The impact of different ages of onset on cardiopulmonary function in Chinese patients with systemic lupus erythematosus

Abstract

Abstract Background Despite being most prevalent in adults, systemic lupus erythematosus (SLE) can also be diagnosed in teenagers and older adults. The levels of sex hormones in people of different ages were varied and the clinical features and disease activity of SLE were affected by hormonal changes. Whether the ages of onset impact the cardiopulmonary manifestations was not well explored in patients with SLE. Purpose The purpose of this registry was to investigate the difference in clinical features and cardiopulmonary performance in patients with childhood-onset SLE, or young adulthood onset SLE and adulthood-onset SLE. Methods patients aged 18 or older and meeting the diagnostic standards of SLE which were established by the ACR in 1997 were included in this study. Patients were divided into childhood-onset (< 18 years old ), young adulthood-onset (18∼35 years old ), and adulthood-onset groups (>35 years old ) based on the different ages at diagnosis. Clinical and demographic data were collected from the clinical management system. In addition, laboratory tests, six-minute walk test (6MWT), electrocardiography, transthoracic echocardiography, and pulmonary function were performed for all patients. Results 1054 patients with SLE were enrolled in this study. The adulthood-onset group has a higher systolic blood pressure, shorter 6MWTD, and a higher proportion of chronic kidney disease compared to the other two groups (p<0.05). In contrast, mixed connective tissue disease (MCTD) has occurred more frequently in the childhood-onset group (14.5%) compared to the other two groups (p<0.05). And thus, immunosuppressive was used more frequently in the childhood-onset group than in the other two groups (p<0.05). The left ventricular diastolic function was evaluated by the ratio of peak early to late diastolic filling velocity (E/A ratio). The E/A ratio was significantly reduced in the adulthood-onset group (1.1±0.0) than in the childhood-onset group (1.4±0.0) and the young adulthood-onset group (1.3±0.0). Moreover, patients in the adulthood-onset group presented with a larger right atrial diameter (4.4±0.0) than the childhood-onset group (4.2±0.0) and the young adulthood-onset group (4.2±0.0). The adulthood-onset group (17.4%) has a high proportion of "pulmonary hypertension" which was evaluated based on the guideline established by the European society of cardiology. An impaired forced vital capacity (FVC) and forced expiratory flow at 75% of FVC (FEF75%) were observed in the adulthood-onset group compared to the other two groups (p<0.05). Conclusions This registry has demonstrated that different ages of onset could impact the clinical and cardiopulmonary performance in Chinese patients with SLE. Patients in the adulthood-onset group presented higher blood pressure, shorter 6MWT, a higher proportion of chronic kidney disease, and impaired pulmonary function compared to the other two groups.Comparisons of clinical and cardiopulmo