Phenome-wide association study identifies marked increased in burden of comorbidities in African Americans with systemic lupus erythematosus

Barnado, April; Carroll, Robert J.; Casey, Carolyn; Wheless, Lee; Denny, Joshua C.; Crofford, Leslie J.

doi:10.1186/s13075-018-1561-8

Cited by 27 publications

(22 citation statements)

References 52 publications

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“…American individuals with lupus were found to have more comorbidities than white individuals with lupus in a recent retrospective cohort, especially hypertension [36] We believe that transition programs focusing on both economic factors and control of comorbidities may help reduce the racial gap in youth of transition age. Further study into the specific features of transition aged youth including cause of death for each age and racial group is required.…”

Section: Discussionmentioning

confidence: 85%

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: Discussionmentioning

confidence: 85%

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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“… 50 Moreover, African-American patients with SLE have demonstrably higher prevalent comorbid hypertensive, renal and cardiovascular disease compared with their European American counterparts. 42 Damage accrual on renal and cardiovascular domains of the SDI are independent risk factors for early SLE mortality. 25 While many socioeconomic factors are at play, the observed association between these critical outcomes and APOL1 risk genotype in SLE may be an underappreciated genetic contribution.…”

Section: Discussionmentioning

confidence: 99%

Apolipoprotein L1 risk genotypes in Ghanaian patients with systemic lupus erythematosus: a prospective cohort study

et al. 2021

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ObjectiveTwo apolipoprotein L1 (APOL1) risk variants (RV) are enriched in sub-Saharan African populations due to conferred resistance to Trypanosoma brucei. These variants associate with adverse renal outcomes by multiple causes including SLE. Despite emerging reports that SLE is common in Ghana, where APOL1 variant allelic frequencies are high, the regional contribution to SLE outcomes has not been described. Accordingly, this prospective longitudinal cohort study tested the associations between APOL1 high-risk genotypes and kidney outcomes, organ damage accrual and death in 100 Ghanaian patients with SLE.MethodsThis was a prospective cohort study of 100 SLE outpatients who sought care at Korle bu Teaching Hospital in Accra, Ghana. Adult patients who met 4 American College of Rheumatology criteria for SLE were genotyped for APOL1 and followed longitudinally for SLE activity as measured by the Safety of Estrogens in Lupus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) hybrid and organ injury as measured by the Systemic Lupus International Collaborating Clinics Damage Index (SDI) at baseline and every 6 months for 1 year. Outcomes of interest were kidney function, SDI and case fatality.ResultsAssuming a recessive inheritance, the APOL1 high-risk genotype (2RV) associated with end-stage renal disease (ESRD) at an OR of 14 (p=0.008). These patients accrued more SDI points particularly in renal and neurological domains. The SDI was 81.3% higher in 2RV patients compared with 0RV or 1RV patients despite no difference in SLE activity (p=0.01). After a 12-month period of observation, 3/12 (25%) of the 2RV patients died compared with 2/88 (2.3%) of the 0RV or 1RV carriers (OR=13.6, p=0.01). Deaths were due to end-stage kidney disease and heart failure.ConclusionAPOL1 RVs were heritable risk factors for morbidity and mortality in this Ghanaian SLE cohort. Despite no appreciable differences in SLE activity, APOL1 high-risk patients exhibited progressive renal disease, organ damage accrual and a 13-fold higher case fatality.

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“…Finally, while it is well-established that blacks are more commonly afflicted by SLE and that they have a more severe course of disease, our study is the first to show that black children hospitalized with SLE are disproportionately afflicted by PCE. 2,16–18 Despite holding multiple variables constant, a black child was 1.7 times more likely to have PCE than children of other races. These data further support our contention that PCE is a marker of disease severity.…”

Section: Discussionmentioning

confidence: 99%

Effect of pericardial effusion on outcomes in children admitted with systemic lupus erythematosus: a multicenter retrospective cohort study from the United States

Dalby

Tang

Daily

et al. 2019

Lupus

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Objective We sought to describe characteristics of children admitted with pericardial effusion (PCE) and systemic lupus erythematosus (SLE) and determine the association between PCE and outcomes of interest. Methods We performed a retrospective cohort study of the Pediatric Health Information System (PHIS). Patients were included if they were admitted to a PHIS participating hospital from 2004 to 2015 with a diagnosis of SLE and age ≤18 years. Children with congenital heart disease or who had undergone heart surgery were excluded. PCE was the primary predictor variable; multivariable analysis was used to evaluate the effect of PCE on the following outcomes: mortality, length of stay (LOS), and readmission within 30 days. Results There were 5679 admissions, of which 705 (12.4%) had PCE. Median age at admission was 15 years (interquartile range: 13–17). There were no significant differences for age or sex between patients admitted either with or without PCE. A significantly higher percentage of children in the PCE group were black compared with those without PCE (43% vs. 31%, p < 0.001). In multivariable analysis, the odds of a black patient having PCE were 1.7 higher than non-black patients ( p < 0.001). In-hospital mortality was 2.5 times higher in children with PCE compared with those without PCE ( p = 0.027). Those with PCE also had 1.5 greater odds of readmission within 30 days ( p < 0.001). PCE was not associated with increased LOS (0.99, p = 0.753). Conclusion PCE is common in admissions of children with SLE. There are disproportionately more black patients with SLE affected by PCE than non-black. PCE is associated with significantly higher mortality and rates of readmission.

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Phenome-wide association study identifies marked increased in burden of comorbidities in African Americans with systemic lupus erythematosus

Cited by 27 publications

References 52 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

Apolipoprotein L1 risk genotypes in Ghanaian patients with systemic lupus erythematosus: a prospective cohort study

Effect of pericardial effusion on outcomes in children admitted with systemic lupus erythematosus: a multicenter retrospective cohort study from the United States

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