Mortality Risks Associated With Specific Clinical Manifestations of Systemic Lupus Erythematosus

Ward, Michael M.; Pyun, Elise; Studenski, Stephanie

doi:10.1001/archinte.1996.00440110109015

Cited by 125 publications

(12 citation statements)

References 29 publications

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“…Significant titers are accepted to be of 1:80 or greater. Thrombocytopenia is common in patients with SLE, occurring approximately 15-20% of patients [7]. Among the many potential contributors to thrombocytopenia in SLE patients, destruction of the platelets by autoantibodies is the major mechanism [16].…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and clinical significance of elevated antinuclear antibody test in children and adult patients with idiopathic thrombocytopenic purpura

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Ozel

Okur

et al. 2007

J Thromb Thrombolysis

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Our data demonstrated that ANA positivity is often found in adult and children patients with ITP, and indicate that the detection of ANA positivity is not enough to identify those patients with ITP who are at risk of developing SLE or other CTD. There is a statistically significant difference in terms of ANA positivity between childhood acute and chronic ITP patients. We think that ANA positivity may be an indicator in terms of chronicity for childhood ITP. However, large-scale studies should be considered to determine the significance of ANA positivity and their utility in differentiating acute from chronic ITP.

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Section: Discussionmentioning

confidence: 99%

“…Thrombocytopenia is the major hematological complication in patients with SLE. Approximately 15-20% of patients with SLE develop thrombocytopenia and thrombocytopenia in SLE are associated with an increased risk of mortality [7].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and clinical significance of elevated antinuclear antibody test in children and adult patients with idiopathic thrombocytopenic purpura

Altıntaş

Ozel

Okur

et al. 2007

J Thromb Thrombolysis

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“…Systemic erythematous lupus (SLE) is characterised by a breach in self-tolerance and propagation of multiple autoantibodies, presenting with heterogeneous phenotypes and a wide range of organ involvement. Lupus nephritis (LN) is one of the most threatening vital organ involvements in patients with SLE, and those with renal involvement have a higher morbidity and mortality rate than those without LN [ 1 – 6 ]. The percentage of LN in SLE patients differs from race to race and tends to be higher in Asian patients with SLE than in Caucasians [ 7 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for subsequent lupus nephritis in patients with juvenile-onset systemic lupus erythematosus: a retrospective cohort study

et al. 2023

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Background Lupus nephritis (LN) is a crucial organ involvement in systemic lupus erythematosus (SLE). Patients with LN have higher morbidity and mortality rates than those without. Among all patients with LN, 20–40% had delayed onset, but the data for patients with juvenile-onset SLE (jSLE), who have a higher percentage of LN than patients with adult-onset SLE (aSLE), were limited. This study aimed to determine the risk factors for subsequent LN in patients with jSLE. Methods A retrospective cohort study was conducted between 2008 and 2018 in a single tertiary medical centre. Patients with diagnosed jSLE were reviewed. We investigated those without LN at diagnosis and whether they developed LN afterward. The primary outcome was the development of subsequent LN. Clinical manifestations at diagnosis, serial laboratory data, and treatments were reviewed during follow-up periods. Results Among the 48 patients with jSLE without initial LN, 20 developed subsequent LN later (Group 1), whereas 28 remained free of LN (Group 2). There was no difference in the percentage of initial manifestations except for more discoid rashes in Group 2 patients. In the Cox regression model, elevated average anti-double-stranded DNA (dsDNA) antibody, low average serum complements, and high average erythrocyte sedimentation rate (ESR) levels during follow-up were predictors of subsequent LN. After adjusting for these factors in multivariable analyses, only high average anti-dsDNA antibody and high average ESR levels remained predictive of subsequent LN. For every 100 IU/ml increase in anti-dsDNA antibody, the risk for subsequent LN in jSLE increases by 1.29 times (hazard ratio = 1.29, 95% confidence interval 1.055–1.573). Conclusion Persistently high anti-dsDNA antibody and ESR levels during the follow-up period were risk factors for subsequent LN in patients with jSLE.

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“…Thrombocytopenia has been associated with worse disease outcomes, 7,11,12 and therefore it can be considered an important prognostic indicator for survival in SLE patients 12 . To the best of our knowledge and search, these studies have involved white SLE patients, Hispanics, Asians, and African Americans, with only one study involved North Africans 3,4,7–10 …”

Section: Introductionmentioning

confidence: 99%

Thrombocytopenia and disease outcomes in a cohort of patients with systemic lupus erythematosus. A post hoc analysis of the COMOSLE‐EGYPT study

Mohamed,

Gamal,

Mokbel

et al. 2024

Int J of Rheum Dis

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BackgroundThrombocytopenia ranges from 20% to 40% in patients with systemic lupus erythematosus (SLE). It is usually associated with severe disease manifestations and worse disease outcomes.Aim of the StudyTo identify the frequency of thrombocytopenia in a cohort of Egyptian patients with SLE and to examine the relationship of thrombocytopenia with various disease manifestations and disease outcomes.MethodsData on 902 SLE patients were collected, including demographics, clinical, laboratory, immunological findings, and medications. SLE Disease Activity Index (SLEDAI) at baseline, last visit, and Systemic Lupus International Collaborating Clinics/ACR Damage Index (SLICC) were calculated. A comparison was done between patients with thrombocytopenia (group I) and patients without (group II) regarding different disease parameters. Regression analysis was done to examine if thrombocytopenia is a predictor of worse disease outcomes.ResultsThrombocytopenia was found in 33% of our cohort. Longer disease duration was observed in group I compared to group II (p value = .01). As regards clinical manifestations, significantly higher frequencies of constitutional manifestations, anemia, arterial thrombosis, pulmonary hypertension, cardiac manifestations, neurological manifestations, gastrointestinal tract (GIT), and hepatic manifestations were detected in group I compared to group II. The disease damage index was detected to be significantly higher in group I as compared to group II (p value < .001). Mortality was higher in group I (p value < .001). Although it was found that antiphospholipid antibodies (APL) were associated with thrombocytopenia and their presence resulted in higher damage (p value: .001), the presence of thrombocytopenia even in patients with negative APL antibodies was associated with higher damage and mortality. Apart from thrombocytopenia, the male gender was also found to be an independent risk factor for mortality.ConclusionThrombocytopenia was associated with more organ damage and higher mortality in SLE patients with or without APL antibodies. SLE patients with thrombocytopenia have a 3.4 times higher risk of mortality than patients without thrombocytopenia. Apart from thrombocytopenia, the male gender was also found to be an independent risk factor for mortality.

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Mortality Risks Associated With Specific Clinical Manifestations of Systemic Lupus Erythematosus

Abstract: The presence of nephritis and seizures each increased the risk of death in patients with SLE approximately 2-fold. Thrombocytopenia also increased the risk of SLE-related mortality, while leukopenia was protective.

Cited by 125 publications

References 29 publications

Prevalence and clinical significance of elevated antinuclear antibody test in children and adult patients with idiopathic thrombocytopenic purpura

Prevalence and clinical significance of elevated antinuclear antibody test in children and adult patients with idiopathic thrombocytopenic purpura

Risk factors for subsequent lupus nephritis in patients with juvenile-onset systemic lupus erythematosus: a retrospective cohort study

Thrombocytopenia and disease outcomes in a cohort of patients with systemic lupus erythematosus. A post hoc analysis of the COMOSLE‐EGYPT study

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