Mortality In Systemic Lupus Erythematosus Research Articles

Identifying damage clusters in patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) causes irreversible damage to organ systems. Recently, evidence has been obtained for subphenotypes of SLE. This study aimed to identify damage clusters and compare the associated clinical manifestations, SLE disease activity, mortality, and genetic risk scores (GRS). The study was conducted on the Hanyang BAE lupus cohort. Patients with disease duration <5years were excluded to minimize confounding effects of disease duration. They were grouped into 3 clusters based on the Systemic Lupus International Collaborating Clinics Damage Index using k-means cluster analysis. Among the 1130 analyzed patients, musculoskeletal damage was most prevalent (20.2%), followed by ocular (11.4%), renal (10.5%), and neuropsychiatric damage (10.2%). Three significantly different damage clusters were identified. Patients in cluster 1 (n=824) showed the least damage. Cluster 2 (n=195) was characterized by frequent renal (55.4%) and ocular (58.0%) damage, and cluster 3 (n=111) was dominated by neuropsychiatric (100%) and musculoskeletal damage (35.1%). Cluster 2 had the highest adjusted mean AMS (adjusted mean SLE Disease Activity Index score; mean±SD: 5.4±2.9), while cluster 3 had the highest mortality (14.4%). Weighted GRS did not differ significantly between the clusters. Patients in prevalent renal and ocular damage cluster had the highest AMS scores, while the cluster with frequent neuropsychiatric damage had the highest mortality.

A prospective study on the prevalence of neurally mediated hypotension in systemic lupus erythematosus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease which affects skin and organ systems. Cardiovascular manifestations are one of the important cause for mortality and morbidity in SLE. Neurally mediated hypotension (NMH) caused by autonomic neuropathy is found to be associated with fibromyalgia responsible for chronic fatigue syndrome in SLE. Our study aims to find the prevalence of NMH in SLE.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective study conducted in the Department of Dermatology, Chengalpattu Medical College from May 2017 to December 2018. All SLE patients who attended the Dermatology OPD were included in the study. The diagnosis of SLE was made based on the ARA criteria. After obtaining informed consent, baseline blood pressure of all patients included in the study were recorded. In patients with low blood pressure other causes of hypotension were ruled out. Patients with no discernible cause of hypotension were subjected to the two stage tilt table test. A drop in systolic BP of &amp;gt;20 mm of Hg or diastolic BP of &amp;gt;10 mm of Hg is considered to be positive.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 20 patients were included in the study, of which 19 were female and one male. The mean age was 31.7 years. 70% of the SLE patients included in our study were found to have NMH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Neurally Mediated Hypotension was found to be highly prevalent in SLE.&lt;/p&gt;

Changing trends in mortality in systemic lupus erythematosus? An analysis of SLE inpatient mortality at University Hospital Coventry and Warwickshire NHS Trust from 2007 to 2016.

The aim of this study was to determine the causes of mortality in patients with systemic lupus erythematosus (SLE) at the University Hospital Coventry and Warwickshire (UHCW) NHS Trust over a 10year period. This was a retrospective study of patients who had died in UHCW NHS Trust between 2007 and 2016, where SLE or lupus was mentioned on the death certificate. Ethics approval was obtained from the Research and Development. We identified 22 patients out of 1979 admissions with SLE who had died during the period between 2007 and 2016, 7 of these patients were under 50years of age. The leading cause of death was infection with pneumococcus being associated with two deaths. Active disease was associated with younger age at death. Median age at death was 58.5years, with median duration of disease of 14.5years. Constitutional and mucocutaneous features were the most common items scoring on disease activity, seen in 68.2% and 45.45%, respectively. We identified three patients with biopsy proven lupus nephritis and one patient with CNS lupus. Surprisingly, none of the patients died because of vascular problems. The study suggests a changing trend in SLE mortality with none of the deaths in this cohort being due to cardiovascular or cerebrovascular disease. Infection continues to be the biggest reason for mortality in this cohort and greater emphasis is needed on vaccination for preventable infections like pneumococcus.

The Role of Neutrophils and Neutrophil Extracellular Traps in Vascular Damage in Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune syndrome of unknown etiology, characterized by multi-organ inflammation and clinical heterogeneity. SLE affects mostly women and is associated with a high risk of cardiovascular disease. As the therapeutic management of SLE improved, a pattern of early atherosclerotic disease became one of the hallmarks of late disease morbidity and mortality. Neutrophils emerged as important players in SLE pathogenesis and they are associated with increased risk of developing atherosclerotic disease and vascular damage. Enhanced neutrophil extracellular trap (NET) formation was linked to vasculopathy in both SLE and non-SLE subjects and may promote enhanced coronary plaque formation and lipoprotein dysregulation. Foundational work provided insight into the complex relationship between NETs and immune and tissue resident cells within the diseased artery. In this review, we highlight the mechanistic link between neutrophils, NETs, and atherosclerosis within the context of both SLE and non-SLE subjects. We aim to identify actionable pathways that will drive future research toward translational therapeutics, with the ultimate goal of preventing early morbidity and mortality in SLE.

One-decade study of distinct features, morbidity and mortality of systemic lupus erythematosus (an update on systemic lupus erythematosus in the Fars Province of Iran).

The objective of this article is to investigate the distinct features, morbidity and mortality of systemic lupus erythematosus (SLE) patients registered in rheumatology tertiary centers of Shiraz University of Medical Sciences from 2008 to 2018. A cross-sectional study was conducted on registered patients by reviewing their medical records. The clinical presentations were classified based on each organ's distinct involvement. Data of 1322 patients with a mean age of 40 at the time of the study were reviewed. The most common primary manifestation of the disease was arthralgia (37.5%), and the most common clinical presentation in course of the disease was skin involvement (61.8%). The most common cause of hospital admission was disease flare (27.8% (108/388)), and mortality was mainly due to pulmonary complications (27.5% (8/29)). Patients who had hypothyroidism had statistically significantly lower rates of constitutional symptoms (p = 0.006), gastrointestinal involvement (p = 0.024), hypertension (p = 0.002), headache (p = 0.019), depression (p = 0.049) and anemia (p = 0.014). Patients who presented with malar rash and photosensitivity in their course of disease were detected to have statistically significantly lower ages of disease onset (p = 0.013 and 0.003, respectively). This study is an update to an epidemiologic study conducted in 2008 in the south of Iran. By comparing results between the two studies, we have tried to investigate the change in morbidity and mortality of SLE during these years.

Patient-Reported Outcomes Predict Mortality in Lupus.

Physician-assessed disease activity and damage predict mortality in systemic lupus erythematosus (SLE). Patient-reported outcomes (PROs) are known predictors of mortality in other chronic diseases, but this relationship has not been well examined in SLE. The aim of the present study was to assess whether PROs predict mortality in SLE. Data were derived from the University of California at San Francisco Lupus Outcomes Study (n = 728). PROs (Medical Outcomes Study Short Form 36 [SF-36] subscales), self-rated health, and depression (Center for Epidemiologic Studies Depression scale [CES-D]) from 2007 (baseline data [T0]) were used to predict mortality (censored 2015). Univariate Cox regression analyses were completed for each PRO as a predictor of mortality, and multivariate Cox regression with covariates for each PRO separately. Covariates were age, sex, race/ethnicity, poverty, disease duration, disease activity (Systemic Lupus Activity Questionnaire), and damage (Brief Index of Lupus Damage). The mean ± SD age of patients was 50.6 ± 12.6 years. Ninety-two percent of patients were women and 68.5% were white. There were 71 deaths (9.1%). In univariate analyses, both the SF-36 physical component subscale score and self-rated health were associated with mortality, and the SF-36 mental health subscale and CES-D scores were not associated with mortality. In multivariate analyses, lower scores of SF-36 physical function at T0 independently predicted mortality after controlling for all other covariates (hazard ratio 0.97 [95% confidence interval 0.94-0.99]; P < 0.01). Patient-reported physical function independently predicted mortality in SLE, even after accounting for demographics (including poverty) and disease (duration, activity, and damage). Because PROs are easy to assess, they may be used to triage, track, and guide early interventions for those at high risk of mortality in SLE.

Pim-1 as a Therapeutic Target in Lupus Nephritis.

Lupus nephritis (LN) is a major determinant of morbidity and mortality in systemic lupus erythematosus (SLE). Pim-1 regulates lymphocyte proliferation and activation. The role of Pim-1 in autoimmune disease remains unclear. This study was undertaken to test the hypothesis that inhibition of Pim-1 would have therapeutic potential in patients with LN. Pim-1 expression was analyzed in lupus-prone (NZB × NZW)F1 mice (n = 6), human peripheral blood mononuclear cells (PBMCs) from SLE patients (n = 10), and glomeruli from patients with LN (n = 8). The therapeutic effect of the Pim-1 inhibitor AZD1208 was assessed in the same murine lupus model (n = 10 mice per group). In vitro analysis was conducted to explore the mechanisms of action of Pim-1 in mouse and human podocytes after Pim-1 expression had been induced by anti-double-stranded DNA (anti-dsDNA) antibody-positive serum. Finally, MRL/lpr mice were used to confirm the therapeutic effects of Pim-1 inhibition in vivo (n = 10 mice per group). Up-regulation of Pim-1 was seen in renal lysates from diseased (NZB × NZW)F1 mice and in PBMCs from patients with SLE and renal biopsy tissue from patients with LN, relative to their control counterparts (each P < 0.05). The Pim-1 inhibitor AZD1208 reduced the severity of proteinuria, glomerulonephritis, renal immune complex deposits, and serum anti-dsDNA antibody levels, concomitant with the suppression of NFATc1 expression and NLRP3 inflammasome activation, in diseased (NZB × NZW)F1 mice (each P < 0.05 versus controls). Moreover, in mouse and human podocytes, Pim-1 knockdown with targeted small interfering RNA (siRNA) suppressed NFATc1 and NLRP3 inflammasome signaling in the presence of anti-dsDNA-positive serum (each P < 0.05 versus control siRNA). Mechanistically, Pim-1 modulated NLRP3 inflammasome activation through intracellular Ca2+ (P < 0.05 versus normal controls). The therapeutic effect of Pim-1 blockade was replicated in MRL/lpr mice. These data identify Pim-1 as a critical regulator of LN pathogenesis in patients with SLE. Targeting of the Pim-1/NFATc1/NLRP3 pathway might therefore have therapeutic potential in human LN.

SUN-024 SERUM FREE LIGHT CHAIN AS SURROGATE MARKER FOR RENAL ACTIVITY IN LUPUS NEPHRITIS

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that can potentially cause inflammation and damage to any organ system. Lupus Nephritis (LN) is a major risk factor for morbidity and mortality in SLE and 10% of patients with LN will develop end-stage renal disease (ESRD). The etiology is believed to be multi-factorial with both environmental and genetic factor contributing to the development of SLE. B cell activation is central in the disease mechanism of SLE and characterized by the production of autoantibodies and during active disease, extensive polyclonal B cell hyperactivity is observed. Excess immunoglobulin (Ig) light chains are produced in proportion to Ig heavy chains during antibody synthesis in plasma cells thus free light chains (FLC) are released to circulation. In this study, we evaluated the utility of polyclonal serum FLC measurements as a clinical biomarker of LN disease activity. This is a cross sectional, prospective, convenient sampling study recruiting patients with LN attending glomerulonephritis clinic at University Malaya Medical Center (UMMC). The patients were divided into active LN, remission and healthy group. UMMC healthcare staffs were recruited for healthy cohort. Active diseases defined as pathological diagnosis on renal biopsy, increased from baseline serum creatinine or proteinuria (with concurrent increase in immunosuppression). Investigations include serum creatinine, urine protein creatinine ratio (PCR), serum complements (C3, C4), double-stranded DNA (dsDNA) antibody and serum FLC (kappa and lambda). SLEDAI 2K score was assessed at the same setting. A total of 65 subjects were analyzed in this study. Median age for our patient was 34, IQR (16.5) years old. Twenty patients were in active group, 23 patients were in remission and the rest consist of healthy group. Median SLEDAI 2K score was 8, IQR (4) and 4, IQR (6) in active and remission group respectively. The serum FLC kappa and lambda were raised in active group with the median of 34.2, IQR (43.7) mg/L, and 40.3, IQR (31.0) mg/L. In the remission group, their FLC kappa and lambda were 26.2, IQR (17.0) mg/L, and 32.7, IQR (18.5) mg/L respectively. Although numerically higher in active LN group, it was not statistically different as compare to remission group. Other clinical biomarkers, namely C3, C4, anti-dsDNA and ANA were abnormal in majority LN patients and did not differ between active and remission status. The Spearman’s correlation test showed that serum FLC kappa and lambda correlated well with SLEDAI 2K score with r = 0.586 (p < 0.001) and r = 0.689 (p < 0.001). Serum FLC (kappa and lambda) level were numerically higher in active LN as compare to remission group. Perhaps this could be a good supplementary tool to ascertain information regarding disease activity in LN patients. A more robust clinical trial is necessary if serum FLC were to be used as surrogate marker to avoid invasive renal biopsy procedure in determining active disease in LN.

Racial Disparities in Mortality Associated with Systemic Lupus Erythematosus - Fulton and DeKalb Counties, Georgia, 2002-2016.

Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune disease with often nonspecific symptoms that can lead to a delay in diagnosis. The disease disproportionately affects women and minorities. Blacks with SLE also have more severe disease and develop it at an earlier age (1). Despite an increase in the 5-year survival rate from 50% in 1955 to approximately 90% in the 2000s, attributed largely to advances in management of SLE (2), premature mortality among SLE patients persists, often as a result of disease severity, infections, and cardiovascular disease. Because existing SLE mortality estimates based on death certificate data are known to underestimate SLE deaths (3), SLE mortality was analyzed using 2002-2004 data from the population-based Georgia Lupus Registry (1). Incident and prevalent SLE cases matched to the National Death Index through 2016 identified 97 and 401 deaths, respectively. Standardized mortality ratios adjusted for age group, sex, and race were two to three times higher among persons with SLE relative to expected deaths in the general population. Blacks had significantly higher cumulative mortality than did whites, and blacks with both incident and prevalent cases were significantly younger at death (mean age 51.8 and 52.3 years, respectively) than were whites (mean age 64.4 and 65.0 years, respectively). Whites had lower mortality after diagnosis than did blacks; among incident cases, mortality among whites did not occur until 5 years after SLE diagnosis, whereas blacks had significantly and persistently higher mortality from the time of diagnosis. There were no significant differences by sex. Current CDC-supported efforts encourage early detection, diagnosis, and treatment, and enhanced self-management skills to mitigate racial disparities and improve outcomes overall among persons with SLE.

Complete renal response at 12 months after induction therapy is associated with renal relapse-free rate in lupus nephritis: a single-center, retrospective cohort study.

Lupus nephritis (LN) is a major risk factor for overall morbidity and mortality in systemic lupus erythematosus (SLE). We retrospectively analyzed cases of proliferative and membranous LN patients who underwent a renal biopsy at our hospital in 1993-2016. We analyzed the association between complete renal response (CR) rates at 12 months after induction therapy and predictive factors for CR and their association with renal flares. Of the 95 cases analyzed, we were able to track the therapeutic responses of 81 patients at 12 months after their induction therapy. The median follow-up duration after renal biopsy was 51 months (interquartile range: 16.5-154.5 months). The Cox proportional hazards model showed that, compared to not attaining CR at 12 months, the attainment of CR at 12 months was correlated with being free from renal flares. The multivariate logistic analysis revealed that the predictive factors for CR at 12 months were the anti-La/SSB antibodies (U/ml) (odds ratio (OR) 1.22, 95% confidence interval (CI) 1.01-1.63, p = 0.0220), blood urea nitrogen (BUN) (OR 0.68, 95% CI 0.44-0.90, p = 0.00048) and serum β2 microglobulin (MG) (OR 0.26, 95% CI 0.06-0.74, p = 0.00098) levels. Among LN patients, being free from renal flares was associated with attaining CR at 12 months after induction therapy. Anti-La/SSB antibodies were a positive predictive factor, and BUN and serum β2MG levels were negative predictive factors of CR at 12 months.

Factors predictive of long-term mortality in lupus nephritis: a multicenter retrospective study of a Japanese cohort.

Lupus nephritis (LN) is a major determinant of mortality in systemic lupus erythematosus (SLE). Here we evaluated the association between complete renal response (CR) and mortality in LN. We retrospectively analyzed the cases of 172 of 201 patients with LN for whom data on the therapeutic response at 6 and 12 months after induction therapy were available. The patients underwent a renal biopsy at Nagasaki University Hospital and community hospitals in Nagasaki between the years 1990 and 2016. We determined the CR rates at 6 and 12 months after induction therapy initiation and evaluated the predictive factors for CR and their relationship with mortality. We performed univariate and multivariable competing risks regression analyses to determine the factors predictive of CR. The patients' survival data were analyzed by the Kaplan-Meier method with a log-rank test. The median follow-up duration after renal biopsy was 120 months (interquartile range: 60.3-191.8 months). The 5-, 10-, 15- and 20-year survival rates of our cohort were 99.3, 94.6, 92.0 and 85.4%, respectively. During follow-up, nine patients (5.2%) died from cardiovascular events, infection, malignancy and other causes. The multivariate analysis revealed that the following factors were predictive of CR. At 6 months: male gender (odds ratio (OR) 0.23, 95% confidence interval (CI) 0.08-0.65, p = 0.0028), proteinuria (g/gCr) (OR 0.83, 95% CI 0.71-0.97, p = 0.0098) and index of activity (0-24) (OR 0.84, 95% CI 0.71-0.99, p = 0.0382). At 12 months: male gender (OR 0.25, 95% CI 0.09-0.67, p = 0.0043) and index of activity (0-24) (OR 0.82, 95% CI 0.69-0.98, p = 0.0236). The Kaplan-Meier analysis showed that compared to not achieving CR at 12 months, achieving CR at 12 months was significantly correlated with the survival rate (OR 0.18, 95% CI 0.04-0.92, p = 0.0339). Our results suggest that the survival rate of patients with LN is associated with the achievement of CR at 12 months after induction therapy, and that male gender and a higher index of activity (0-24) are the common predictive factors for failure to achieve CR at 6 and 12 months.

Remission and low disease activity state (LDAS) are protective of intermediate and long-term outcomes in SLE patients. Results from LUMINA (LXXVIII), a multiethnic, multicenter US cohort.

The objective of this report is to determine the impact of remission and low disease activity state (LDAS) on damage accrual and mortality in systemic lupus erythematosus (SLE) patients. Visits from the Lupus in Minority populations: Nature vs. Nurture (LUMINA) cohort were categorized into remission (Systemic Lupus Activity Measure (SLAM) score = 0 and prednisone ≤ 5 mg/day and no immunosuppressants), LDAS ((not on remission), SLAM score ≤ 3, prednisone ≤ 7.5 mg/day, no immunosuppressants), or neither: active. Remission and LDAS visits were combined because of the relatively small number of remission visits. Their impact on damage accrual and mortality were examined by Poisson and logistic multivariable regressions adjusting for variables known to affect these outcomes. A total of 3879 visits for 558 patients (28% Caucasian, 37% African descent, 35% Hispanic) were studied. These visits corresponded to 71 in remission, 585 in LDAS, and 3223 active. The longer the percentage of time the patients were in remission/LDAS, the less damage accrual observed (rate ratio 0.1773 (95% confidence interval (CI) 0.1216 to 0.2584) p < 0.0001). A trend was observed in terms of mortality although statistical significance was not reached (odds ratio 0.303 (95% CI 0.063 to 1.456), p = 0.1360). The longer the patient's state on Remission/LDAS, the less damage accrual that occurs. The protective effect on mortality was not statistically significant.

Mortality in systemic lupus erythematosus at a teaching hospital in India: A 5-year retrospective study.

Objective:Systemic lupus erythematosus (SLE) is an autoimmune disease with an unknown etiology that can be life threatening. This study aimed to study the cause of mortality among admitted SLE patients over a period of 5 years at a teaching hospital in India.Methods:A 5-year retrospective analysis of mortality in SLE patients admitted under department of medicine of our institute was done. The presenting complaints, treatment history, clinical parameters, laboratory investigations, organ involvement, systemic lupus erythematosus disease activity index (SLEDAI), and cause of mortality were collected from the medical records on a predesigned proforma. A further analysis of two groups based on the cause of mortality was done.Results:In total, 53 death records were analyzed. Mortality in 28 SLE patients was due to high disease activity (Group I) and mortality in 25 patients was attributed due to both high disease activity and concomitant infection (Group II). Most of the patients were female (98%) and mean age of patient was 30.6 years. About 19 patients (35.8%) were diagnosed with SLE during hospital admission. Fever was the most common presenting complaint (69.8%) and lupus nephritis was the most common organ dysfunction seen (84.9%). Myocarditis was observed in 11 patients and 9 patients had cerebrovascular accident. The mean hemoglobin was lower in Group II (7.4 vs. 8.7 g/dL, P = 0.02). The median total leukocyte count was significantly higher in Group II (10,200 vs. 6600, P = 0.02). The mean serum urea and creatinine levels were also significantly higher in Group II (141.41 vs. 87.8 mg/dL, P = 0.006 and 4.7 vs. 1.7, P = 0.0001), respectively. The mean SLEDAI in Group I was 20.8 ± 8.9 and in Group II was17.7 ± 7.5. Bacterial pneumonia (17) was the most common infection, followed by tuberculosis (2) and fungal infection (2).Conclusion:Mortality among SLE patients could be due to disease flare or concomitant infection. Lung is the most common organ affected by infection in these patients.

Cardiac manifestations of Han Chinese patients with systemic lupus erythematosus: a retrospective study

ObjectiveTo investigate cardiac manifestations and the risk factors in Han Chinese patients with systemic lupus erythematosus (SLE).MethodsSeven hundred fifty SLE patients who were hospitalized at our department were recruited in the present study. The patients were divided into two groups—those with or without cardiac manifestations. Cardiac manifestations in those SLE patients, such as pericarditis, myocarditis, heart valve disease, arrhythmia, were analyzed. The risk and protective factors of cardiac diseases in patients with SLE, as well as the predictors of mortality, were assessed, respectively.ResultsIn all 750 SLE patients, there were 339 (45.20%) patients suffered from one or more cardiac manifestations, involving pericarditis in 9.5%, myocarditis in 5.7%, heart valve disease in 15.6%, arrhythmia in 16.67%, and cardiovascular diseases (CVD) in 14%. 15.7% of SLE patients were accompanied with pulmonary arterial hypertension (PAH), of which 13.7% were mild, 1.2% were moderate, and 0.8% were severe. No significant differences were found between the two groups in age, disease duration, gender, antibody, and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). The incidence of pericarditis, heart valve disease, arrhythmia, and PAH was positively correlated with age. The incidence of arrhythmia, CVD, and PAH was correlated with SLEDAI. PAH and myocarditis were the risk factors of mortality in SLE patients with disease duration ≤ 10 years (P = 0.034 and 0.001, respectively).ConclusionCardiac involvement is common in Han Chinese SLE patients and associated with age and disease activity. PAH and myocarditis are the risk factors of mortality in SLE.

Influence of +299G>A and +62G˃A resistin gene promoter variants on cardiovascular risk in Egyptian women with systemic lupus erythematosus

BackgroundCardiovascular diseases (CVDs) are major causes of morbidity and mortality in systemic lupus erythematosus (SLE) patients. Resistin is an inflammatory adipocytokine associated with insulin resistance and an increased risk of CVD. Aim of the workTo study the possible role of resistin (RETN) +299A>G and +62G˃A gene polymorphisms in the development of CVDs among Egyptian SLE patients and their impact on cardio metabolic risk and disease activity. Patients and methods+299A>G and +62G˃A genes polymorphisms were assessed in 140 patients and 100 controls by polymerase chain reaction (PCR). The carotid intima-media thickness (CIMT) was measured. SLE disease activity index (SLEDAI) was assessed. Serum resistin, homeostasis model assessments (HOMA-IR and HOMA-β), fibrinogen and homocysteine were measured. ResultsThe mean age of patients was 31.1 ± 7.6 years and disease duration 5.4 ± 2.5 years. Serum resistin was significantly increased in patients (4.9 ± 0.2 ng/ml) compared to control (3.02 ± 0.9 ng/ml) (p < 0.001). Serum resistin significantly correlated with uric acid (p < 0.001), homocysteine (p < 0.001), fibrinogen (<0.001) and SLEDAI (p < 0.001). AA genotypes and A allele +299G>A were significantly higher in patients than control (37.9% vs 10% and 63.6% vs 33.5%; p < 0.001). Serum resistin, CIMT, uric acid, fibrinogen and homocysteine was significantly higher in +299G>A GA and AA patients compared to GG (p < 0.001) and HOMA-β decreased (p < 0.001). HOMA-β, fibrinogen and uric acid were independently correlated with resistin (p < 0.001). ConclusionResistin +299G/A gene polymorphisms especially the AA genotype and A allele may play an important role in pathogenesis and activity of SLE as well as susceptibility to develop CVD in Egyptian population.

Plasma cytokines as potential biomarkers of kidney damage in patients with systemic lupus erythematosus.

Systemic lupus erythematosus is a heterogeneous chronic inflammatory autoimmune disorder characterized by an exacerbated expression of cytokines and chemokines in different tissues and organs. Renal involvement is a significant contributor to the morbidity and mortality of systemic lupus erythematosus, and its diagnosis is based on renal biopsy, an invasive procedure with a high risk of complications. Therefore, the development of alternative, non-invasive diagnostic tests for kidney disease in patients with systemic lupus erythematosus is a priority. To evaluate the plasma levels of a panel of cytokines and chemokines using multiplex xMAP technology in a cohort of Colombian patients with active and inactive systemic lupus erythematosus, and to evaluate their potential as biomarkers of renal involvement. Plasma from 40 systemic lupus erythematosus non-nephritis patients and 80 lupus nephritis patients with different levels of renal involvement were analyzed for 39 cytokines using Luminex xMAP technology. Lupus nephritis patients had significantly increased plasma eotaxin, TNF-α, interleukin-17-α, interleukin-10, and interleukin-15 as compared to the systemic lupus erythematosus non-nephritis group. Macrophage-derived chemokine, growth regulated oncogene alpha, and epidermal growth factor were significantly elevated in systemic lupus erythematosus non-nephritis patients when compared to lupus nephritis individuals. Plasma eotaxin levels allowed a discrimination between systemic lupus erythematosus non-nephritis and lupus nephritis patients, for which we performed a receiver operating characteristic curve to confirm. We observed a correlation of eotaxin levels with active nephritis (Systemic Lupus Erythematosus Disease Activity Index). Our data indicate that circulating cytokines and chemokines could be considered good predictors of renal involvement in individuals with systemic lupus erythematosus.

Acute Myocardial Infarction Outcomes in Systemic Lupus Erythematosus (from the Nationwide Inpatient Sample)

One of the major causes of mortality in systemic lupus erythematosus (SLE) is acute myocardial infarction. Whether in-hospital outcomes and management of ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) are different in SLE patients compared with those without SLE from large, recent dataset is unclear. We queried the Nationwide Inpatient Database from 2005 to 2014 and identified STEMI and NSTEMI admissions with and without SLE. The primary outcome was in-hospital mortality. Secondary outcomes were revascularization strategy (percutaneous coronary intervention, coronary artery bypass surgery, or thrombolytics), medical therapy rates (no reperfusion), and major adverse clinical events. A propensity-matched cohort was created to compare these outcomes. Odds ratio (OR) was calculated from the propensity-matched cohort. A total of 321,048 STEMI admissions, of which 1,001 (0.31%) and 572,971 NSTEMI admissions, of which 2,134 (0.37%) were SLE, were identified. In those with STEMI, 882 SLE and non-SLE admissions were propensity-matched. In-hospital mortality (9.1% vs 11.8%, OR 0.75, p = 0.07), revascularization strategy, medical therapy rates, and major adverse events were similar. Similarly, in those with NSTEMI, 1,770 SLE and 1,775 non-SLE were matched. In-hospital mortality (4.1% vs 4.50%, OR 0.90, p = 0.51), coronary artery bypass surgery, medical therapy rates, and major adverse events were mostly similar but the rate of percutaneous coronary intervention was higher in SLE (32.9% vs 29.6%, OR 1.16, p = 0.04). For both STEMI and NSTEMI, hospital cost and length of stay were similar between SLE and non-SLE cohorts. From a large administrative database in the United States, revascularization strategies and in-hospital outcomes of acute coronary syndrome were mostly similar between SLE and non-SLE.

Improvement of survival rates in the last decade in Thai childhood-onset systemic lupus erythematosus

BackgroundMorbidity and mortality in childhood onset systemic lupus erythematosus (SLE) is more severe than adult onset SLE. Long-term follow up is needed to determine the prognosis. The objectives of this study are to describe the mortality of childhood SLE in a single tertiary care centre over three decades, compare trends in survival over time, and determine predictors for survival.MethodsWe retrospectively reviewed the medical records of children aged < 18 years who were diagnosed with SLE at the Department of Pediatrics, Songklanagarind Hospital, Thailand, from 1985 to 2016.ResultsThere were 331 children (272 girls, 59 boys) with a mean age at presentation of 11.5 ± 2.6 years. The mean follow-up duration was 7.0 ± 5.0 (range 1–28) years, 77 children (23.3%) died, 28.6% within the first year after diagnosis.The overall mortality rate was 3.3 per 100 person-years. Survival rates at 1, 5 and 10 years were 93.4%, 83.1% and 72.6%, respectively. Ten-year survival rates for the children diagnosed in the decades 1985–1996, 1997–2006 and 2007–2016 were 67.4%, 63.4% and 82.8%, respectively (p < 0.001).Boys had worse survival than girls (hazard ratio = 2.3, 95% CI: 1.4–3.7) even after adjusting for decade of diagnosis. Lupus nephritis (LN) class IV had similar survival compared to LN classes II/III/V combined (hazard ratio = 1.0, 95% CI: 0.6–1.7).ConclusionIn our setting, the survival rate of childhood onset SLE has improved during the past 10 years, but mortality is still high compared to developed countries, particularly in boys.

Lupus and vaccinations.

To review the latest data in the field of vaccinations in systemic lupus erythematosus (SLE), focusing on pneumococcal, seasonal influenza, herpes zoster and human papillomavirus infections. Less than 40% of patients responded adequately to the 23-valent pneumococcal polysaccharide (PPS23) vaccine. A randomized controlled trial showed that sequential administration of the pneumococcal conjugate vaccine followed by the PPS23 vaccine was well tolerated but was not superior to the PPS23 vaccine alone in terms of immunogenicity. A real-life observation confirmed that annual influenza vaccination has an impact on morbidity and mortality in SLE. Three meta-analyses did not show any particular adverse effect of influenza vaccines in SLE. These vaccines are less immunogenic in SLE. A study confirmed that the quadrivalent human papillomavirus vaccine was well tolerated and highly immunogenic in SLE. New data confirm the safety and the lower immunogenicity of pneumococcal and influenza vaccine in SLE patients. Current efforts to improve immunization coverage in SLE should focus on spreading to patients and physicians information on the safety, efficacy and usefulness of vaccines in this population.

P5425Increased mortality in systemic lupus erythematosus affected patients with myocardial infarction: a nationwide study using National Inpatient Sample (NIS) of 1999-2014

P5425Increased mortality in systemic lupus erythematosus affected patients with myocardial infarction: a nationwide study using National Inpatient Sample (NIS) of 1999-2014