodies were more frequent among cSLE patients. Conclusion Arthritis was the most common clinical manifestation over time in aSLE compared to renal involvement in cSLE. Renal disease tends to be more active in cSLE. The differences in disease manifestations between this cohort and other studies can be attributed to the ethnic and socioeconomic disparities.

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Prevalence of and Factors Associated with Hypertension in Young and Old Women with Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.101132 ◽

2011 ◽

Vol 38 (6) ◽

pp. 1026-1032 ◽

Cited By ~ 58

Author(s):

JOSÉ MARIO SABIO ◽

JOSÉ ANTONIO VARGAS-HITOS ◽

NURIA NAVARRETE-NAVARRETE ◽

JUAN DIEGO MEDIAVILLA ◽

JUAN JIMÉNEZ-JÁIMEZ ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Activity Index ◽

Renal Involvement ◽

Disease Activity Index ◽

Systemic Lupus ◽

Entire Cohort ◽

Younger Women ◽

Factors Associated ◽

Age Range

Objective.Hypertension (HT) is more prevalent in patients with systemic lupus erythematosus (SLE) than among the general population and it has been associated with atherosclerotic cardiovascular diseases in these patients. We examined the proportion of HT and factors associated with it in young and old women with SLE.Methods.Participants (112 women with SLE and 223 healthy age-matched women) were categorized as young (age ≤ 40 years) or old (age > 40 years). We compared cardiovascular and specific SLE-related variables and inflammatory markers in hypertensive and normotensive women with SLE for each age range. We also assessed the factors independently associated with HT in the entire cohort and in each age range by means of a multivariate regression analysis.Results.The prevalence of HT was higher in women with SLE than in controls (56% vs 29%; p < 0.001), and was proportionally higher in younger women with SLE (40% vs 11%; p < 0.001) than in older women with SLE (74% vs 47%; p = 0.001). After adjustment for potential confounders, HT was associated with renal involvement and higher nonobesity-related insulin levels in younger women with SLE. In older patients, HT was associated with age, renal involvement, and obesity. Finally, in the entire cohort, HT was associated with age, insulin, renal involvement, and the Systemic Lupus Erythematosus Disease Activity Index score.Conclusion.An association between HT and insulin has been identified in women with SLE, particularly younger ones. Factors associated with HT in women with SLE differed depending on their age. HT was more prevalent in women with SLE than in control subjects, being proportionally higher in young women with SLE.

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