non-SLE Group Research Articles

Cardiovascular profile of systemic lupus erythematosus patients hospitalized for COVID-19 in Spain: Analysis of the SEMI-COVID-19 Registry.

Despite advancements in understanding the interplay between systemic lupus erythematosus (SLE), cardiovascular disease and COVID-19, challenges and knowledge gaps persist. This study aimed to characterize the cardiovascular profiles of SLE patients hospitalized with COVID-19 and to evaluate the influence of SLE on the development of cardiovascular complications. This was a multicentre, nationwide observational study in which data were sourced from the SEMI-COVID-19 Registry between March 1, 2020, and March 31, 2021, involving 150 Spanish hospitals. SLE patients were matched with non-SLE patients based on sex, age, and hospitalization date. Of the 20,970 patients included in the SEMI-COVID-19 Registry, 38 were previously diagnosed with SLE. The non-SLE group was composed of 103 patients. The mean age of the SLE patients was 63 years, with 81.6% females and 21.1% non-European patients. SLE patients exhibited a significantly higher frequency of chronic kidney disease (14.4% vs 2.9%; p=0.004), stroke (23.7% vs 2.9%; p<0.001), and increased use of cardiovascular medications. SLE demonstrated an independent association with the occurrence of major cardiovascular events (MACE) (OR: 3.934; 95% CI: 1.247-12.432). SLE patients hospitalized for COVID-19 are at high risk of having an unfavorable baseline cardiovascular profile and are more prone to MACEs and adverse noncardiovascular outcomes during hospitalization.

Adverse Pregnancy Outcomes in Patients With Systemic Lupus Erythematosus: A Retrospective Cohort Study

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease that may result in adverse pregnancy outcomes, posing a significant risk to both the mother and the fetus. The major purpose of the current study was to investigate the impact of SLE on the outcomes of pregnancy among women with SLE. This was a retrospective cohort study. Two groups of pregnant women, one with Systemic Lupus Erythematosus (SLE) and one without SLE, were included at the Gynecology and Obstetrics Clinic of Ayatollah Mousavi Hospital in Zanjan, Iran, from 2019 to 2020. Participants from both cohorts completed a checklist of study variables based on their medical records. The data were analyzed using binary logistic regression, chi-square test, analysis of variance, and independent samples t-test with SPSS software version 23. The research involved 400 pregnant women, with the mean age of the SLE and non-SLE groups being 36.68±4.90 and 29.46±6.56 years, respectively. The most prevalent adverse outcome was cesarean section (271 [67.8%]), significantly higher in the SLE group (54.5% vs. 10.0%, P=0.0001). The likelihood of experiencing spontaneous abortion, preterm labor, cesarean section, and LBW was increased by more than 6.5 times (odds ratio, 6.54; 95% CI, 2.22-19.27; P=0.001), 3.6 times (odds ratio, 3.67; 95% CI, 1.47-9.18; P=0.005), 18.9 times (odds ratio, 18.94; 95% CI, 6.46-55.49; P=0.0001), and 3 times (odds ratio, 3.04; 95% CI, 1.09-8.46; P=0.030) in individuals with SLE, respectively. Women with SLE have an increased likelihood of encountering spontaneous abortion, preterm labor, cesarean section, and delivering a low-birth-weight infant.

Phosphatidylserine-Dependent Anti-prothrombin Antibodies as a Key Predictor for Systemic Lupus Erythematosus in Patients with Primary Antiphospholipid Syndrome: A retrospective longitudinal cohort study.

Primary antiphospholipid syndrome (PAPS) is an autoimmune disorder characterized by thrombosis and pregnancy morbidity. Although PAPS is distinct from systemic lupus erythematosus (SLE), the two conditions share clinical features and susceptibility genes. Progression from PAPS to SLE is well-recognized. However, risk factors for this transition are poorly understood. We aimed to identify predictors of progression to SLE in patients with PAPS. A longitudinal single-center study was conducted at Hokkaido University Hospital from 1990 to 2021. Baseline characteristics including clinical features, laboratory data, aPL profiles were compared between patients who progressed to SLE (SLE group) and those who did not (non-SLE group). Among 64 patients diagnosed with PAPS at baseline, nine (13.8%) progressed to SLE over a mean follow-up of 9 years (incidence rate, 1.61 per 100 person-years). At the diagnosis of PAPS, the SLE group had a higher prevalence of anti-phosphatidylserine/prothrombin antibodies (aPS/PT) and anti-dsDNA antibodies compared to the non-SLE group. Other clinical findings, autoantibody profiles, and serum complement levels were similar between the two groups. Multivariate Cox analysis showed that IgG aPS/PT was significantly associated with SLE development (Hazard ratio: 10.3, 95% CI: 1.13-92.6, p=0.04). IgG aPS/PT may be a predictive factor for new-onset SLE in patients with PAPS, suggesting its utility in guiding risk stratification and monitoring strategies for these patients.

Role of second look endoscopy in endoscopic submucosal dissection and peptic ulcer bleeding: Meta-analysis of randomized controlled trials.

Second-look endoscopy (SLE) to prevent recurrent bleeding in patients with peptic ulcer disease (PUD) and those undergoing endoscopic submucosal dissection (ESD) is routinely being performed. Conflicting evidence exists regarding efficacy, risk, benefit, and cost-effectiveness. To identify the role and effectiveness of SLE in ESD and PUD, associated rebleeding and PUD-related outcomes like mortality, hospital length of stay, need for endoscopic or surgical intervention and blood transfusions. A systematic review of literature databases PubMed, Cochrane, and Embase was conducted from inception to January 5, 2023. Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included. The study was conducted per PRISMA guidelines, and the protocol was registered in PROSPERO (ID CRD42023427555:). RevMan was used to perform meta-analysis, and Mantel-Haenszel Odds ratio (OR) were generated using random effect models. A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis, of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding. In ESD, the rates of rebleeding were 7% in the SLE group compared to 4.4% in the non-SLE group with OR 1.65, 95% confidence intervals (CI) of 0.96 to 2.85; P = 0.07, whereas it was 11% in the SLE group compared to 13% in the non-SLE group with OR 0.8 95%CI: 0.50 to 1.29; P = 0.36. The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01, 95%CI: -0.22 to 0.25; P = 0.91. In SLE vs non-SLE groups with PUD, the OR for Endoscopic intervention was 0.29, 95%CI: 0.08 to 1.00; P = 0.05 while it was OR 2.03, 95%CI: 0.95 to 4.33; P = 0.07, for surgical intervention. The mean difference in the hospital length of stay was -3.57 d between the SLE and no SLE groups in PUD with 95%CI: -7.84 to 0.69; P = 0.10, denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE. For mortality between SLE and non-SLE groups in PUD, the OR was 0.88, 95%CI: 0.45 to 1.72; P = 0.70. SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding. SLE also does not provide any significant improvement in mortality, need for interventions, or blood transfusions in PUD patients. SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.

Risk of new-onset glaucoma in patients with systemic lupus erythematosus: A nationwide, population-based cohort study.

To explore the relationship of systemic lupus erythematosus (SLE) and subsequent glaucoma incidence. Patients with SLE were defined as those newly diagnosed by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 710.0 in at least 3 outpatient visits or 1 hospitalization during 2000-2012 by using the National Health Insurance Research Database. We selected a non-SLE comparison cohort at a 1:1 ratio by propensity score matching on age, gender, index date, comorbidities and medications. We identified outcome as the incident glaucoma in patients with SLE. Multivariate Cox regression analysis was used to calculate the adjusted hazard ratio (aHR) in 2 groups. Kaplan- Meier analysis was performed to estimate the cumulative incidence rate between both groups. There were 1743 patients who were included in the SLE group and non-SLE group. The aHR of glaucoma was 1.56 (95% CI = 1.03-2.36) in the SLE group, compared to non-SLE controls. Subgroup analysis showed that SLE patients present greater risk of glaucoma, especially in males (aHR = 3.76; 95% CI, 1.5-9.42), and the P for interaction between gender and risk of glaucoma was 0.026. This cohort study showed that patients with SLE have 1.56-fold risk of glaucoma development. Gender acted as an effect modifier between SLE and the risk of new-onset glaucoma.

Nationwide analysis of adult hospitalizations with hemophagocytic lymphohistiocytosis and systemic lupus erythematosus.

Hemophagocytic lymphohistiocytosis (HLH) is a well-recognized complication of systemic lupus erythematosus (SLE). This study aims to characterize HLH with and without SLE in the US adult inpatient population. We performed a retrospective study of HLH with and without SLE from the 2016-2019 National Inpatient Sample (NIS) database. We described the demographic characteristics of HLH with and without SLE. Multivariable analysis was performed to calculate odds ratios (OR) for in-hospital death. A total of 8690 hospitalizations had HLH. Of those 605 (7%) had SLE, and 8085 (93%) did not have SLE. Relative to the non-SLE group, the SLE group was younger, had more females, less whites, more African Americans, more Hispanics, and more Asian/Pacific Islanders. Over 60% of HLH with or without SLE had a concurrent infection. Sixty (9.9%) of HLH hospitalizations with SLE died compared to 1735 (21.5%) of those without SLE. Among HLH hospitalizations, multivariable analysis showed that age (OR 1.02; 95% C.I. 1.016-1.031), Charlson Comorbidity Index (OR 1.15; 95% C.I. 1.091-1.213), infections (OR 3.35; 95% C.I. 2.467-4.557), and leukemia/lymphoma (OR 1.46; 95% C.I. 1.112-1.905) had higher odds of in-hospital death. SLE did not increase the odds of death. Inpatients with both HLH and SLE were younger, had a higher proportion of racial/ethnic minorities, and were predominately female. One out of every 10 hospitalizations for HLH ended in death but SLE itself was not an independent risk factor for death. Concurrent infection was the variable most associated with HLH death. Key Points • HLH and SLE group were younger and had higher proportions of female and racial/ethnic minorities. • SLE was not an independent risk factor for death in HLH patients.

Association of preterm outcome with maternal systemic lupus erythematosus: a retrospective cohort study

BackgroundMaternal systemic lupus erythematosus (SLE) is at greater risk of pregnancy complications and is associated with increased risk of preterm delivery. However hardly any study has looked at the influence of SLE on the outcomes of preterm infants. This study aimed to explore the influence of SLE on the outcomes of preterm infants.MethodsIn this retrospective cohort study, preterm infants born to mothers with SLE from Shanghai Children’s Medical Center during 2012 to 2021 were enrolled. Infants were excluded if they were died during hospitalization or has major congenital anomalies and neonatal lupus. Exposure was defined as mother diagnosed SLE before or during pregnancy. Maternal SLE group was matched with Non-SLE group by gestational age, birth weight and gender. Clinical data has been extracted from patients’ records and registered. Major morbidities of premature and biochemical parameters in the two groups were compared using multiple logistic regression.ResultsOne hundred preterm infants born to 95 mothers with SLE were finally enrolled. The mean (standard deviation) of gestational age and birth weight were 33.09 (7.28) weeks and 1768.50 (423.56) g respectively. There was no significant difference in major morbidities between SLE group and non-SLE group. Compared with non-SLE group, SLE off-spring had significantly lower leukocytes, neutrophiles after birth, neutrophils and platlet in one week (mean difference: -2.825, -2.001, -0.842, -45.469, respectively). Among SLE group, lower birth weight and smaller gestational age were observed in SLE mothers with disease active during pregnancy, kidney involved, blood system involved and not taking Aspirin during pregnancy. In the multivariable logistic regression analysis, exposure to aspirin during pregnancy reduced the risk of very preterm birth and increased the incidence of survive without major morbidities among preterm infants born to SLE mothers.ConclusionBorn to mothers with SLE may not increase the risk of major premature morbidities, but the hematologic profile of SLE preterm infants may be different from preterm infants born to women without SLE. The outcome of SLE preterm infants is associated with maternal SLE status and may benefit from maternal aspirin administration.

Co-occurrence of familial Mediterranean fever with systemic lupus erythematosus in South Asian population

Background and objectiveFamilial Mediterranean fever (FMF) and systemic lupus erythematosus (SLE) are autosomal recessive auto-inflammatory diseases, triggered by FMF-associated gene mutations and auto-antigens. The literature on the co-occurrence of these two disorders is limited to case reports and their correlation is considered rare. We investigated the proportion of FMF among SLE patients when compared with a healthy adult cohort in South Asia. MethodsFor this observational study, data from our institutional database were collected for the patients diagnosed with SLE. The control group was randomly selected from the database and were age- matched for SLE. The overall proportion of FMF among patients with and without SLE was considered. Student's t-test, Chi-square, and ANOVA were used for univariate analysis. ResultsThe study population included 3623 SLE patients and 14,492 controls. In the SLE group, there was a significantly higher proportion of FMF patients compared with the non-SLE group (1.29% vs. 0.79% respectively; p=0.015). SLE was prevalent in Pashtun's (50%) in the middle socioeconomic group while FMF was dominant in Punjabi's and Sindhi's (53%) in the low socioeconomic class. ConclusionThis investigation demonstrates that FMF is more prevalent in a South-Asian population cohort of SLE patients.

Increased risk of type 2 diabetes in patients with systemic lupus erythematosus: A nationwide cohort study in Taiwan

Data on the risk of developing diabetes in patients with systemic lupus erythematosus (SLE) are limited and have yielded mixed results. We conducted a nationwide cohort study to investigate the risk of subsequent type 2 diabetes in patients with SLE compared with matched non-SLE controls. Data were collected from the Taiwan National Health Insurance Research Database. Adult patients newly diagnosed with SLE between 2003 to 2010 were identified as the study cohort. The non-SLE group was matched for age, gender, and date of initial diagnosis as the comparison cohort. A total of 6159 SLE patients (87.90% female, mean age 38.79 years) were identified during this period. Of these, 206 (3.34%) developed type 2 diabetes. The 3-year incidence of type 2 diabetes was significantly higher in the SLE cohort than in the control group (130.26 vs 101.18 cases per 10,000 person-years), with an adjusted hazard ratio of 1.22 (95% confidence interval [CI] 1.04-1.44), after adjusting for age, gender, underlying comorbidities, and monthly income. Stratified analyses showed that women with SLE and low-income SLE patients (monthly income < 20,000 New Taiwan Dollar) had a higher risk of type 2 diabetes than non-SLE controls, with adjusted hazard ratios of 1.21 (95% CI 1.01-1.45) and 1.36 (95% CI 1.10-1.69), respectively. Patients with newly diagnosed SLE had a 22% increased risk of developing type 2 diabetes during the 3-year follow-up period compared with matched controls.

Breastfeeding Initiation, Duration, and Associated Factors in Mothers with Systemic Lupus Erythematosus.

<b><i>Objective:</i></b> To study breastfeeding initiation, duration, and associated factors in patients with systemic lupus erythematosus (SLE), a cross-sectional study comparing with SLE and non-SLE mothers was conducted. <b><i>Methods:</i></b> Thirty patients with SLE who had pregnancy outcomes from September 2018 to December 2020 and 120 non-SLE patients (excluding mothers with other immune system diseases) were included in the study. Data on sociodemographic, obstetric, and SLE clinical information were collected. Breastfeeding initiation, breastfeeding duration, and reasons for not initiating breastfeeding were investigated via telephone. <b><i>Results:</i></b> The rate in breastfeeding of SLE group was significantly lower than non-SLE group (36.7% versus 86.7%, respectively, <i>p</i> &lt; 0.001; odds ratio 0.059; 95% confidence interval 0.015-0.241). Non-SLE mothers had a longer duration of breastfeeding than mothers with SLE (log-rank <i>p</i> = 0.001). Fearing of the adverse effects of drugs on babies is the main reason (68.4%) for not initiating breastfeeding in SLE group. Infants with high weight and Apgar scores, primipara women, and having a college degree were significantly associated with breastfeeding among patients with SLE. <b><i>Conclusion:</i></b> SLE women showed a lower breastfeeding rate and shorter breastfeeding duration. Postpartum medications are safe for lactation in most patients with SLE. Targeted intervention programs that enhance breastfeeding consultations are required for this group.

Complete omission of second-look endoscopy after gastric endoscopic submucosal dissection in real-world practice.

Gastric endoscopic submucosal dissection (ESD) is increasingly performed in patients receiving antithrombotic therapy. Second-look endoscopy (SLE) has been performed empirically in several clinical settings. We investigated whether SLE omission was associated with an increased risk of postESD bleeding in all patients, including those administered antithrombotic agents. Between July 2016 and June 2018, 229 patients were treated with a clinical pathway for gastric ESD that involved SLE on the day after ESD (SLE group). Between September 2018 and May 2020, 215 patients were treated using a clinical pathway that did not include SLE (nonSLE group). We retrospectively compared the incidence of postESD bleeding among the propensity score-matched cohorts and determined the risk factors for postESD bleeding using multivariate analysis. The propensity score-matched cohorts showed no significant differences in the incidence of postESD bleeding between the SLE (3.2%) and nonSLE (5.1%) groups. Multivariate analysis revealed that the presence of lesions in the lower gastric body (adjusted odds ratio [OR] 2.17, 95% confidence interval [CI] 1.06-4.35, P.03) was a significant risk factor for postESD bleeding during admission, whereas resected specimen size ≥ 40 mm (adjusted OR 3.21, 95% CI 1.19-8.19, P.02) and antiplatelet therapy (adjusted OR 4.16, 95% CI 1.47-11.80, P.007) were significant risk factors after discharge. Complete omission of SLE after gastric ESD does not increase postESD bleeding in clinical practice.

Effectiveness of second-look endoscopy after gastric endoscopic submucosal dissection in patients taking antithrombotic agents: a multicenter propensity score matching analysis.

The risk of bleeding after gastric endoscopic submucosal dissection (ESD) in antithrombotic agent users has increased, and its management remains a problem. Second-look endoscopy (SLE) following gastric ESD in antithrombotic agent users may be effective in preventing delayed bleeding, but this requires elucidation. Therefore, this study aimed to investigate the efficacy of SLE in reducing bleeding after gastric ESD in patients receiving antithrombotic agents. This retrospective cohort study was conducted at 19 referral hospitals in Japan. A total of 1,245 patients who were receiving antithrombotic agents underwent gastric ESD between January 2013 and July 2018. The incidence of delayed bleeding was compared between SLE and non-SLE groups using propensity score matching analysis. Overall, 858 patients (SLE group, 657 patients; non-SLE group, 201 patients) were analyzed. After matching, 198 pairs were created. Delayed bleeding occurred in 10 patients (5.1%) in the SLE group and 16 patients (8.1%) in the non-SLE group [odds ratio (OR) 0.605, 95% confidence interval (CI) 0.23-1.46, p = 0.310]. In the subgroup analysis, SLE reduced the incidence of delayed bleeding in patients receiving heparin bridging therapy (6.3% and 40.0%, respectively; p = 0.004). In the SLE group, prophylactic coagulation did not significantly reduce delayed bleeding compared to the no treatment group (14.6% and 8.6%, respectively; p = 0.140). SLE was ineffective in reducing bleeding after gastric ESD in antithrombotic agent users, overall. A prospective comparative study is warranted to definitively evaluate the effectiveness of SLE in reducing bleeding in high-risk patients.

OA18 The sex-specific outcomes of acute stroke in patients with comorbid Systemic Lupus Erythematosus - National Inpatient Sample Study

Abstract Background/Aims Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease with variable presentation and clinical manifestations. Previous research has established the higher risk of incident cardiovascular disease and stroke in SLE patients. However, the evidence on how stroke outcomes differ between SLE and non-SLE patient groups in contemporary practice is limited. Furthermore, given that SLE tends to affect predominantly females, with a female-to-male ratio of 9:1, the question remains if and to what extent stroke outcomes might differ between males and females with SLE. Thus, we aimed to explore sex-specific acute stroke outcomes amongst patients with comorbid SLE. Methods A total of 316,531 records representing 1,581,430 acute stroke hospitalisations between 2015 and 2018 from the United States National Inpatient Sample (NIS) were analysed. The primary exposure of interest was comorbid SLE. Patients were grouped according to SLE status and sex (no SLE-reference, male with SLE, female with SLE). Outcome measures of interest (in-patient mortality, length-of-stay in hospital [LoS] and routine home discharge) were examined utilising multivariable logistic regressions, adjusting for age, ethnicity, stroke type, receipt of revascularisation therapies, region, hospital status and 49 comorbidities including major cardiovascular disease. Results The median (interquartile range) age was 71 (60-82) years. There were 940 (0.06%) males and 6110 (0.39%) females with SLE. After adjustments, female patients with SLE had 21% increased odds of dying in hospital, adjusted odds ratios (aOR) = 1.21, 95% CI (0.92 - 1.61), whereas the risk of in-patient mortality for male patients with SLE was 24% lower compared to the reference group, aOR = 0.76 (0.32 - 1.81). However, none of the differences in the in-patient mortality were of statistical significance. Secondly, compared to patients without SLE, females with SLE had significantly longer hospitalisation, aOR=1.20 (1.06 - 1.36), while there was no significant difference for males with SLE, aOR=1.06 (0.75 - 1.49). The odds of being routinely discharged were 28% lower for females with SLE, aOR=0.72, (0.63 - 0.82), in comparison to a non-significant increase in the odds of 18% for males with SLE, aOR=1.18, (0.84 - 1.65). Conclusion Our results highlight the sex differences in acute stroke outcomes in patients with SLE. Due to a small sample size of males with SLE, our findings need to be cautiously interpreted. Further understanding of the influence of SLE amongst male patients with acute stroke is needed. Disclosure S. Jesenakova: None. T.A. Pana: None. B. Carter: None. M.O. Mohamed: None. M.A. Mamas: None. P.K. Myint: None.

Outcome of total hip arthroplasty for avascular necrosis of femoral head in systemic lupus erythematosus patients: A comparative study

BackgroundAvascular necrosis (AVN) is a major cause of disability in systemic lupus erythematosus (SLE) patients which directly affects the functionality and quality of life. Total hip arthroplasty (THA) is indicated for severe cases with major disability and severe pain. It is still debatable if SLE is an independent risk factor for poor outcome in THA or not. Aim of the workTo evaluate the result of THA for AVN of the femur head in SLE patients. Patients and methods22 THAs were performed in 20 SLE patients and were compared with the results of 25 hips of 22 patients who had THA due to AVN with non-SLE conditions. All patients were followed up after the surgery at 6 weeks, 3, 6 and 12 months post-operatively, and then yearly for functional and radiological outcomes. ResultsThe Harris hip score (HHS) increased from a preoperative average of 26 points to 93.52 at the most recent follow-up. In the control group, the mean HHS was 26 preoperatively and 95.52 postoperatively at the last follow-up. Visual analog scale for pain (VAS pain) decreased from 8 in SLE and 6 in the non-SLE group to 2 and 1 respectively. No significant difference was found between SLE patients and non-SLE patients regarding complications except for more chest infections in the SLE group. No mortality was recorded in both groups in the postoperative follow-up period of a mean of thirty months. ConclusionTHA outcome is as favorable in AVN patients with SLE as in non-SLE.

Incidence of Kidney Replacement Therapy and Subsequent Outcomes Among Patients With Systemic Lupus Erythematosus: Findings From the ERA Registry

There is a dearth of data characterizing patients receiving kidney replacement therapy (KRT) for kidney failure due to systemic lupus erythematosus (SLE) and their clinical outcomes. The aim of this study was to describe trends in incidence and prevalence of KRT among these patients as well as to compare their outcomes versus those of patients treated with KRT for diseases other than SLE. Retrospective cohort study based on kidney registry data. Patients recorded in 14 registries of patients receiving KRT that provided data to the European Renal Association Registry between 1992 and2016. SLE as cause of kidney failure. Incidence and prevalence of KRT, patient survival while receiving KRT, patient and graft survival after kidney transplant, and specific causes of death. Kaplan-Meier methods and Cox regression models were fit to compare patient survival between the SLE and non-SLE groups, overall KRT, dialysis, and patient and graft survival after kidney transplant. In total, 1,826 patients commenced KRT for kidney failure due to SLE, representing an incidence of 0.80 per million population (pmp) per year. The incidence remained stable during the study period (annual percent change, 0.1% [95% CI,-0.6% to 0.8%]). Patient survival among patients with SLE receiving KRT was similar to survival in the comparator group (hazard ratio [HR], 1.11 [95% CI, 0.99-1.23]). After kidney transplant, the risk of death was greater among patients with SLE than among patients in the comparator group (HR, 1.25 [95% CI, 1.02-1.53]), whereas the risk of all-cause graft failure was similar (HR, 1.09 [95% CI, 0.95-1.27]). Ten-year patient overall survival during KRT and patient and graft survival after kidney transplant improved over the study period (HRs of 0.71 [95% CI, 0.56-0.91], 0.43 [95% CI, 0.27-0.69], and 0.60 [95% CI, 0.43-0.84], respectively). Patients with SLE receiving KRT were significantly more likely to die of infections (24.8%) than patients in the comparator group (16.9%; P< 0.001). No data were available on extrarenal manifestations of SLE, drug treatments, comorbidities, kidney transplant characteristics, or relapses of SLE. The prognosis of patients with SLE receiving KRT has improved over time. Survival of patients with SLE who required KRT was similar compared with patients who required KRT for other causes of kidney failure. Survival following kidney transplants was worse among patients with SLE.

Impact of systemic lupus erythematosus on the 5-year survival of critically ill septic patients

BackgroundInfectious disease is an increasing threat to patients with systemic lupus erythematosus (SLE); however, the long-term outcome in critically ill septic patients with SLE remains unclear, and we aimed to address the impact of SLE on 5-year survival in critically ill septic patients.MethodsWe used the 2003–2017 nationwide data with 825,556 patients with sepsis in Taiwan. We identified lupus cases with sepsis that required admission to the intensive care unit and mechanical ventilation and selected controls matched (1:4) for age, sex, and index-year. Conditional logistic regression analysis was used to determine risk factors for mortality risk and shown as odds ratios (HRs) with 95% confidence intervals (CIs).ResultsA total of 513 SLE-sepsis patients and 2052 matched non-SLE septic individuals were enrolled. The mortality rate was higher in the SLE group (38.5 per 100,000 person-year) than that in the non-SLE group (13.7 per 100,000 person-year), with an IRR of 2.8 (95% CI, 2.5–3.2). We found that SLE was independently associated with a high mortality rate after adjusting relevant variables (HR 1.47, 95% CI 1.27–1.77). In addition to SLE, a higher age (HR 1.02, 95% CI 1.02–1.02), more comorbidities, and receiving prednisolone equivalent dose higher than 5 mg/day (HR 1.55, 95% CI 1.27–1.90), methotrexate (HR 2.19, 95% CI 1.61–2.99), and immunosuppressants (HR 1.45, 95% CI 1.22–1.74) were also independent risks for mortality.ConclusionsWe identified that SLE affects the long-term mortality in critically ill septic patients, and more studies are warranted for the underlying mechanism.

Does second-look endoscopy reduce the bleeding after gastric endoscopic submucosal dissection for patients receiving antithrombotic therapy?

BackgroundIn patients with average risk of bleeding, second-look endoscopy does not reportedly reduce bleeding after gastric endoscopic submucosal dissection. However, effectiveness of second-look endoscopy for patients with a high risk of bleeding, such as those who are taking antithrombotic agents, is unclear. Hence, this study aims to clarify the effectiveness of second-look endoscopy for patients with antithrombotic therapy.MethodsWe studied 142 consecutive patients with 173 gastric epithelial neoplasms who were routinely taking antithrombotic agents and were treated by endoscopic submucosal dissection at Tonan Hospital between November 2013 and December 2019. They were classified into two groups: those with second-look endoscopy (SLE group, 69 patients with 85 lesions) and those without second-look endoscopy (non-SLE group, 73 patients with 88 lesions). The incidence of post-endoscopic submucosal dissection bleeding was compared between the SLE and non-SLE groups.ResultsThere were no statistical differences in the rate of patients undergoing single antiplatelet therapy, single anticoagulant therapy, and multiple therapy between the SLE and non-SLE groups (SLE group vs. non-SLE group; 32 [46.4%], 16 [23.2%], and 21 [30.4%] patients vs. 37 [50.7%], 20 [27.4%], and 16 [21.9%] patients, respectively; p = 0.50). Post-endoscopic submucosal dissection bleeding incidence was 21.7% (15/69) and 21.9% (16/73) in the SLE and non-SLE groups, respectively, and did not significantly differ between the two groups (p = 0.98).ConclusionsFor patients taking antithrombotic agents, the incidence of post-endoscopic submucosal dissection bleeding was not reduced by second-look endoscopy.

POS0173 METABOLOMIC PROFILING AND SYMPTOM BURDEN IN BLACK WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:Black individuals with systemic lupus erythematosus (SLE), who are predominantly women, have disproportionately poorer health outcomes across the trajectory of their disease including increased mortality, higher symptom burden, and poor quality of life than non-Hispanic Whites. The heterogeneity of immunopathology and biochemical complexity of SLE create major knowledge gaps around the mechanisms of disease and differences in SLE symptom expression. Metabolomics may reveal biochemical dysregulation that underlies SLE symptoms and provide novel metabolic targets for precision symptom interventions.Objectives:We conducted untargeted metabolomic plasma profiling of Black females with SLE and Black female non-SLE controls to gain insight into metabolic disturbances associated with SLE.Methods:We analyzed blood specimens collected from 23 Black female patients with diagnosis of SLE during a routine outpatient rheumatology visit and from 21 Black female non-SLE controls whose data were collected as part of another study of obese caregivers. Data collection for both cases and controls was completed with harmonized protocols. Clinical data for cases were obtained via chart review and both cases and controls completed identical, reliable and valid measures of fatigue, depression, anxiety, and sleep disturbance. A commercial metabolomics analysis company within the US conducted untargeted metabolomics on the 44 plasma samples using ultrahigh performance liquid chromatography/tandem mass spectrometry along with metabolite identification and quantification to examine differences between SLE/non-SLE groups.Results:All SLE subjects met 2019 EULAR/ACR criteria (Aringer et al., 2019). SLE subjects were significantly (p &lt; .05) younger (42.5 ± 12.2 vs. 63.2 ± 6.4), had a lower BMI (30.3 ± 9.4 vs. 34.9 ± 4.1), and greater co-morbidities (2.3 ± 1.3 vs. 1.1 ± 1.3) than non-SLE controls. SLE subjects reported higher symptoms than controls across all measures, but differences were not statistically significant. Metabolomics analysis revealed 290 biochemicals that were statistically significant (p ≤ .05) between SLE and non-SLE groups. Random Forest analysis had a predictive accuracy of 91% in differing between the two groups using out-of-bag sampling. Significant metabolic differences between groups were noted in biochemicals associated with glycolysis, the TCA cycle (see Table 1), fatty acid metabolism, branched chain amino acids, sterol levels, heme catabolism, and potential markers of renal impairment. Overall, the differences would suggest reduced energy production among SLE patients compared to controls.Conclusion:Black women with SLE had biochemical profiles consistent with reduced energy production which has implications for the high burden of fatigue and other symptoms in this population. Future work with larger sample sizes should involve integrating symptom and metabolomics data to identify potential biomarkers of symptom burden.

Explore comorbidities associated with systemic lupus erythematosus: a total population-based case-control study.

Because of the increasing incidence and overall burden of systemic lupus erythematosus (SLE), efforts have been made to identify the factors that contribute to SLE onset and progression. We conducted a total population-based case-control study to explore the prior comorbidities associated with SLE. Data were collected from Taiwan's National Health Insurance Research Database. Newly diagnosed SLE patients from 1 January 2010, to 31 December 2013 (n = 2847), were exactly matched at a 1:4 ratio for gender, age, residence and insurance premium to form a non-SLE group. Multivariate conditional logistic regression with stepwise selection was used to find the prior-associated comorbidities. A total of 38 prior comorbidities were associated with SLE incidence (32 positive and 6 negative associations). Positively associated comorbidities could be categorized as autoimmune-related inflammation of multiple organs including skin, blood, liver, tooth, thyroid, musculoskeletal and connective tissue. Among them, diffuse diseases of connective tissue (International Classification of Disease, Ninth Revision, Clinical Modification 710) exhibited the most robust association (OR = 5.68, 95% CI = 4.02-8.03, P < 0.001) in the 5 years before the index date. Negatively associated comorbidities could be attributed to diabetes mellitus and pregnancy related symptoms. Our results supported that increased awareness of SLE may be warranted for patients with autoimmune-related comorbidities of multiple organs. However, diabetes mellitus and pregnancy related symptoms were negatively associated with SLE incidence in this study. Further studies are warranted to elucidate the possible underlying mechanism and for better understanding the pathogenesis of SLE.

Second-look endoscopy-guided therapy under sedation prevents early rebleeding after variceal ligation for acute variceal bleeding.

To investigate whether second-look endoscopy (SLE)-guided therapy could be used to prevent post-endoscopic variceal ligation (EVL) early bleeding. Consecutive cirrhotic patients with large esophageal varices (EV) receiving successful EVL for acute variceal bleeding (AVB) or secondary prophylaxis were enrolled. The patients were randomized into a SLE group and a non-SLE group (NSLE) 10 days after EVL. Additional endoscopic interventions as well as proton pump inhibitors and octreotide administration were applied based on the SLE findings. The post-EVL early rebleeding and mortality rates were compared between the two groups. A total of 252 patients were included in the final analysis. Post-EVL early rebleeding (13.5% vs 4.8%, P = 0.016) and bleeding-caused mortality (4.8% vs 0%, P = 0.013) were more frequently observed in the NSLE group than in the SLE group. However, post-EVL early rebleeding and mortality rates were reduced by SLE in patients receiving EVL for AVB only but not in those receiving secondary prophylaxis. Patients with Child-Pugh classification B to C at randomization (hazard ratio [HR] 8.77, P = 0.034), AVB at index EVL (HR 3.62, P = 0.003), discontinuation of non-selective β-blocker after randomization (HR 4.68, P = 0.001) and non-SLE (HR 2.63, P = 0.046) were more likely to have post-EVL early rebleeding. No serious adverse events occurred during SLE. SLE-guided therapy reduces post-EVL early rebleeding and mortality rates in cirrhotic patients with large EV receiving EVL for AVB.