Determining risk factors that increase hospitalizations in patients with systemic lupus erythematosus

Lupus ◽  
2018 ◽  
Vol 27 (8) ◽  
pp. 1321-1328 ◽  
Author(s):  
D Li ◽  
H M Madhoun ◽  
W N Roberts ◽  
W Jarjour
Keyword(s):  
Systemic Lupus Erythematosus ◽  
High Risk ◽  
Blood Cell ◽  
Serum Creatinine ◽  
Cell Count ◽  
Lupus Erythematosus ◽  
Blood Cell Count ◽  
Systemic Lupus ◽  
Screening Algorithm ◽  
Increased Risk

Introduction Systemic lupus erythematosus (SLE) is a complex disease that is associated with significant mortality and an increased risk of hospitalization. Several validated instruments are available to measure disease activity in SLE patients. However, these instruments were not designed to screen for SLE patients at an increased risk of hospitalization. These instruments also fail to incorporate some data that are easily obtainable from electronic health records, such as the frequency of missed outpatient appointments. Methods All patients at a single academic medical center with an International Classification of Disease (ICD-10) code for SLE (M32) that were seen at least once between 2010 and 2017 were identified. Of these 3552 patients, 813 were randomly selected for chart review using a random number generator, and 226 were verified to have seen an outpatient rheumatologist and met the American College of Rheumatology Classification Criteria for SLE. Physician notes, laboratory values, and appointment information were reviewed, and relevant data were extracted. Weighted Cox regression models were used to estimate the risk of hospitalization and develop a screening algorithm, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the algorithm. Results There were 160 patients with no lupus-related hospitalizations and 66 patients with such a hospitalization. In a multivariate analysis accounting for age, gender, and race, serum creatinine >1.20 mg/dL, white blood cell count > 10 (thousand)/µL, hemoglobin <11 g/dL, platelets < 180 (thousand)/µL, high risk immunosuppression use, missing between 0 and 20% of appointments, and missing ≥ 20% of appointments were associated with an increased risk of hospitalizations. Our proposed screening algorithm does well identifying SLE patients at risk of hospitalization (area under the curve (AUC): 0.90, 95% CI: 0.86–0.94). We recommend flagging patients with a score of ≥ 3 (sensitivity: 0.95; specificity: 0.54). Conclusions A new screening algorithm accounting for serum creatinine, white blood cell count, hemoglobin, platelets, high-risk immunosuppression, and the proportion of missed appointments may be useful in identifying SLE patients at an increased risk of hospitalization. Missing appointments may be a proxy for an underlying variable (such as access to health care) that is directly related to an increased risk of hospitalization.

scholarly journals Phase 1 double-blind randomized safety trial of the Janus kinase inhibitor tofacitinib in systemic lupus erythematosus

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Sarfaraz A. Hasni ◽  
Sarthak Gupta ◽  
Michael Davis ◽  
Elaine Poncio ◽  
Yenealem Temesgen-Oyelakin ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Kinase Inhibitor ◽  
Janus Kinase ◽  
Controlled Clinical Trial ◽  
Type I ◽  
Systemic Lupus ◽  
Double Blind ◽  
Premature Cardiovascular Disease ◽  
Increased Risk

AbstractIncreased risk of premature cardiovascular disease (CVD) is well recognized in systemic lupus erythematosus (SLE). Aberrant type I-Interferon (IFN)-neutrophil interactions contribute to this enhanced CVD risk. In lupus animal models, the Janus kinase (JAK) inhibitor tofacitinib improves clinical features, immune dysregulation and vascular dysfunction. We conducted a randomized, double-blind, placebo-controlled clinical trial of tofacitinib in SLE subjects (ClinicalTrials.gov NCT02535689). In this study, 30 subjects are randomized to tofacitinib (5 mg twice daily) or placebo in 2:1 block. The primary outcome of this study is safety and tolerability of tofacitinib. The secondary outcomes include clinical response and mechanistic studies. The tofacitinib is found to be safe in SLE meeting study’s primary endpoint. We also show that tofacitinib improves cardiometabolic and immunologic parameters associated with the premature atherosclerosis in SLE. Tofacitinib improves high-density lipoprotein cholesterol levels (p = 0.0006, CI 95%: 4.12, 13.32) and particle number (p = 0.0008, CI 95%: 1.58, 5.33); lecithin: cholesterol acyltransferase concentration (p = 0.024, CI 95%: 1.1, −26.5), cholesterol efflux capacity (p = 0.08, CI 95%: −0.01, 0.24), improvements in arterial stiffness and endothelium-dependent vasorelaxation and decrease in type I IFN gene signature, low-density granulocytes and circulating NETs. Some of these improvements are more robust in subjects with STAT4 risk allele.

Serum uric acid as a predictor for nephritis in Egyptian patients with systemic lupus erythematosus

Lupus ◽  
2020 ◽  
pp. 096120332097904
Author(s):  
Eman Ahmed Hafez ◽  
Sameh Abd El-mottleb Hassan ◽  
Mohammed Abdel Monem Teama ◽  
Fatma Mohammed Badr
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Renal Function ◽  
Uric Acid ◽  
Lupus Nephritis ◽  
Serum Creatinine ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Group 2 ◽  
Group 1

Objective Lupus nephritis (LN) is closely associated with hyperuricemia, and uric acid is considered a risk factor for renal involvement in systemic lupus erythematosus (SLE). This study aimed to examine the association between serum uric acid (SUA) level and LN development and progression in SLE patients with normal renal function. Methods A total of 60 SLE patients with normal renal function from Ain Shams University Hospital were selected and assigned to group 1 (30 patients with LN) and group 2 (30 patients without LN). All patients were subjected to history taking, clinical examination, disease activity assessment based on SLE disease activity index (SLEDAI) and renal SLEDAI (SLEDAI-R) scores, and laboratory investigations, including as SUA, complete blood count, blood urea nitrogen (BUN), serum creatinine, creatinine clearance, urine analysis, protein/creatinine ratio, 24-h urinary protein excretion, Antinuclear antibodies (ANA), anti-dsDNA antibody, and serum complement (C3, C4). Results Disease duration, SLEDAI score, and SUA level were higher in group 1 than in group 2 (p < 0.001). SUA level was positively correlated with SLEDAI and SLEDAI-R scores, proteinuria, urinary casts, renal biopsy class, disease activity and chronicity indices, BUN level, and serum creatinine level but was negatively correlated with creatinine clearance (p < 0.05). SUA was a predictor of LN development in SLE patients (sensitivity, 83.3%; specificity, 70%). Conclusion SUA is associated with the development of lupus nephritis in patients with normal kidney function also SUA in-dependently correlated with disease activity and chronicity in LN.

Leukocytosis as a major thrombotic risk factor in patients with polycythemia vera

Blood ◽  
2006 ◽  
Vol 109 (6) ◽  
pp. 2446-2452 ◽  
Author(s):  
Raffaele Landolfi ◽  
Leonardo Di Gennaro ◽  
Tiziano Barbui ◽  
Valerio De Stefano ◽  
Guido Finazzi ◽  
...  
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
Polycythemia Vera ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Vascular Risk ◽  
Blood Cell Count ◽  
Thrombotic Risk ◽  
European Collaboration ◽  
Increased Risk

Abstract In polycythemia vera, vascular risk assessment is based on age and thrombotic history, while the role of other potential predictors of this risk is still uncertain. Thus, we exploited the large database collected by the observational study of the European Collaboration on Low-Dose Aspirin in Polycythemia Vera (ECLAP) to investigate the association of hematologic variables and cardiovascular risk factors with the thrombotic risk. Among 1638 polycythemic patients followed for 2.7 ± 1.3 years, there were 205 thromboses. Subjects with hypertension had a mild nonsignificant increase in the risk of arterial thrombosis, while this risk was significantly increased by smoking (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.15-3.14; P = .012). The time-dependent analysis adjusted for potential confounders showed that patients with a white blood cell count above 15 × 109/L, compared with those with a white blood cell count below 10 × 109/L, had a significant increase in the risk of thrombosis (HR, 1.71; 95% CI, 1.10-2.65; P = .017), mainly deriving from an increased risk of myocardial infarction (HR, 2.84; 95% CI, 1.25-6.46; P = .013). Thus, leukocyte count may help in defining the vascular risk of polycythemic subjects.

FRI0516 FACTORS ASSOCIATED WITH DECREASED CERVICAL CANCER SCREENING IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 857.1-857
Author(s):  
S. Bruera ◽  
R. Zogala ◽  
X. Lei ◽  
X. Pundole ◽  
H. Zhao ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cervical Cancer ◽  
Cancer Screening ◽  
Autoimmune Disease ◽  
Cervical Cancer Screening ◽  
Lupus Erythematosus ◽  
Screening Rate ◽  
Systemic Lupus ◽  
Comorbidity Score ◽  
Increased Risk

Background:Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that carries an increased risk for both viral illnesses and malignancies, including a greater risk for both human papilloma virus (HPV) infection and cervical cancer. Due to this increased risk, the American Society of Colposcopy and Cervical Pathology guidelines for SLE patients recommend more frequent cervical cancer screening. Few studies have examined patient characteristics associated with decreased cervical cancer screening in patients with autoimmune disease, specifically SLE.Objectives:To estimate cervical cancer screening rates in women with recently diagnosed SLE, and to identify characteristics associated with decreased screening.Methods:We identified women with an initial diagnosis of SLE in the United States MarketScan Commercial Claims and Encounter (CCAE, age 18-64) administrative claims database. We included patients with at least three claims with a lupus diagnosis (first and last at least >90 days apart), no lupus claims within the year before initial claim, and who had been on antimalarial drugs for at least 90 days. We excluded all patients with a previous claim for hysterectomy.Cervical cancer screening was ascertained using diagnosis and procedure codes within 1 year before and 2 years after the first SLE claim. Our covariates included the year of first SLE claim (2001-2014), age at first SLE claim, comorbidity score, insurance type, geographical region, and prescriptions for multiple types of corticosteroids. Control patients included age-matched females without autoimmune disease. Univariate comparison and multivariate logistic regression models were built to evaluate determinants of screening.Results:We included 4,316 SLE patients (median age 45) and 86,544 control patients. The screening rate in SLE patients was 73.4% vs 58.5% in the controls (P < 0.001). The screening rate was 71% in 2001, increased to 75% in 2004, then decreased to 70% in 2014 (trend P =0.005). In the multivariate model the following factors were associated with decreased cervical cancer screening: year of first SLE claim 2012-2014 versus 2001-2005 (odds ratio (OR) 0.67, 95% confidence interval (CI) 0.53 – 0.84, P < 0.001); older age 61-64 versus 21-30 (OR 0.27, 95% CI 0.19 – 0.39, P < 0.001); comorbidity score of ≥2 versus <2 (OR 0.71, 95% CI 0.6 – 0.83, P < 0.001); and use of corticosteroids for ≥ 90 days versus <90 days (OR 0.73, 95% CI 0.59 – 0.9, P = 0.003). Insurance type and geographical region were not associated with cervical cancer screening.Conclusion:About three quarters of women with SLE underwent cervical cancer screening within 3 years of their first lupus claim, at higher rates than controls. However, there was a concerning downward trend in screening rates in recent years. In addition, higher risk populations for cervical cancer (older age, increased comorbidities, and longer duration of corticosteroids) had lower screening rates. These findings highlight the need to enhance education for healthcare providers to improve utilization of screening in women with SLE at high risk of cervical cancer.Disclosure of Interests:Sebastian Bruera: None declared, Richard Zogala: None declared, Xiudong Lei: None declared, Xerxes Pundole: None declared, Hui Zhao: None declared, Sharon Giordano: None declared, Jessica Hwang Grant/research support from: MERCK grant funding unrelated to SLE., Maria Suarez-Almazor: None declared

scholarly journals An Analytic Approach Using Candidate Gene Selection and Logic Forest to Identify Gene by Environment Interactions (G × E) for Systemic Lupus Erythematosus in African Americans

Genes ◽  
2018 ◽  
Vol 9 (10) ◽  
pp. 496 ◽  
Author(s):  
Bethany Wolf ◽  
Paula Ramos ◽  
J. Hyer ◽  
Viswanathan Ramakrishnan ◽  
Gary Gilkeson ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Secondhand Smoke ◽  
Gene Selection ◽  
Search Space ◽  
Higher Order ◽  
Candidate Snps ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Main Effects

Development and progression of many human diseases, such as systemic lupus erythematosus (SLE), are hypothesized to result from interactions between genetic and environmental factors. Current approaches to identify and evaluate interactions are limited, most often focusing on main effects and two-way interactions. While higher order interactions associated with disease are documented, they are difficult to detect since expanding the search space to all possible interactions of p predictors means evaluating 2p − 1 terms. For example, data with 150 candidate predictors requires considering over 1045 main effects and interactions. In this study, we present an analytical approach involving selection of candidate single nucleotide polymorphisms (SNPs) and environmental and/or clinical factors and use of Logic Forest to identify predictors of disease, including higher order interactions, followed by confirmation of the association between those predictors and interactions identified with disease outcome using logistic regression. We applied this approach to a study investigating whether smoking and/or secondhand smoke exposure interacts with candidate SNPs resulting in elevated risk of SLE. The approach identified both genetic and environmental risk factors, with evidence suggesting potential interactions between exposure to secondhand smoke as a child and genetic variation in the ITGAM gene associated with increased risk of SLE.

scholarly journals Maternal Near Miss in Patients with Systemic Lupus Erythematosus

2021 ◽  
Author(s):  
Arlley Cleverson Belo Silva ◽  
Sue Yazaki Sun ◽  
Felipe Favorette Campanharo ◽  
Letícia Tiemi Morooka ◽  
José Guilherme Cecatti ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Maternal Death ◽  
Lupus Erythematosus ◽  
Neonatal Death ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Control Group ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Life Threatening

Abstract Introduction: Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with coexisting SLE may have severe life-threatening risks. Severe maternal morbidities (SMM) include maternal death, maternal near miss (MNM), and potentially life-threatening conditions (PLTC). This study aimed to determine the prevalence of SMM in patients with SLE and analyze the parameters that contributed to cases of greater severity. Methods: This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at São Paulo Hospital , Brazil, from 2005 to 2015. The pregnant women were divided in control group without complications, group with PLTC, and group with MNM. Results: Out of 149 pregnancies, there were 14 cases of MNM (9.4%), 56 cases of PLTC (37.6%), and no maternal death. The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with control group [p=0.0042; OR (95% CI): 12.05 (1.5-96.6) for MNM group and p=0.0001; OR (95% CI): 4.84 (2.2-10.8) for PLTC group]. SMM increases the risk of longer hospitalization [p<0,0001; OR (95% CI): 18.8 (7.0-50.6) and p <0.0001; OR (95% CI): 158.17 (17.6-1424,2) for PLTC and MNM, respectively], newborns with low birth weight [p=0.0006; OR (95% CI): 3.67 (1.7-7.9) and p=0.0009; OR (95% CI): 17.68 (2-153.6) for PLTC and MNM group, respectively] as well as renal diseases [PLTC (58.9%, 33/56; p = 0.0069) and MNM (78.6%, 11/14; p = 0.0026)]. MNM cases presented increased risk for neonatal death [p=0.0128; OR (95% CI): 38.4 (3.3-440.3)], stillbirth and miscarriage [p=0.0011; OR (95% CI): 7.68 (2.2-26.3)]. Conclusion: SLE was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes, such as prematurity, neonatal death, miscarriage and fetal loss.

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