Risk factors of pulmonary arterial hypertension in patients with systemic lupus erythematosus

Abstract

Objectives: Pulmonary arterial hypertension symptoms in systemic lupus erythematosus patients are non-specific and early diagnosis and intervention are challenging. It remains essential to explore risk factors for pulmonary arterial hypertension in systemic lupus erythematosus patients to identify high risk patients and allow intensive monitoring. Methods: From January 2010 to December 2018, 84 patients with systemic lupus erythematosus and pulmonary arterial hypertension and 160 patients with systemic lupus erythematosus but without pulmonary arterial hypertension were enrolled. Clinical manifestations and laboratory test results were compared between the two groups to identify predictors of pulmonary arterial hypertension. Candidate pulmonary arterial hypertension risk factors were further compared among systemic lupus erythematosus-pulmonary arterial hypertension patients with different characteristics. Results: Among collected patient characteristics, Raynaud’s phenomenon (OR 2.32, 95% CI: 1.17–4.61), digital vasculitis (OR 4.12, 95% CI: 1.48–11.49), pericardial effusion, pulmonary interstitial lesions, positive anti-u1 ribonucleoprotein antibodies, and positive anticardiolipin antibodies immunoglobulin G were associated with significantly higher risk of pulmonary arterial hypertension in systemic lupus erythematosus patients. Among these candidate risk factors, positive anti-u1 ribonucleoprotein antibody was independently associated with severe pulmonary arterial hypertension and more active disease. Digital vasculitis was independently associated with systemic lupus erythematosus alleviation, while pericardial effusion was associated with systemic lupus erythematosus deterioration. Pericardial effusion was associated with longer pulmonary arterial hypertension duration. Conclusion: The significant association between studied clinical and laboratory indicators and risk of pulmonary arterial hypertension, pulmonary arterial hypertension and systemic lupus erythematosus characteristics suggested that these factors can be used to identify patients at higher risk of pulmonary arterial hypertension and adverse outcomes. Close monitoring may be indicated in patients with these risk factors, especially with more than one risk factor.

Immune cell multiomics analysis reveals contribution of oxidative phosphorylation to B-cell functions and organ damage of lupus

“…Associations between Raynaud’s syndrome and neuropsychiatric signs in single-photon emission tomography analysis29 30 were reported. Furthermore, for patients with SLE with pulmonary arterial hypertension, Raynaud’s phenomenon was a risk factor for the incidence and decreased survival 31 32. Considering these clinical linkages, potential process of vasculopathy related to innate immune signalling and OXPHOS signature may contribute to the increased SDI in our cohort.…”

Risk factors of systemic lupus erythematosus patients with pulmonary arterial hypertension: A systematic review and meta-analysis

“…After removing duplicates, 24 literature were finally screened by looking at titles and abstracts and full text. [3–26] The guidelines flow diagram of literature screening is shown in Figure 1.…”

“…Rheumatoid factor. 9 papers examined the relationship between the rheumatoid factor and the development of PAH YunxiaLEI [26] in patients with SLE, with no statistical heterogeneity among the papers (P = .23, I 2 = 23.7%), and were analyzed using a fixed-effects model. The results showed that rheumatoid factorpositive SLE patients had a higher risk of developing PAH than rheumatoid factor-negative patients, with a statistically significant difference [OR = 1.66, 95% CI (1.24, 2.24), P < .05, see Fig.…”

Systemic Lupus Erythematosus and Pulmonary Hypertension

“…Prospective observational studies suggest female gender and child-bearing age as risk factors for PH development in SLE patients [ 10 , 12 ]. A recent observational study identified the following clinical conditions and laboratory findings highly associated with PH incidence in SLE patients: Raynaud’s phenomenon, digital vasculitis, pericardial effusion, pulmonary interstitial lesions, presence of anti-U1 ribonucleoprotein and anticardiolipin IgG antibody [ 13 ]. Interestingly, positive anti-U1 ribonucleoprotein had an independent correlation with PH severity, while pericardial effusion was associated with a longer duration of PH and worse prognosis.…”

“…There are also several possible underlying pathogenic mechanisms, including cardiovascular, respiratory and thromboembolic disorders. The hemodynamic and clinical consequences become obvious when pulmonary vascular resistance (PVR) elevates and right heart failure appears leading eventually to death [ 13 , 20 ].…”