Mortality and prognostic factors in Chinese patients with systemic lupus erythematosus

Mu, Liangshan; Hao, Yanjie; Fan, Yong; Huang, Hong; Yang, Xue; Xie, A; Zhang, X; Ji, Lanlan; Geng, Yan; Zhang, Zhuoli

doi:10.1177/0961203318789788

Cited by 47 publications

(45 citation statements)

References 44 publications

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“…Our finding that 39% of youth who died had infectious diseases as their primary diagnosis demonstrates once again that infection is a major complication of the rheumatic diseases. The rate of infection we found was higher than reported by Butt et al in a Danish cohort with systemic sclerosis [37] and by Aggarwal et al in an Indian cohort of youth with lupus [38] but similar to the Chinese lupus cohort of all ages by Mu et al [39] We also found that patients with vasculitis and scleroderma were at higher risk of dying in the hospital relative to patients with other rheumatic diseases (of which lupus was the most frequent comparator diagnosis). While this can be explained by the increased severity of these diseases, they are understudied in the transition literature [40,41].…”

Section: Discussionsupporting

confidence: 73%

Inpatient mortality in transition-aged youth with rheumatic disease: an analysis of the National Inpatient Sample

Jensen¹,

Koh²,

Cash³

et al. 2020

Pediatr Rheumatol

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Background: Transition from pediatric to adult care is a vulnerable time for youth with chronic diseases. In youth with rheumatic disease, studies show high rates of loss to follow up and increased disease activity. However, mortality data are lacking. In this study, we assessed whether transitional age is a risk factor for inpatient mortality. Methods: We analyzed the 2012-2014 National Inpatient Sample database, a representative sample of discharges in the United States. Individuals with rheumatic diseases were identified by International Statistical Classification of Disease-9 (ICD-9) codes at time of discharge. Youth were categorized into three age groups: pre-transitional (11-17), transitional (18-24) and post transitional (25-31). We fitted univariable and multivariable logistic regression models to assess whether transitional age was a risk factor for inpatient mortality. Results: There were 30,269 hospital discharges which met our inclusion criteria of diagnosis and age. There were 195 inpatient deaths (0.7%). The most common causes of death were infection (39.5%), pulmonary disease (13.8%), and cardiac disease (11.2%). The Odds ratio for inpatient mortality of a transitional-aged individual was 1.18 compared to controls (p = 0.3). Black race (OR = 1.4), male sex (OR = 1.75), and a diagnosis of systemic sclerosis (OR = 4.81) or vasculitis (OR = 2.85) were the greatest risk factors of inpatient mortality. Conclusion: Transitional age was not a risk factor for inpatient mortality in this study. We did identify other risk factors other than age. Further studies are required to assess if there is an increased risk of mortality in outpatients of the transitional age group.

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Section: Discussionsupporting

confidence: 73%

Inpatient mortality in transition-aged youth with rheumatic disease: an analysis of the National Inpatient Sample

Jensen¹,

Koh²,

Cash³

et al. 2020

Pediatr Rheumatol

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“…Lymphopenia and hemolytic anemia are common hematologic manifestations and one of biomarkers for disease activity or prognosis of SLE (Mu et al 2018). Hemoglobin levels are decreased through the complicated ways including hemolysis, iron deficiency or chronic inflammation, could represent disease status in chronic inflammatory disease.…”

Section: Discussionmentioning

confidence: 99%

Plasma Free Protein S Is Correlated with Disease Activity, but not with Subclinical Atherosclerosis among Patients with Systemic Lupus Erythematosus: A Cross-Sectional Study

Jung

Lee

Kim

et al. 2019

Tohoku J. Exp. Med.

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A defect in clearance of apoptotic materials is pivotal in the pathogenesis of systemic lupus erythematosus (SLE). Protein S participates in the removal of apoptotic remnants and the anticoagulation pathway. The aim of the study was to clarify the relationship between plasma levels of free protein S and the disease activity or subclinical atherosclerosis in SLE. Free protein S was measured by an enzyme-linked immunosorbent assay, and patients were classified into two groups of free protein S levels: low (< 50%) and normal (≥ 50%). One hundred-eleven Korean female patients with SLE were enrolled, and the levels of free protein S were 67.4 ± 19.7%. Carotid plaque was detected in 25 (22.5%) patients. Twenty-one patients with low free protein S had lower hemoglobin (11.4

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“…Consequently, the normal immune cells are also disproportionately affected, which in turn might increase the patient's susceptibility to infection [3,4]. Indeed, it has been reported widely by clinical studies that severe infection is the leading cause of death in patients with autoimmune diseases, which was partly due to the long-term usage of immunosuppressive drugs [5][6][7]. Thus, new drugs or therapy which is less deleterious to patients' normal immune responses is in urgent need.…”

Section: Introductionmentioning

confidence: 99%

Mesenchymal Stem Cells Enhance Pulmonary Antimicrobial Immunity and Prevent Following Bacterial Infection

Chen

Huang

et al. 2020

Stem Cells International

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Background. Immunosuppressants such as cyclophosphamide (CTX) have been employed to treat a wide array of autoimmune diseases. The most unfavourable side effects of these drugs are their suppression on the antimicrobial immunity and increasing the risk of infection. As a promising substitution/adjunct, mesenchymal stem cells (MSCs) are currently being tested in several clinical trials. However, their influence on the recipients' antimicrobial immunity remains unclear. Methods. In this study, C57BL/6 mice were treated with either CTX or MSCs, and then both the innate and adaptive immunity of the lung were determined. To investigate the influence of CTX and MSCs on the immune defence against infection, the treated mice were intranasally infected with opportunistic pathogen Haemophilus influenzae (Hi). Bacterial clearance and antibacterial immune responses were analysed. Results. Our data showed that CTX strongly inhibited the proliferation of lung immune cells, including alveolar macrophages (AMs) and T cells, whereas MSCs increased the numbers of these cells. CTX suppressed the phagocytic activity of AMs; on the contrary, MSCs enhanced it. Notably, infusion of MSCs led to a remarkable increase of regulatory T cells and Th1 cells in the lung. When infected by Hi, CTX did not significantly impair the elimination of invaded bacteria. However, MSC-treated mice exhibited accelerated bacterial clearance and moderate inflammation and tissue damage. Conclusion. Our study reported that unlike traditional immunosuppressants, modulation of MSCs on the recipient's immune response is more elegant. It could preserve and even enhance the antimicrobial defence, suggesting that MSCs are better choice for patients with high risk of infection or those who need long-term immunosuppressive regimen.

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Mortality and prognostic factors in Chinese patients with systemic lupus erythematosus

Cited by 47 publications

References 44 publications

Inpatient mortality in transition-aged youth with rheumatic disease: an analysis of the National Inpatient Sample

Inpatient mortality in transition-aged youth with rheumatic disease: an analysis of the National Inpatient Sample

Plasma Free Protein S Is Correlated with Disease Activity, but not with Subclinical Atherosclerosis among Patients with Systemic Lupus Erythematosus: A Cross-Sectional Study

Mesenchymal Stem Cells Enhance Pulmonary Antimicrobial Immunity and Prevent Following Bacterial Infection

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