scholarly journals Cytomegaloviral or Pneumocystis Jiroveci Pneumonia Increases Mortality in Systemic Lupus Erythematosus Patients with Pulmonary Hemorrhage: Evidence from Bronchoalveolar Lavage Fluid

2018 ◽  
Vol 46 (3) ◽  
pp. 251-258 ◽  
Author(s):  
Yi-Syuan Sun ◽  
De-Feng Huang ◽  
Fang-Chi Lin ◽  
Chih-Kai Hsu ◽  
I-Ting Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Bronchoalveolar Lavage ◽  
Lupus Erythematosus ◽  
Bronchoalveolar Lavage Fluid ◽  
Pulmonary Hemorrhage ◽  
Lavage Fluid ◽  
Mortality Rates ◽  
Systemic Lupus ◽  
Pneumocystis Jiroveci

Objective.To evaluate the role of cytomegaloviral or Pneumocystis jiroveci pneumonia (CMV/PJP) in systemic lupus erythematosus (SLE) patients with pulmonary hemorrhage (PH).Methods.We retrospectively examined hospital records for 27 SLE patients with PH who received bronchoalveolar lavage fluid (BALF) analyses. Clinical profile and mortality rates were compared between groups with and without CMV/PJP. Risk factors for PH-related mortality were analyzed.Results.Among 27 SLE patients with PH, 15 had pathogens from BALF samples, and 8 had CMV/PJP. Although CMV/PJP was treated, the RR for 90- and 180-day mortality rates of SLE patients with CMV/PJP were higher than those without these infections (5.94, 95% CI 1.44–24.48; 7.13, 95% CI 1.81–28.06, respectively). Risk factors for 90- and 180-day mortality were presence of CMV/PJP (OR 14.2, 95% CI 1.83–109.9; OR 25.5, 95% CI 2.91–223.3, respectively) and use of pulse methylprednisolone for PH treatment (OR 12.0, 95% CI 1.48–97.2; OR 8.5, 95% CI 1.13–63.9, respectively). Factors increasing the 90-day mortality rate were duration of mechanical ventilation exceeding 14 days (OR 11.1, 95% CI 1.11–112.0) and use of aggressive immunosuppression close to PH onset (OR 7.56, 95% CI 1.09–52.4). Three of the 7 patients receiving aggressive immunosuppression died with the presence of CMV/PJP.Conclusion.Owing to the high prevalence of CMV/PJP and its association with mortality, routine BALF analysis is recommended for all suitable SLE patients with PH. Use of aggressive immunosuppression does not benefit SLE patients with opportunistic infections during PH attack.

scholarly journals AB0366 DIFFUSE ALVEOLAR HEMORRHAGE IN LUPUS NEPHRITIS PATIENTS: MULTICENTER RECTROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1483.1-1484
Author(s):  
S. Abdulaziz ◽  
H. Halabi ◽  
S. Bahlas ◽  
S. Attar ◽  
M. Dessougi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Clinical Presentation ◽  
Pulmonary Hemorrhage ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Systemic Lupus ◽  
Cns Involvement

Background:Diffuse alveolar hemorrhage (DAH) is a rare and potentially lethal complication of systemic lupus erythematosus (SLE) with a high mortality rate. It occurs more frequently in patients with lupus nephritis (LN).Objectives:The aim of our study is to explore the characteristics of patients that develop DAH with lupus nephritis, risk factors that predispose DAH, treatment response and outcomes.Methods:Multicenter retrospective cohort study was undertaken including 6 centers in Saudi Arabia from 2002 to 2018. Systemic lupus erythematosus patients meeting the SLICC criteria with lupus nephritis (biopsy proven or proteinuria or renal impairment due to lupus) presenting with diffuse alveolar hemorrhage (fulfilling a predefined criteria) were included in the study. An identical number of control group with lupus nephritis was also studied. Data was obtained from medical records by using a data sheet: demographics including age, gender, diagnosis, date of diagnosis of lupus, date of presentation of alveolar hemorrhage, clinical presentation, detection of alveolar hemorrhage proved by radiology, lavage or biopsy and laboratory parameters: including level of hemoglobin before and during DAH, sign of activity, treatment and outcome of DAH. Identification of risk factors predisposing to DAH in lupus nephritis patients was analyzed.Results:We identified 23 cases of DAH with lupus nephritis, all fulfilling the criteria. Mean age at presentation of DAH was 31.09 ± 12.6 years ranging from 14-57 years, of which 87 % were females. 13 patients 56.5% had Class 4 LN and 21.7% had Class 4 and 5 LN on renal pathology. DAH occurred at a mean of 6.5 years ±3.8 in 13/23 patients with LN. Shortness of breath 95%, new chest x ray finding 95.7% and mean drop of haemoglobin of 2.72 gm/dl ±0.97 were more frequent at presentation of DAH with LN patients. High SLE disease activity - SELENA SLEDAI 2K was 38.56 ±19.3 was present at the onset of DAH. All were treated with methyprednisone,15/23 (65.2%) underwent mechanical ventilation and plasmapheresis was done in 21/23 patients (91.3%). Cyclophosphamide was given in 14/21 patients (60.9%), Intravenous immunoglobulins were given in 14/23 patients (65.2%) and dialysis was done in 12/23 patients (52.2%). Mortality occurred 8 patients 34.8 %. In comparison with the LN group, a mean haemoglobin of 7.56 ± 1.3, CNS involvement, vasculitis and fever>38% were of statistically significance P value: <0.001,0.02,0.03 and 0.03 respectively.Conclusion:In this multicenter cohort series with DAH in LN patients CNS involvement, vasculitis and fever>38 were associated in the occurrence of DAH. Mortality was low in our cohort in comparison to previous series which may be explained by early diagnosis and use of aggressive management.Well designed prospective studies are required to identify high risk patients for preventing this serious complication.References:[1]Eagen JW, Memoli VA, Roberts JL, et al. Pulmonary hemorrhage in systemic lupus erythematosus. Medicine (Baltimore) 1978; 57:545.[2]Badsha H, Teh CL, Kong KO, et al. Pulmonary hemorrhage in systemic lupus erythematosus. Semin Arthritis Rheum 2004; 33:414.[3]Zamora MR, Warner ML, Tuder R, Schwarz MI. Diffuse alveolar hemorrhage and systemic lupus erythematosus. Clinical presentation, histology, survival, and outcome. Medicine (Baltimore) 1997; 76:192.[4]Hsu BY, Edwards DK 3rd, Trambert MA. Pulmonary hemorrhage complicating systemic lupus erythematosus: role of MR imaging in diagnosis. AJR Am J Roentgenol 1992; 158:519.Disclosure of Interests:None declared

scholarly journals Diffuse Alveolar Haemorrhage as Initial Presentation of Systemic Lupus Erythematosus

2018 ◽  
Vol 56 (214) ◽  
pp. 970-973
Author(s):  
Ashesh Dhungana ◽  
Prajowl Shrestha ◽  
Bhakta Dev Shrestha ◽  
Anil Baral ◽  
Gita Sayami
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Bronchoalveolar Lavage Fluid ◽  
Lavage Fluid ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Alveolar Haemorrhage ◽  
Systemic Lupus ◽  
Fluid Analysis ◽  
Prompt Diagnosis

Diffuse alveolar hemorrhage results from accumulation of red blood cells in the alveolar space originating from alveolar capillaries. Alveolar hemorrhage in Systemic Lupus Erythematosus is rare but catastrophic and can rapidly progress to respiratory failure. We report a 22-year old lady who presented with dyspnoea on exertion, hemoptysis, bilateral leg swelling and oliguria. Diffuse alveolar hemorrhage was confirmed by bronchoalveolar lavage fluid analysis. Serologic tests and renal biopsy confirmed lupus nephritis. She was treated with systemic immunosuppressive therapy and plasma exchange, to which she had a favourable response. Lupus presenting as alveolar hemorrhage is rare which warrants prompt diagnosis and treatment to prevent complications.

Risk Factors Associated with Systemic Lupus Erythematosus in Oman

2020 ◽  
Vol 03 (04) ◽  
Author(s):  
Asma Al-Kindi ◽  
Batool Hassan ◽  
Aliaa Al-Moqbali ◽  
Aliya Alansari
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Factors Associated

scholarly journals Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL)

RMD Open ◽  
2020 ◽  
Vol 6 (3) ◽  
pp. e001299
Author(s):  
Cristina Reátegui-Sokolova ◽  
Manuel F Ugarte-Gil ◽  
Guillermina B Harvey ◽  
Daniel Wojdyla ◽  
Guillermo J Pons-Estel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Latin American ◽  
Lupus Erythematosus ◽  
Renal Damage ◽  
Cox Regression ◽  
Damage Index ◽  
Early Response ◽  
Male Gender ◽  
Systemic Lupus

AimA decrease in proteinuria has been considered protective from renal damage in lupus nephritis (LN), but a cut-off point has yet to be established. The aim of this study was to identify the predictors of renal damage in patients with LN and to determine the best cut-off point for a decrease in proteinuria.MethodsWe included patients with LN defined clinically or histologically. Possible predictors of renal damage at the time of LN diagnosis were examined: proteinuria, low complement, anti-double-stranded DNA antibodies, red cell casts, creatinine level, hypertension, renal activity (assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)), prednisone dose, immunosuppressive drugs and antimalarial use. Sociodemographic variables were included at baseline. Proteinuria was assessed at baseline and at 12 months, to determine if early response (proteinuria <0.8 g/day within 12 months since LN diagnosis) is protective of renal damage occurrence. Renal damage was defined as an increase of one or more points in the renal domain of The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). Cox regression models using a backward selection method were performed.ResultsFive hundred and two patients with systemic lupus erythematosus patients were included; 120 patients (23.9%) accrued renal damage during their follow-up. Early response to treatment (HR=0.58), antimalarial use (HR=0.54) and a high SES (HR=0.25) were protective of renal damage occurrence, whereas male gender (HR=1.83), hypertension (HR=1.86) and the renal component of the SLEDAI (HR=2.02) were risk factors for its occurrence.ConclusionsEarly response, antimalarial use and high SES were protective of renal damage, while male gender, hypertension and higher renal activity were risk factors for its occurrence in patients with LN.

scholarly journals AB0507 INVASIVE ASPERGILLOSIS IN ADULT RHEUMATOLOGICAL PATIENTS IN SAINT PETERSBURG, RUSSIA.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1551.1-1552
Author(s):  
V. Mazurov ◽  
O. Shadrivova ◽  
M. Shostak ◽  
L. Martynova ◽  
M. Tonkoshkur ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Renal Failure ◽  
Invasive Aspergillosis ◽  
Lupus Erythematosus ◽  
Granulomatosis With Polyangiitis ◽  
Control Group ◽  
Systemic Lupus ◽  
Anca Associated Vasculitis ◽  
Underlying Diseases

Background:Invasive aspergillosis (IA) is a severe opportunistic infection that is not well understood in rheumatological patients.Objectives:To study risk factors, etiology, clinical manifestations and results of treatment of IA in adult rheumatological patients.Methods:Retrospective analysis of 830 patients (1998-2019) with “proven” and “probable” IA (EORTC / MSG, 2019), adults - 699 (84%). The main group included 18 (3%) adult rheumatological patients with IA, a control group included 610 (87%) adult hematological patients. Rheumatological patients were older, the average age was 59 years (21–75) vs 45 years (18–79), p = 0.005, and among them there were more women – 56% vs 42%, p = 0.01.Results:In rheumatological patients with IA, underlying diseases were ANCA-associated vasculitis (28%), granulomatosis with polyangiitis (22%), periarteritis (11%), systemic lupus erythematosus (22%), rheumatic heart disease (11%) and ankylosing spondylitis (6%). In the control group, underlying diseases were acute leukemia (45%), lymphomas (34%), chronic leukemia (9%), multiple myeloma (7%), myelodysplastic syndrome (3%), and other hematological diseases (2%).The main risk factors for IA development in rheumatological patients were: systemic steroids use (89% vs 69%), prolonged lymphocytopenia (76% vs 65%, median - 14 vs 12 days), treatment in ICU (44% vs 18%, p = 0.01), acute or chronic renal failure (39% vs 1%, p = 0.0008) and immunosuppressive therapy (28% vs 25%). Severe neutropenia was noted significantly less frequently (18% vs 83%, p = 0.0001). Additional risk factors were decompensated diabetes mellitus (17% vs 2%, p = 0.004), previous surgery (17% vs 1%, p = 0.001) and organ transplantation (6% vs 0%). In rheumatological patients, lung (83% vs 98%, p = 0.0001) and ≥2 organs (6% vs 8%) involvement were less common. Heart (11% vs 0%), sinuses (6% vs 5%) and central nervous system (6% vs 4%) involvement more often developed. In rheumatological patients, respiratory failure (61 vs 37%, p = 0.03), hemoptysis (28% vs 7%, p = 0.0001) and chest pain (17% vs 7%, p = 0, 04) were noted more often, less often - fever ≥380С (67% vs 85%, p = 0.01) and cough (61% vs 70%). CT signs of lung damage were similar in both groups, but rheumatologic patients were more likely to show an «air crescent» sign and / or destruction cavity (44% vs 10%, p = 0.0001). In rheumatologic patients, IA was more often confirmed by isolation ofAspergillusspp. from BAL (80% vs 45%, p = 0.005) and by histological examination (22% vs 7%, p = 0.01). The main pathogens wereA. fumigatus(50% vs 43%),A. niger(29% vs 32%), andA. flavus(14% vs 17%).Rheumatological patients were less likely to receive antifungal therapy 89% vs 99%, p = 0,0003. The main drug in both groups was voriconazole. The overall 12-week survival did not significantly differ between groups, but was lower in rheumatological patients with IA (69% vs 81%).Conclusion:In rheumatological patients, invasive aspergillosis more often developed at an older age, mainly in women. The main background diseases were ANCA-associated vasculitis, granulomatosis with polyangiitis, and systemic lupus erythematosus. Typical risk factors were steroids and immunosuppressants use, prolonged lymphocytopenia, ICU stay, and renal failure. The main causative agents wereA. fumigatus,A. niger, andA. flavus. The main localization of infection were lungs. Respiratory failure, hemoptysis and heart involvement were typical. The overall 12-week survival of rheumatological patients with invasive aspergillosis was 69%.Disclosure of Interests:None declared

Risk of osteonecrosis in systemic lupus erythematosus: An 11-year Chinese single-center cohort study

Lupus ◽  
2021 ◽  
pp. 096120332110211
Author(s):  
Yin Long ◽  
Shangzhu Zhang ◽  
Jiuliang Zhao ◽  
Hanxiao You ◽  
Li Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Risk Factor ◽  
Femoral Head ◽  
Lupus Erythematosus ◽  
Femoral Head Necrosis ◽  
Joint Involvement ◽  
Multiple Site ◽  
Systemic Lupus ◽  
Cns Involvement

Objective Osteonecrosis (ON), which can lead to physical disability, is a common complication of systemic lupus erythematosus (SLE). The purpose of this study was to determine the prevalence of ON and identify possible risk factors in Chinese SLE patients. Methods SLE patients who fulfilled the 1997 American College of Rheumatology SLE classification criteria were recruited from the Peking Union Medical College Hospital. The chi-square test (χ 2 test) and multivariate regression analyses were used to evaluate risk factors. The Cox proportional-hazards model was used to construct the survival curves and estimate the simultaneous effects of prognostic factors on survival. Results We consecutively enrolled 1,158 patients, of which 88 patients (7.6%) developed ON. Among ON patients, 57.1% of patients had isolated femoral head necrosis and 42.9% had multiple joint involvement. The mean age of ON patients (24.62 ± 8.89 years) was significantly younger than SLE patients without ON (27.23 ± 10.16 years, p = 0.09). The ON group presented with a much longer disease course (10.68 ± 5.97 years, p < 0.001) and increased incidence of arthritis, kidney, and central nervous system (CNS) involvement (65.9% [ p < 0.05], 57.6% [ p < 0.05], and 16.5% [ p < 0.05], respectively, in the ON group). ON patients were more likely to be treated with glucocorticoid (GC) and to receive a high dose of prednisolone at the initial stage of SLE ( p < 0.05). The percentage of patients who received hydroxychloroquine was much higher in the control group ( p < 0.001). Cox regression analysis suggested that CNS involvement and GC therapy were two independent risk factors for ON in SLE patients. The presence of anti-phospholipid antibodies (aPLs) was a risk factor for multiple joint necrosis (odds ratio: 6.28, p = 0.009). Conclusions ON remains a serious and irreversible complication in SLE. In addition to glucocorticoid therapy, we found that CNS system involvement was a risk factor for ON, while the administration of hydroxychloroquine was a protective factor. The clinical characteristics of multiple site ON patients were distinct from isolated femoral head necrosis patients. The presence of aPLs was a risk factor for multiple site osteonecrosis.

scholarly journals Disease activity index is associated with subclinical atherosclerosis in childhood-onset systemic lupus erythematosus

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Priscila B. S. Medeiros ◽  
Roberta G. Salomão ◽  
Sara R. Teixeira ◽  
Diane M. Rassi ◽  
Luciana Rodrigues ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Subclinical Atherosclerosis ◽  
Disease Activity Index ◽  
Uncontrolled Hypertension ◽  
Childhood Onset ◽  
Systemic Lupus

Abstract Background Systemic lupus erythematosus (SLE) is an independent risk factor for cardiovascular events. The present study determined the prevalence of subclinical atherosclerosis in childhood-onset SLE using the carotid intima-media thickness (CIMT) measurement and investigated associations between traditional and nontraditional risk factors for atherosclerosis, such as medications, SLE Disease Activity Index - SLEDAI-2 K and SLICC-ACR damage index and CIMT. Methods Cross-sectional prospective study between 2017 and 2018. CIMT was assessed by ultrasonography. Data were collected by chart review, nutritional evaluation and laboratory tests and analyzed by Fisher, Wilcoxon-Mann-Whitney tests, multiple linear and log binomial regression. Results Twenty-eight patients (mean age 13.9 years, SD 3) were enrolled. The prevalence of subclinical atherosclerosis was 32% (95% CI 14.8, 49.4). The mean CIMT was 0.43 ± 0.035 mm. The most common traditional risk factors observed were dyslipidemia (82.1%), uncontrolled hypertension (14.2%), obesity (14.3%), and poor diet (78.6%). Uncontrolled hypertension (p = 0.04), proteinuria (p = 0.02), estimated glomerular filtration rate < 75 ml /min/1.73 m2 (p = 0.02) and SLEDAI-2 K > 5 (P = 0.04) were associated with subclinical atherosclerosis. SLEDAI-2 K > 5 maintained association with CIMT after adjusting for control variables. Conclusion Subclinical atherosclerosis is frequently observed in cSLE, mainly in patients with moderate to severe disease activity.

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