Clinical Immunology and Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Lupus Sci Med. 2023 Sep;10(2). doi: 10.1136/lupus-2023-000933.
Dysregulation of interferon-alpha (IFN-α) is considered central to the immunological abnormalities observed in SLE. Short-term mortality during high disease activity in lupus is up to 30%. Adenovirus vector-introduced IFN-α into a lupus-prone mouse causes the development of glomerulonephritis and death within weeks. We studied serum IFN-α as a biomarker of in-hospital mortality in patients of SLE with high disease activity.
Serum IFN-α (ELISA) was measured in patients hospitalised for acute severe lupus in a tertiary care rheumatology unit in India and the levels were compared between survivors and non-survivors. Serum IFN-α was compared with traditional clinical and serological markers associated with disease activity to assess which better prognosticates survival.
In a cohort of 90 patients with a mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) of 19.3 (±5.5), the mean serum IFN-α was 88±144 pg/dL. Levels were undetectable in patients with inactive disease. SLEDAI, anti double stranded DNA (dsDNA) antibody titres and serum IFN-α levels were higher and serum complement (C3) lower in non-survivors (p=0.003, p=0.017, p<0.001, p=0.029, respectively). Serum IFN-α level of 140 pg/mL had a sensitivity of 86.7%, specificity of 94.6%, positive predictive value of 76% and negative predictive value of 83.3% (p<0.001) in predicting mortality. The area under the curve for predicting in-hospital mortality was 0.25 for C3, 0.72 for dsDNA, 0.77 for SLEDAI and 0.92 for serum IFN-α.
Serum IFN-α was better in predicting in-hospital mortality compared with conventional measures of disease activity such as anti-dsDNA, complements and SLEDAI.
干扰素-α（IFN-α）的失调被认为是系统性红斑狼疮（SLE）中观察到的免疫异常的核心。狼疮活动期的短期死亡率高达 30%。腺病毒载体将 IFN-α导入狼疮易感小鼠，可在数周内引发肾小球肾炎和死亡。我们研究了血清 IFN-α作为狼疮活动期患者住院期间死亡率的生物标志物。
在印度一家三级风湿病护理中心，对因急性严重狼疮住院的患者进行了血清 IFN-α（ELISA）检测，并比较了幸存者和非幸存者之间的水平。将血清 IFN-α与与疾病活动相关的传统临床和血清学标志物进行比较，以评估哪种标志物更能预测生存率。
在一组平均系统性红斑狼疮疾病活动指数（SLEDAI）为 19.3（±5.5）的 90 例患者中，平均血清 IFN-α为 88±144pg/dL。无活动期疾病患者的水平无法检测到。非幸存者的 SLEDAI、抗双链 DNA（dsDNA）抗体滴度和血清 IFN-α水平更高，血清补体（C3）水平更低（p=0.003、p=0.017、p<0.001、p=0.029）。血清 IFN-α水平为 140pg/mL 时，预测死亡率的敏感性为 86.7%、特异性为 94.6%、阳性预测值为 76%、阴性预测值为 83.3%（p<0.001）。预测住院死亡率的曲线下面积分别为 C3 的 0.25、dsDNA 的 0.72、SLEDAI 的 0.77 和血清 IFN-α的 0.92。
与抗 dsDNA、补体和 SLEDAI 等常规疾病活动测量指标相比，血清 IFN-α更能预测住院期间的死亡率。
