Predictive models of infection in patients with systemic lupus erythematosus: A systematic literature review

Lupus ◽  
2021 ◽  
pp. 096120332098346
Author(s):  
Mauricio Restrepo-Escobar ◽  
Paula A Granda-Carvajal ◽  
Daniel C Aguirre ◽  
Johanna Hernández-Zapata ◽  
Gloria M Vásquez ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Predictive Models ◽  
Data Extraction ◽  
Risk Of Bias ◽  
Therapeutic Interventions ◽  
Prognostic Models ◽  
Risk Of Infection ◽  
Systemic Lupus ◽  
Model Studies

Introduction Having reliable predictive models of prognosis/the risk of infection in systemic lupus erythematosus (SLE) patients would allow this problem to be addressed on an individual basis to study and implement possible preventive or therapeutic interventions. Objective To identify and analyze all predictive models of prognosis/the risk of infection in patients with SLE that exist in medical literature. Methods A structured search in PubMed, Embase, and LILACS databases was carried out until May 9, 2020. In addition, a search for abstracts in the American Congress of Rheumatology (ACR) and European League Against Rheumatism (EULAR) annual meetings’ archives published over the past eight years was also conducted. Studies on developing, validating or updating predictive prognostic models carried out in patients with SLE, in which the outcome to be predicted is some type of infection, that were generated in any clinical context and with any time horizon were included. There were no restrictions on language, date, or status of the publication. To carry out the systematic review, the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) guideline recommendations were followed. The PROBAST tool (A Tool to Assess the Risk of Bias and Applicability of Prediction Model Studies) was used to assess the risk of bias and the applicability of each model. Results We identified four models of infection prognosis in patients with SLE. Mostly, there were very few events per candidate predictor. In addition, to construct the models, an initial selection was made based on univariate analyses with no contraction of the estimated coefficients being carried out. This suggests that the proposed models have a high probability of overfitting and being optimistic. Conclusions To date, very few prognostic models have been published on the infection of SLE patients. These models are very heterogeneous and are rated as having a high risk of bias and methodological weaknesses. Despite the widespread recognition of the frequency and severity of infections in SLE patients, there is no reliable predictive prognostic model that facilitates the study and implementation of personalized preventive or therapeutic measures. Protocol registration number: PROSPERO CRD42020171638.

scholarly journals Multiple Functions of B Cells in the Pathogenesis of Systemic Lupus Erythematosus

2019 ◽  
Vol 20 (23) ◽  
pp. 6021 ◽  
Author(s):  
Kongyang Ma ◽  
Wenhan Du ◽  
Xiaohui Wang ◽  
Shiwen Yuan ◽  
Xiaoyan Cai ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
B Cells ◽  
B Cell ◽  
Lupus Erythematosus ◽  
Therapeutic Interventions ◽  
Systemic Lupus ◽  
Autoantibody Production ◽  
Regulatory B Cell ◽  
Functional Features ◽  
B Cell Subsets

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by excessive autoantibody production and multi-organ involvement. Although the etiology of SLE still remains unclear, recent studies have characterized several pathogenic B cell subsets and regulatory B cell subsets involved in the pathogenesis of SLE. Among pathogenic B cell subsets, age-associated B cells (ABCs) are a newly identified subset of autoreactive B cells with T-bet-dependent transcriptional programs and unique functional features in SLE. Accumulation of T-bet+ CD11c+ ABCs has been observed in SLE patients and lupus mouse models. In addition, innate-like B cells with the autoreactive B cell receptor (BCR) expression and long-lived plasma cells with persistent autoantibody production contribute to the development of SLE. Moreover, several regulatory B cell subsets with immune suppressive functions have been identified, while the impaired inhibitory effects of regulatory B cells have been indicated in SLE. Thus, further elucidation on the functional features of B cell subsets will provide new insights in understanding lupus pathogenesis and lead to novel therapeutic interventions in the treatment of SLE.

scholarly journals Validation of the REVEAL Prognostic Models in Systemic Lupus Erythematosus-Associated Pulmonary Arterial Hypertension

2021 ◽  
Vol 8 ◽  
Author(s):  
Jingge Qu ◽  
Mengtao Li ◽  
Xiaofeng Zeng ◽  
Xiao Zhang ◽  
Wei Wei ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Risk Score ◽  
Lupus Erythematosus ◽  
Validation Cohort ◽  
Prognostic Models ◽  
Systemic Lupus ◽  
Prognostic Equation ◽  
Pulmonary Arterial

No previous studies have investigated the predictive performance of the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL) prognostic equation and simplified risk score calculator in patients with systemic lupus erythematosus-associated pulmonary arterial hypertension (SLE-PAH). We aimed to validate these prediction tools in an external cohort of patients with SLE-PAH. In this study, the validation cohort consisted of patients with SLE-PAH registered in a prospective, multicenter, nationwide database between November 2006 and May2016. The follow-up of patients was censored at 1 year. Discrimination, calibration, model fit, and risk stratification of the REVEAL prognostic equation and simplified risk score calculator were validated. As a result, a total of 306 patients with SLE-PAH were included. The 1-year overall survival rate was 91.5%. The C-index of the prognostic equation was 0.736, demonstrating reasonably good discrimination, and it was greater than that for the simplified risk score calculator (0.710). The overall calibration slope was 0.83, and the Brier score was 0.079. The risk of renal insufficiency and World Health Organization Functional Class III (WHO FC III) were underestimated, and the risk assigned to a heart rate >92 bpm in the REVEAL prognostic models was not observed in our validation cohort. Both model discrimination and calibration were poor in the very high-risk group. In conclusion, the REVEAL models exhibit good discriminatory ability when predicting 1-year overall survival in patients with SLE-PAH. Findings from both models should be interpreted with caution in cases of renal insufficiency, WHO FC III, and heart rate >92 bpm.

scholarly journals Altered cognitive function in systemic lupus erythematosus and associations with inflammation and functional and structural brain changes

2019 ◽  
Vol 78 (7) ◽  
pp. 934-940 ◽  
Author(s):  
Michelle Barraclough ◽  
Shane McKie ◽  
Ben Parker ◽  
Alan Jackson ◽  
Philip Pemberton ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cognitive Function ◽  
Sustained Attention ◽  
Lupus Erythematosus ◽  
Recognition Task ◽  
Organ Damage ◽  
Therapeutic Interventions ◽  
Bold Signal ◽  
Systemic Lupus ◽  
Brain Responses

ObjectivesCognitive dysfunction (CD) is common in systemic lupus erythematosus (SLE) but the cause remains unclear and treatment options are limited. We aimed to compare cognitive function in SLE and healthy controls (HCs) using both behavioural and neuroimaging techniques.MethodsPatients with SLE with stable disease and HCs were recruited. Clinical and psychological data were collected along with a blood sample for relevant biomarkers. Neurocognitive function was assessed using tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and functional magnetic resonance imaging (fMRI) was used to examine brain responses to working memory (WM) and emotional processing (facial emotional recognition task, FERT) tasks.ResultsCompared with HCs (n=30), patients with SLE (n=36) scored higher on measures of depression, fatigue and had higher hsCRP (p=0.013), IL-6 (p=0.003) and B lymphocyte stimulator (p<0.001). Patients with SLE had poorer performance on a task of sustained attention (p=0.002) and had altered brain responses, particularly in default mode network (DMN) regions and the caudate, during the WM task. Higher organ damage and higher VCAM-1 were associated with less attenuation of the DMN (p=0.005 and p=0.01, respectively) and lower BOLD signal in the caudate areas (p=0.005 and p=0.001, respectively). Increased IL-6 was also associated with lower BOLD signal in caudate areas (p=0.032).ConclusionsSustained attention was impaired in patients with SLE. Poor attenuation of the DMN may contribute to cognitive impairments in SLE and our data suggest that in addition to mood and fatigue inflammatory mechanisms and organ damage impact cognitive functioning in SLE. The multifaceted nature of CD in SLE means any therapeutic interventions should be individually tailored.

Successful Pregnancy Outcome in a Case of Systemic Lupus Erythematosus

2017 ◽  
Vol 9 (2) ◽  
pp. 134-136
Author(s):  
Leelavathi Basava ◽  
K Triveni ◽  
G Sindhu Sree
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Pregnancy Outcome ◽  
Lupus Erythematosus ◽  
Immunosuppressive Agents ◽  
Fetal Loss ◽  
Therapeutic Interventions ◽  
Elective Cesarean Section ◽  
Childbearing Age ◽  
Systemic Lupus ◽  
Successful Pregnancy

ABSTRACT Systemic lupus erythematosus (SLE) is an autoimmune disease most frequently found in women of childbearing age and may coexist with pregnancy. Disease exacerbation, increased fetal loss, neonatal lupus, and an increased incidence of preeclampsia are the major challenges. Its multisystem involvement and therapeutic interventions like anticoagulants, steroids, and immunosuppressive agents pose a high risk for both the mother and the fetus during the antenatal period as well as postpartum. Good multidisciplinary medical care is mandatory when detection or flare-up of SLE occurs during pregnancy. We describe the successful management of an antinuclear antibody, antiribonucleoprotein antibody, and anti-Sjogren's syndrome A (Ro) antibody positive parturient with bad obstetric history who underwent elective cesarean section and delivered a healthy child. How to cite this article Basava L, Roy P, Triveni K, Sree GS. Successful Pregnancy Outcome in a Case of Systemic Lupus Erythematosus. J South Asian Feder Obst Gynae 2017;9(2): 128-130.

Utility of neutrophil-to-lymphocyte ratio plus C-reactive protein for infection in systemic lupus erythematosus

Lupus ◽  
2019 ◽  
Vol 28 (2) ◽  
pp. 217-222 ◽  
Author(s):  
B E Broca-Garcia ◽  
M A Saavedra ◽  
M A Martínez-Bencomo ◽  
D H Montes-Cortes ◽  
L J Jara ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Predictive Value ◽  
Neutrophil To Lymphocyte Ratio ◽  
Therapeutic Interventions ◽  
C Reactive Protein ◽  
Systemic Lupus ◽  
Lymphocyte Ratio ◽  
Reactive Protein ◽  
Active Disease

Distinction between infection and flare in patients with systemic lupus erythematosus (SLE) is a challenge in clinical practice. Objective To analyze the utility of neutrophil-to-lymphocyte ratio (NLR) plus C-reactive protein (CRP) to differentiate between infection and active disease in patients with SLE. Methods A cross-sectional study of a cohort of patients with SLE was carried out. Blood samples from four groups (patients without infection or active disease, patients with infection, patients with active disease, and patients with both infection and active disease) before therapeutic interventions were analyzed. We excluded patients with current malignancy, pregnancy, ischemic heart disease or use of antimicrobials during previous 7 days. Hematological cell count, CRP and cultures were obtained. We constructed receiver operating characteristic curves; sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results Forty patients were included. NLR cut-off ≥6.3 had sensitivity 70%, specificity 85%, PPV 83% and NPV 74% to detect patients with non-viral infections. A CRP cut-off ≥7.5 mg/L had sensitivity 90%, specificity 75%, PPV 78% and NPV 88% to detect infections regardless of SLE activity. Combination of CRP plus NLR improves the specificity to 90% and PPV to 88%. Excluding the group with both infection and active disease, CRP plus NLR expands specificity to 95% and NPV to 90%. Conclusion In our experience, levels of CRP, particularly CRP plus NLR, were useful in differentiating patients with SLE from those with suspected non-viral infection regardless of the activity of the disease.

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