Jolly Meenakshi, Katz Patricia
Department of Medicine, Rush University Medical Center, Chicago, IL, United States.
Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.
Front Med (Lausanne). 2022 Sep 29;9:986968. doi: 10.3389/fmed.2022.986968. eCollection 2022.
Stress is common in patients with Systemic Lupus Erythematosus (SLE), and is associated with depression, fatigue, and disease flares. Stress may be modifiable and identifying those at high risk allows clinicians and allied health care professionals to develop a multidisciplinary management plan to direct appropriate resources. This study is aimed at identifying predictors of high stress over time among patients with SLE.
Longitudinal data from two interviews of the Lupus Outcomes Study 2 years apart from 726 patients with SLE were analyzed for stress, measured using the Perceived Stress Scale (PSS; high-stress PSS ≥6). -test and Chi-square analyses compared patient characteristics by high-stress status. Logistic regressions were conducted with high stress as the dependent variable. Covariates included demographics, disease features, quality of life (QOL), health care utilization (HCU), and comorbidities. QoL was measured using the SF-36 form (Physical Component Score, PCS; Mental Component Score, MCS) and MOS Cognitive Functioning Scale (CFS). HCU indicated having established care with a rheumatologist, use of an emergency room or hospitalization, and quality of care. ≤ 0.05 were considered significant.
The mean age of the cohort was 50.6 (12.5) years, 92% were women and 68% were Caucasian. The mean (SD) PSS was 5.3 (3.6), and high stress (PSS >6) was noted in 253 participants. Those with high stress were more frequently below the poverty line and less commonly employed. They had a greater prevalence of comorbidities and HCU; and worse disease severity (activity, flare, damage) and QOL. In regression analyses, high stress (baseline) was associated with younger age, married status, worse QOL, and presence of diabetes. Better QOL (PCS, MCS) independently predicted decreased odds of high stress, while high stress (baseline) predicted high stress (OR 3.16, 95% CI 1.85, 5.37, < 0.0001) at follow-up, after adjusting for demographics, disease features, HCU, and comorbidities.
Patients with SLE should be routinely screened for QOL and stress during their clinical care, to identify those at risk for poor health outcomes. This information can facilitate multidisciplinary management for those at risk for worse health outcomes.
压力在系统性红斑狼疮（SLE）患者中很常见，且与抑郁、疲劳和疾病发作有关。压力可能是可以改变的，识别高危人群可使临床医生和相关医疗保健专业人员制定多学科管理计划，以合理分配资源。本研究旨在确定SLE患者长期高压力的预测因素。
对狼疮结局研究中726例SLE患者相隔两年的两次访谈的纵向数据进行分析，以评估压力，采用感知压力量表（PSS；高压力定义为PSS≥6）进行测量。采用t检验和卡方分析按高压力状态比较患者特征。以高压力为因变量进行逻辑回归分析。协变量包括人口统计学特征、疾病特征、生活质量（QOL）、医疗保健利用情况（HCU）和合并症。生活质量采用SF-36量表（生理成分得分，PCS；心理成分得分，MCS）和MOS认知功能量表（CFS）进行测量。医疗保健利用情况指标包括是否已在风湿病专家处就诊、是否使用过急诊或住院以及医疗质量。P≤0.05被认为具有统计学意义。
该队列的平均年龄为50.6（12.5）岁，92%为女性，68%为白种人。PSS的平均（标准差）值为5.3（3.6），253名参与者存在高压力（PSS>6）。高压力者更频繁地处于贫困线以下且就业情况较少见。他们合并症和医疗保健利用情况的患病率更高；疾病严重程度（活动度、发作、损伤）和生活质量更差。在回归分析中，高压力（基线）与年龄较小、已婚状态、较差的生活质量和糖尿病的存在有关。较好的生活质量（PCS、MCS）独立预测高压力几率降低，而高压力（基线）在调整人口统计学特征、疾病特征、医疗保健利用情况和合并症后，预测随访时的高压力（比值比3.16，95%可信区间1.85，5.37，P<0.0001）。
SLE患者在临床护理期间应常规筛查生活质量和压力，以识别健康结局较差的高危人群。这些信息有助于对健康结局较差的高危人群进行多学科管理。
