Ab1049 co-Morbidity Index in Children With Systemic Lupus Erythematosus

Abstract

BackgroundComorbid conditions in patients with rheumatic diseases (RD) aggravate the course of diseases, worsen the prognosis, impede the response to therapy, and reduce the quality of life of patients. Initial manifestations of comorbid lesions of organs and systems are already manifested in childhood and adolescence, and in the future are the causes of persistent morphologic and functional disorders, disability and mortality of patients.ObjectivesThe purpose was to identify comorbid conditions in children with systemic lupus erythematosus (SLE), followed by an assessment of the comorbidity index (CI).Methods41 patients with SLE aged 7-18 years were examined. The average duration of the disease at the time of the survey was 44.5± 2.9 months, 20 persons (48.78%) had a period of illness up to 3 years, 21 (51.22%) - over 3 years. Among the patients female subjects predominated - 37(90.24%). The comorbidity index (CI) was determined by the total score (points) of the disturbances in all systems of the organism without specific diagnoses.ResultsPathological changes of the one or two systems were noted in 19.51% of patients, between three and four systems - in 24,4%, and in some cases - five (7.32%) and six systems (2.44%).The mean values of CI among patients with SLE were 2.6±0.3 points and did not differ significantly depending on the duration of the disease (2.5±0.7 points before 3 years and 2.4±0.3 points after 3 years; p>0.05), as well as did not differ in female and male patients (2.6±0.3 and 2.8±0.5 respectively, p>0.05). The IC was higher in the cases of development of SLE before the age of 7 years than in older patients (3.6±0.5 vs 2.4±0.3 respectively, p<0.05).The activity of the pathological process significantly influenced the indicators of the CI: 2.4±0.4 with its minimal activity; 2.7±0.4 with an average degree of activity and 3.0±0.6 with a high degree (p<0.05). The frequency of the smallest CI (0 or 1) turned out to be associated with the lowest activity of the disease.The CI with ANA-positivity association was defined: 2.8±0.3 points among patients with ANA that has twice exceeded the CI of ANA-negative patients (1.4±0.5), p <0,05). Its highest level (like 4, 5 and 6 points) was registered only among the ANA-positive patients.In patients with SLE with high CI, changes in the system of coagulation due to elevated fibrinogen levels predominated (3.7±0.4 g/l vs 2.8±0.3 g/l (p<0.05). Similar changes were recorded with the atherogenic coefficient increased (2.7±0.7 vs 1.3±0.5; p<0,05).ConclusionAccording to the research, it was found that in children and adolescents with SLE the formation of lesions of systems and organs occurs while maintaining the activity of the process, especially immunological (ANA-positivity). Disruption of lipid metabolism and blood coagulation were associated with the formation of comorbid states.Disclosure of InterestsNone declared

Identifying multimorbidity patterns of non-communicable diseases in paediatric inpatients: a cross-sectional study in Shanghai, China

“… 45 A study on the comorbidity index in children with SLE also indicated that it is not uncommon for the initial manifestations of comorbid lesions in organs and other systems to occur in children and adolescents, potentially leading to continuous morphological and functional disorders, morbidity and mortality in children. The underlying mechanism responsible for developing the above comorbid conditions might be associated with the disruption of lipid metabolism and blood coagulation 46 and deserves further confirmation in future studies.…”