AB0335 SURVIVAL ASSESSMENT IN PATIENTS WITH SLE AND PULMONARY MANIFESTATIONS IN A COLOMBIAN COHORT WITH 2-YEAR FOLLOW-UP

Abstract

Background:Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease with heterogenous and variable behavior. The frequency of pulmonary involvement ranges from 10-90%, with this variability in occurrence attributed to differences in populations and heterogeneity in detection methods and study designs.Objectives:To analyze survival in patients with SLE and the presence of pulmonary manifestations according to clinical and demographic characteristics in a cohort of patients in ColombiaMethods:Observational-analytical, retrospective, follow-up study of a cohort of adult patients with SLE. We included 559 adult patients who fulfilled the 2012 SLICC SLE classification criteria and with at least 6 months of disease evolution, treated in a medical center specialized in rheumatology with locations in 6 cities in Colombia between 2015 and 2018. Pregnant patients and those who had incomplete data or visits were excluded. Immunoserological profile was characterized and pulmonary involvement was followed for 1 year. The diagnosis of pulmonary involvement was obtained from the rheumatology report in the clinical chart. The prevalence of pulmonary manifestations and the immunoserological profile were determined and subsequently a logistic regression adjusted for age, sex and level of education was performed to establish the association between pulmonary manifestations and a positive autoantibody profileResults:Median age was 44.5 ± 14 years, 96.6% were women. In patients with pulmonary compromise 9.7% were smokers, 12.4% had an active alcohol intake, 58.4% had a low socioeconomic status, 38.1% medium and 4.7% high. Pulmonary involvement was present in 20% of patients, the most common manifestations were pleuritis (14.3%), lupus pneumonitis (3.6%), pulmonary hypertension (3.2%), interstitial lung disease (2.3%), pulmonary embolism (2.3%), pulmonary fibrosis (2.14%), alveolar hemorrhage (1.4%), shrinking lung (0.2%). there was no significant difference in the follow up at one year. Immunoserological characteristics shows ANA positivity in 92%, anti-DNA in 53%, ENAS in 97%, with anti-RNP being the most common (41.7%), and low complement levels in 53%. Mortality for pulmonary compromise was 1.4%, and survival at 2 years did not have a statistically significant difference (p=0.155)Conclusion:Survival was not found to be lower in patients with SLE and pulmonary involvement (p=0.155) when compared to SLE patients without pulmonary involvement after 2-year follow-up. This finding was independent of age, gender, and educational level. Previous large cohorts like GLADEL and RELESSER describe an association between pulmonary involvement and lower survival HR 2,79 (95% CI: 1,80-4,31), p <0,001 and HR 3.13, (95% IC: 1.56– 6.28, P = 0.00 respectively. In the RELESSER cohort pleural involvement and pulmonary embolism was found to have low to minimal impact on survival.In our cohort pleuritis was the most common finding whereas the other pulmonary manifestations were reported in less than 4% of patients. This difference could explain our differences with other cohorts. Other causes for this difference are a smaller sample size and a short follow-up.The results of our study do not suggest that there is an association between pulmonary involvement and mortality in Colombian patients with SLE during a 2-year follow-up. We will continue to monitor and report in this regard