Abstract
Thrombotic events (TE), including deep vein thrombosis, stroke, and myocardial infarction, occur in 30–40% of patients with systemic lupus erythematosus (SLE) resulting in substantial morbidity and mortality. We explored the risk factors for TE in SLE patients. We analyzed data obtained during a prospective cohort based on the KORean lupus NETwork (KORNET) registry, and enrolled 259 SLE patients with clinical data available at the onset of SLE. TE was defined as the presence of arterial or venous thrombosis. Multivariate Cox-proportional hazards analysis was performed to investigate risk factors for TE. During a mean follow-up of 103.3 months (SD 53.4), 27 patients (10.4%) had a TE. In multivariate analysis, hypertension (hazard ratio [HR] 7.805, 95% confidence interval [CI]: 1.929–31.581; P = 0.004), anti-phospholipid syndrome (APS) (HR 12.600, 95% CI: 4.305–36.292; P < 0.001), mean daily prednisolone > 5 mg/day (HR 3.666, 95% CI: 1.318–10.197; P = 0.013), and SLICC/ACR Damage Index (SDI) score (HR 1.992, 95% CI: 1.465–2.709; P < 0.001) were significantly associated with the development of TE in SLE patients. Instead, use of an ACEi or ARB (HR 0.159, 95% CI: 0.043–0.594; P = 0.006) was a protective factor against TE development in these patients. In conclusion, hypertension, higher mean daily dose of prednisolone, diagnosis of APS, and higher SDI were risk factors for TE in patients with SLE. On the other hand, the use of an ACEi or ARB was associated with a reduced risk of TE.
Highlights
There were no significant differences in sex ratio, symptom duration, smoking history, presence of diabetes mellitus, or SLE disease activity index (SLEDAI) score at the time of Systemic lupus erythematosus (SLE) onset between the two groups
Our study suggested that aggressive monitoring and judicious use of immunosuppressive agents for prompt control of disease activity are important to minimize the risk of thrombosis in patients with SLE
Only one study has shown that the use of an angiotensinconverting enzyme inhibitor (ACEi) was associated with a reduced risk of developing thrombotic complications in patients with SLE30. This possible antithrombotic effect of ACEi or angiotensin receptor blocker (ARB) use in patients with SLE should be confirmed in further prospective studies, our findings indicated that an ACEi or ARB should be considered as the first-line antihypertensive medication to prevent thrombosis in patients with SLE at high risk of thrombotic events (TE)
Summary
KORNET is a nationwide, multicenter, hospital-based registry used to assess clinical manifestations and long-term outcomes in Korean patients with SLE11. We obtained laboratory findings, such as WBC count, hemoglobin concentration, platelet level, serum albumin level, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, total cholesterol level, serum creatinine level, urinalysis, and level of proteinuria (g/day) at the time of SLE diagnosis. Serological markers, such as anti-nuclear antibody (ANA), complement (C3 and C4), and various autoantibodies, including anti-dsDNA, Smith (Sm), ribonucleoprotein (RNP), Ro, and La, were assessed by enzyme-linked immunosorbent assays (ELISA). P < 0.05 was taken to indicate statistical significance
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