Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, Beijing, 100730, China.
Clinical Immunology Centre, Medical Epigenetics Research Centre, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, Beijing, 100730, China.
Arthritis Res Ther. 2021 Feb 16;23(1):57. doi: 10.1186/s13075-021-02435-9.
BACKGROUND: Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening complication of systemic lupus erythematosus (SLE). The current knowledge of the prognostic factors for SLE-associated DAH is controversial. This meta-analysis was undertaken to investigate the relevant risk factors for mortality in SLE-associated DAH. METHODS: Studies were searched from PubMed, EMBASE, and Web of Science databases published up to May 27, 2020, and were selected or removed according to the inclusion and exclusion criteria. Two reviewers extracted data independently from the enrolled studies, and the odds ratios (OR) or the standardized mean difference (SMD) was utilized to identify and describe the prognostic factors for mortality. RESULTS: Eight studies encompassing 251 patients with SLE-associated DAH were included in the meta-analysis. No significant publication bias was shown. Age at the diagnosis of DAH (SMD = 0.35, 95% confidence interval (CI) (0.08, 0.61), P = 0.01, I = 0.0%) was found to be an independent risk factor of mortality. Longer lupus disease duration (SMD = 0.28, 95% CI (0.01, 0.55), P = 0.042, I = 0.0%), concurrent infection (OR = 2.77, 95% CI (1.55, 4.95), P = 0.001, I = 37.5%), plasmapheresis treatment (OR = 1.96, 95% CI (1.04, 3.70), P = 0.038, I = 14.6%), and mechanical ventilation (OR = 6.11, 95% CI (3.27, 11.39), P < 0.0001, I = 23.3%) were also related to poor survival, whereas no noticeable relationships were revealed between survival and concurrent lupus nephritis (OR = 5.45, 95% CI (0.52, 56.95), P = 0.16, I = 58.4%) or treatment of cyclophosphamide (CTX) (OR = 0.74, 95% CI (0.16, 3.41), P = 0.70, I = 75.5%). CONCLUSIONS: Older age at the diagnosis of DAH, longer disease duration of SLE, concurrent infection, plasmapheresis treatment, and mechanical ventilation were found related to increased mortality in patients with SLE-associated DAH according to our meta-analysis. However, due to limited studies with heterogeneity, these results should be interpreted cautiously. Notably, severe diseases rendered the requirement of plasmapheresis treatment and mechanical ventilation are themselves associated with poor outcome. Randomized trials of therapeutics are needed to determine the most efficacious strategies for SLE-associated DAH for better management of this life-threatening complication.
背景：弥漫性肺泡出血（DAH）是系统性红斑狼疮（SLE）的一种罕见但危及生命的并发症。目前，SLE 相关 DAH 的预后因素的相关知识存在争议。本荟萃分析旨在研究 SLE 相关 DAH 患者死亡的相关危险因素。
方法：检索了截至 2020 年 5 月 27 日，PubMed、EMBASE 和 Web of Science 数据库中发表的研究，并根据纳入和排除标准进行选择或排除。两名评审员从纳入的研究中独立提取数据，并使用优势比（OR）或标准化均数差（SMD）来识别和描述与死亡率相关的预后因素。
结果：荟萃分析纳入了 8 项共 251 例 SLE 相关 DAH 患者的研究。未发现明显的发表偏倚。DAH 诊断时的年龄（SMD=0.35，95%置信区间（CI）（0.08，0.61），P=0.01，I=0.0%）是死亡率的独立危险因素。SLE 疾病持续时间较长（SMD=0.28，95%CI（0.01，0.55），P=0.042，I=0.0%）、合并感染（OR=2.77，95%CI（1.55，4.95），P=0.001，I=37.5%）、血浆置换治疗（OR=1.96，95%CI（1.04，3.70），P=0.038，I=14.6%）和机械通气（OR=6.11，95%CI（3.27，11.39），P<0.0001，I=23.3%）与预后不良相关，而合并狼疮性肾炎（OR=5.45，95%CI（0.52，56.95），P=0.16，I=58.4%）或环磷酰胺（CTX）治疗（OR=0.74，95%CI（0.16，3.41），P=0.70，I=75.5%）与生存率之间无明显关系。
结论：根据我们的荟萃分析，DAH 诊断时年龄较大、SLE 疾病持续时间较长、合并感染、血浆置换治疗和机械通气与 SLE 相关 DAH 患者死亡率增加相关。然而，由于存在异质性的研究有限，这些结果应谨慎解释。值得注意的是，严重疾病导致需要血浆置换治疗和机械通气本身与不良预后相关。需要随机临床试验来确定 SLE 相关 DAH 的最有效治疗策略，以更好地管理这种危及生命的并发症。
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