Impact of markers of endothelial injury and hypercoagulability on systemic lupus erythematosus

Abstract

We have explored the relationship between possible hemostatic changes and clinical manifestation of the systemic lupus erythematosus (SLE) as a function of greater or lesser disease activity according to Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K) criteria. Endothelial injury and hypercoagulability were investigated in patients with SLE by measuring thrombomodulin (TM), D-dimer (DDi) and thrombin generation (TG) potential. A total of 90 participants were distributed into three groups: 1) women with SLE presenting with low disease activity (laSLE) (SLEDAI-2K ≤ 4), 2) women with SLE presenting with moderate to high disease activity (mhaSLE) (SLEDAI-2K > 4), and 3) a control group comprising healthy women. Levels of TM and DDi were higher both in the laSLE and mhaSLE groups compared to controls and in mhaSLE compared to the laSLE group. With respect to TG assay, lagtime and endogen thrombin potential, low concentrations of tissue factor provided the best results for discrimination among groups. Analysis of these data allow us to conclude that TM, DDi and TG are potentially useful markers for discriminating patients with very active from those with lower active disease. Higher SLE activity may cause endothelial injury, resulting in higher TG and consequently a hypercoagulability state underlying the picture of thrombosis common in this inflammatory disease.

Connexin 43 Expression in Cutaneous Biopsies of Lupus Erythematosus

“…43 Moreover, several biomarkers associated with endothelial dysregulation are increased in patients with systemic LE when compared with controls. 38,44 More specifically, the flow-mediated skin fluorescence technique has allowed for the demonstration of disorders of cutaneous microcirculation in patients with LE. 45…”

The predictive value of fibrinogen‐to‐albumin ratio in the active, severe active, and poor prognosis of systemic lupus erythematosus: A single‐center retrospective study

“… 24 FIB is an important biomarker in the coagulation system, which has been proved to be closely related to disease activity and organ damage. 10 He et al 25 found that FIB in active SLE was significantly higher than stable SLE and was positively correlated with a variety of inflammatory factors. These studies support that coagulation system imbalance plays an important role in the pathogenesis and disease progression of SLE.…”

“…Autoimmune and inflammatory reaction in SLE patients can damage vascular endothelium, break the balance between procoagulant and anticoagulant, cause coagulation and fibrinolysis disorders, and lead to high risk of thrombosis and atherosclerosis 24 . FIB is an important biomarker in the coagulation system, which has been proved to be closely related to disease activity and organ damage 10 . He et al 25 found that FIB in active SLE was significantly higher than stable SLE and was positively correlated with a variety of inflammatory factors.…”

“… 9 Previous studies have shown that hypercoagulable state is the result of interruption of hemostasis and fibrinolysis caused by endothelial cell injury and is closely related to SLEDAI. 10 Fibrinogen (FIB) is an acute time response protein, rises rapidly in inflammation, infection, myocardial infarction and tumor and is closely related to SLEDAI and poor prognosis. Dhillon et al 11 have proved that the activation of endothelial cells also change the properties of endothelial cells and become a coagulant rather than an anticoagulant, resulting in the decreasing degradation and increasing concentration of FIB.…”

“…The inflammatory response process is closely related to the deposition of immune complexes in vascular endothelium, and the subsequent activation of complement leads to endothelial cell injury 9 . Previous studies have shown that hypercoagulable state is the result of interruption of hemostasis and fibrinolysis caused by endothelial cell injury and is closely related to SLEDAI 10 . Fibrinogen (FIB) is an acute time response protein, rises rapidly in inflammation, infection, myocardial infarction and tumor and is closely related to SLEDAI and poor prognosis.…”