Rheumatology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal.
Rheumatology Department, Centro Hospitalar de Leiria, Leiria, Portugal.
Clin Rheumatol. 2022 Oct;41(10):2977-2986. doi: 10.1007/s10067-022-06251-7. Epub 2022 Jun 23.
INTRODUCTION/OBJECTIVES: Recognising systemic lupus erythematosus (SLE) patients at higher risk for hospitalization, aiming at developing tailored management strategies, may help minimize admissions and improve long-term health outcomes. Our study aimed to identify predictors for hospitalization in patients with SLE.
Cohort study of SLE patients followed in a referral centre. All hospitalizations from study baseline up to 120 months were identified, and the primary indication for admission was categorized as follows: (1) SLE disease activity; (2); infection; and (3) other conditions. Demographic, clinical, and laboratory parameters at baseline were sought as predictors of hospitalization for (i) any cause, (ii) disease activity, and (iii) infection using survival analysis with Kaplan-Meier curves and log-rank tests. Potential predictors were further tested using multivariate Cox proportional hazards regression models.
We included 398 patients (median follow-up: 120 months). The incidence rate of hospitalization was 17.7 per 100 patient-years. The most frequent indications for hospitalization were SLE disease activity (29.4%) and infection (23.4%). In multivariate analysis, male gender, age > 50 years, antiphospholipid antibodies positivity (aPL), SLEDAI-2 K > 5, organ damage, and prednisone daily dose (PDN) predicted hospitalization for any cause. SLEDAI-2 K > 5, aPL, PDN, and IS medication predicted hospitalization for active SLE. Male gender, prior biopsy-proven lupus nephritis, aPL, organ damage, and ongoing treatment with high-risk IS predicted hospitalization for infection. Treatment with antimalarials was associated with a lower risk of hospitalization for any cause and for infection.
Positive aPL identifies SLE patients presenting a higher risk of hospitalization, while medication with antimalarials was associated with a lower risk. Key Points • Positive aPL is predictive of hospitalization for any medical condition, disease activity, and infection • Organ damage is predictive of hospitalization for any condition and infection • Antimalarials are predictive of a lower risk of hospitalization for any condition and infection.
简介/目的：识别患有系统性红斑狼疮（SLE）的患者中住院风险较高的人群，旨在制定有针对性的管理策略，可能有助于减少住院人数并改善长期健康结果。本研究旨在确定 SLE 患者住院的预测因素。
对一家转诊中心的 SLE 患者进行队列研究。确定从研究基线到 120 个月的所有住院情况，并将入院的主要指征分为以下几类：（1）SLE 疾病活动；（2）感染；（3）其他情况。在基线时寻找人口统计学，临床和实验室参数，以预测（i）任何原因，（ii）疾病活动和（iii）感染的住院情况，使用 Kaplan-Meier 曲线和对数秩检验进行生存分析。使用多变量 Cox 比例风险回归模型进一步测试潜在的预测因素。
我们纳入了 398 例患者（中位随访时间：120 个月）。住院率为每 100 患者年 17.7 例。住院最常见的指征是 SLE 疾病活动（29.4%）和感染（23.4%）。在多变量分析中，男性，年龄>50 岁，抗磷脂抗体阳性（aPL），SLEDAI-2 K>5，器官损害和泼尼松每日剂量（PDN）预测任何原因的住院。SLEDAI-2 K>5，aPL，PDN 和 IS 药物预测 SLE 活动的住院。男性，先前经活检证实的狼疮肾炎，aPL，器官损害和正在接受高风险 IS 治疗的患者预测感染住院。使用抗疟药与任何原因和感染的住院风险降低相关。
阳性 aPL 可识别出住院风险较高的 SLE 患者，而使用抗疟药与降低住院风险相关。关键点•阳性 aPL 可预测任何医疗状况，疾病活动和感染的住院•器官损害可预测任何疾病和感染的住院•抗疟药可预测任何疾病和感染的住院风险降低。
