Background and Aims There is little information on the incremental prognostic importance of frailty beyond conventional prognostic variables in heart failure (HF) populations from different country income levels. Methods A total of 3429 adults with HF (age 61 ± 14 years, 33% women) from 27 high-, middle- and low-income countries were prospectively studied. Baseline frailty was evaluated by the Fried index, incorporating handgrip strength, gait speed, physical activity, unintended weight loss, and self-reported exhaustion. Mean left ventricular ejection fraction was 39 ± 14% and 26% had New York Heart Association Class III/IV symptoms. Participants were followed for a median (25th to 75th percentile) of 3.1 (2.0–4.3) years. Cox proportional hazard models for death and HF hospitalization adjusted for country income level; age; sex; education; HF aetiology; left ventricular ejection fraction; diabetes; tobacco and alcohol use; New York Heart Association functional class; HF medication use; blood pressure; and haemoglobin, sodium, and creatinine concentrations were performed. The incremental discriminatory value of frailty over and above the MAGGIC risk score was evaluated by the area under the receiver-operating characteristic curve. Results At baseline, 18% of participants were robust, 61% pre-frail, and 21% frail. During follow-up, 565 (16%) participants died and 471 (14%) were hospitalized for HF. Respective adjusted hazard ratios (95% confidence interval) for death among the pre-frail and frail were 1.59 (1.12–2.26) and 2.92 (1.99–4.27). Respective adjusted hazard ratios (95% confidence interval) for HF hospitalization were 1.32 (0.93–1.87) and 1.97 (1.33–2.91). Findings were consistent among different country income levels and by most subgroups. Adding frailty to the MAGGIC risk score improved the discrimination of future death and HF hospitalization. Conclusions Frailty confers substantial incremental prognostic information to prognostic variables for predicting death and HF hospitalization. The relationship between frailty and these outcomes is consistent across countries at all income levels.

in 11 babies (including a pair of twin). Caesarean operations were performed in 14 courses (including a pair of twin). Conclusions In our hospital, we could well manage the course of pregnancy associated with SLE. Background and aims Neonatal lupus erythematosus (NLE) is a passively acquired autoimmune disease of infancy, caused by the transplacental passage of maternal autoantibodies, mostly anti-RO/SSA and anti-LA/SSB. NLE presents with a transient rash and/ or congenital heart block (CHB). The risk of developing NLE in SSA-positive women is~2%, however the risk increases to 25%, if the mother has had a previous child with NLE. Objectives We present a case of NLE characterised by a thirddegree CHB, ascites and life-threatening pericardial effusion, which was treated twice with intrauterine pericardiocentesis in week 22 and 29. After birth the child was treated with systemic corticosteroid on and off for 1 year, and she later received a pacemaker and was treated with ACE inhibitor and diuretics due to heart failure. Now, at the age of 6 years, she is still treated with ACE inhibitor. Her older sister also had NLE and her mother was found to have asymptomatic anti-SSA >100 U/ml. Discussion This case is exceptional, as the fetus had severe exudative pericarditis and had life-saving pericardiocentesis performed in utero. We want to draw the clinicians' attention to the increased risk of NLE, when a mother earlier has given birth to a child with NLE. Regular fetal echocardiography is important from week 16. In case of first-and second-degree CHB, maternal corticosteroid can be tried to reverse the condition. Also, treatment with hydroxychloroquine or IVIG may decrease the risk of CHB. 394 FIRST REPORT OF INTRAUTERINE PERICARDIOCENTESIS IN A FETUS WITH NEONATAL LUPUS ERYTHEMATOSUS 395 MATERNAL AND FETAL OUTCOMES AMONG FILIPINO PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A SINGLE CENTRE STUDYCA Dela Cruz-Tan*. University of Santo Tomas Hospital, Rheumatology, Manila, Philippines 10.1136/lupus-2017-000215.395Background and aims Systemic lupus erythematosus (SLE) usually affects women of child-bearing age, with pregnancy thus posing a relevant management challenge. This paper describes materno-fetal outcomes among Filipino SLE patients in a single tertiary care centre. Methods We retrospectively reviewed the medical files of patients in the Lupus Database of the University of Santo Tomas Hospital in Manila, Philippines, who had a recorded pregnancy after SLE diagnosis, describing the maternal and fetal outcomes of each pregnancy. Results There were a total of 197 pregnancies among 99 patients. Average age at first pregnancy was 29 years old. Lupus Nephritis (LN) was present in 13.7%, hyperthyroidism 1.0%, and autoimmune thyroiditis 1.0%. Maternal complications intra-and post-partum included hypertension (5.6%), pulmonary tuberculosis (TB) (4.0%), pre-eclampsia (3.6%), HELLP syndrome, gestational diabetes (GDM) (3.0%), urinary tract infections (UTI) (3.0%), herpes zoster (2.0%) and 0.5% cases each of TB meningitis, TB s...

BackgroundTNF-like WEAK inducer of apoptosis (TWEAK) is able to increase the expression of various molecules involved in the inflammatory response with relevant effects also in angiogenesis. The pathological functions of TWEAK are primarily attributed to its ability to induce the expression of several pro-inflammatory cytokines, chemokines and cell adhesion molecules, including vascular cell adhesion molecule-1 (VCAM-1) (1). Some previous studies (most of them in Caucasic, Afro-American and Asiatic cohorts) have demonstrated clinical utility of VCAM-1 and TWEAK as biomarkers in patients with systemic lupus erythematosus SLE (2).ObjectivesTo evaluate the diagnostic value of urinary VCAM-1 and TWEAK in a cohort of Latin-American patients with SLE.MethodsPatients meeting the revised ACR criteria for SLE were recruited from 2 different centers at Medellín and Baranquilla, Colombia. Urinary levels of VCAM-1 (uVCAM-1) and TWEAK (uTWEAK) were measured using an ELISA kit (R&D system, USA). SLE activity was measured with SLEDAI. Inactive LN was defined by the presence of: 24 hours proteinuria ≤500 mg/dl, inactive urine sediments and stable serum creatinine. Mann-Whitney tests were used to compare data and Spearman's rank correlations were used to examine associations.ResultsOne hundred and fifty eight SLE patients were recruited (89% female) with median age of 32.8±12.1 years and median disease duration of 7.27±6.6 years. Mestizo (77%) and African Latin-American patients (20%) were majority. Mean SLEDAI score was 8.5±8.7. One hundred and four patients (64%) had lupus nephritis (LN). 76 out of 104 patients had biopsy proven LN, in 62% of cases with proliferative forms. uVCAM-1 and uTWEAK were significantly higher in patients with LN than without LN. At the same time, uVCAM-1 and uTWEAK were significantly higher in patients with active vs inactive LN (Figure). uVCAM-1 (581±1197 vs 189±256 ng/ml, p<0.001) and uTWEAK levels (3202±3778 vs 1123±1873 pg/ml, p=0.038) were significantly higher in patients with Class V LN in comparison with other LN classes. uVCAM-1 and uTWEAK levels had a mild positive correlation with SLEDAI (r=0.22 and r=0.16, respectively). In addition, uTWEAK correlated with 24 hours proteinuria (r=0.28). No significant correlation was found between uVCAM-1 and uTWEAK.Figure 1.Urinary levels of VCAM-1 and TWEAK in patients with and without LN (A and B) and in patients with active vs inactive LN (C and D).ConclusionsuVCAM-1 and uTWEAK are useful biomarkers in Latin-American patients with SLE for the identification of patients with LN and active LN. In addition, urinary levels of VCAM-1 and TWEAK were significantly more elevated in patient with membranous LN.References González-Sánchez DA, Άlvarez CM, Vásquez G, Gόmez-Puerta JA. Role of TWEAK/Fn14 signalling pathway in lupus nephritis and other clinical settings. Nefrologia. 2016. pii: S0211–6995(16)30084–4.Skeoch S, Haque S, Pemberton P, Bruce IN. Cell adhesion molecules as potential biomarkers of nephritis, damage and accelerated atherosclerosis in patients wit...

Resumen – Actualmente en la injuria miocárdica, ha tenido gran relevancia clínica la utilidad de las troponinas como método diagnóstico, repercutiendo en el manejo del síndrome coronario agudo. Objetivo: Analizar la importancia de los biomarcadores troponina T e I y otros elementos adyuvantes que cumplen un papel trascendental como es el electrocardiograma y los diferentes métodos invasivos, el cual brinda una orientación para la concepción de un diagnóstico oportuno que permita tomar las acciones pertinentes en un paciente con síndrome coronario agudo. Materiales y Métodos: Estudio descriptivo comparativo en 35 pacientes, adultos mayores de 21 años y menores 80 años, que se encontraban hospitalizados en la Empresa Social del Estado Centro de Atención y Rehabilitación Integral - E.S.E CARI de Alta complejidad, en el periodo comprendido entre el año 2012 a 2014. Resultados: Los pacientes presentaron síndrome coronario agudo (infarto agudo de miocardio con o sin elevación del ST), con factores de riesgo cardiovascular tales como: sedentarismo, tabaquismo, hipertensión arterial, diabetes, valvulopatías, dislipidemia y antecedentes de cardiopatía isquémica. El punto a analizar fue la elevación de los biomarcadores troponina T y troponina I en un periodo menor y mayor a 3 horas, desde el inicio de los síntomas (dolor torácico, criodiaforesis, disnea) hasta el ingreso a la institución hospitalaria. Se compararon los resultados obtenidos de cada uno de estos biomarcadores en el diagnóstico precoz y oportuno del síndrome coronario agudo. De las muestra analizada (n=35 pacientes) se obtuvo que la troponina T< 3 horas se elevó un 76.4% en rangos de edad entre los 60-80 años en contraste con troponina I < 3 horas en ese mismo grupo etario que fue de 70.5%. Conclusiones: se evidenció que ambos biomarcadores son equiparables con una ligera ventaja de la troponina T con respecto a la I.

Methods NEFRORED begins in 2008 as a multicenter registry of prospective observational cohorts, which includes patients with confirmed diagnosis of NL through renal biopsy. Study the incidence of the clinical and pathological characteristics of NL in the Colombian Caribbean region. The database was implemented with the variables of the clinical records of the patients. Results Eight centres were involved and 400 patients have been included, 88% female; ratio between men and women is 7:1 with a median age 37 years. Urinary parameters have evidenced 24 hours mean proteinuria of 1.9±3.3g/24 hours and microscopic hematuria in 50% of patients. Among nephrological syndromes, nephritic syndrome and hematuria-proteinuria have been the most frequent 70%, followed by nephrotic syndrome and non-nephrotic proteinuria 30%. Hypocomplementemia is evidenced in 60% of the patients. The median of the SLEDAI has been 10.2 points. Antinuclear Antibodies are positive in 90%. NL class IV-G (A) has been the most frequent 75%. Chronic Renal Disease is concomitant in 52% of the cases. Conclusions NEFRORED represents the first Colombian cohort of patients diagnosed with NL, with up-to-date information on the renal manifestations of SLE, comorbidities, disease status and clinical evolution under conditions of real clinical practice. CKD remains a significant comorbidity in patients with NL. Background and aims Our objective was to create a model for the characterisation, classification and management, according to the protocols, of patients with lupus nephritis, which is done in real time and with the generation of alerts at the right time, which allows inferring that we will obtain a Better quality of life of the patients, reduction of complications and, therefore, decrease in the cost of handling these patients. Methods Initially patients with NL were classified with the CCM system for the risk of the disease. With the help of the CCM information tools, protocols of care and follow-up were incorporated into the software, which made it possible to manage, monitor and control patients. Results The management of NL patients was handled by a group of specialists whose ultimate goal was to improve the quality of life and identify possible deterioration in the patient's health. In an integral way with CCM, a work plan was determined for each of them, keeping a strict record of the results of examinations that allowed to take medical actions in favour of the patients. Also, a mobile application (CheckUp! ) is made available to the user in order to monitor the patient in real time with NL. 398 USE OF TICS FOR THE GENERATION OF A MODEL OF MANAGEMENT AND FOLLOW-UP OF PATIENTS WITH LUPIC NEPHRITIS