Department of Pharmacy, College of Medicine and Health Sciences, Madda Walabu University, Bale Goba, Ethiopia.
Department of Internal Medicine, School of Medicine, College of Health Sciences, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Sci Rep. 2024 Mar 7;14(1):5603. doi: 10.1038/s41598-024-56317-6.
Lupus nephritis (LN) is kidney involvement of systematic lupus erythematous that ranges from mild to severe and occurs in 60% of adult patients. Despite advances in therapy, LN morbidity and mortality remains high. There is a paucity of data regarding adult LN patient's treatment outcome, survival status, and associated factors in developing countries, particularly in Ethiopia. This study aimed to assess the treatment outcome, survival status, and associated factors of adult patients treated for LN in two selected tertiary hospitals [Tikur Anbessa Specialized Hospital (TASH) and St. Paul's Hospital Millennium Medical College (SPHMMC)] of Addis Ababa, Ethiopia. A hospital-based retrospective cross-sectional multicenter study was conducted from January 1, 2016 to January 1, 2021. Socio-demographic, clinical, and treatment-related data were collected from patient's medical records by using a structured abstraction checklist. Descriptive statistics were used to summarize the quantitative data as appropriate. The modified Aspreva Lupus Management Study (mALMS) criteria was applied to categorize LN treatment outcomes into complete, partial, and non-response. Multinomial logistic regression analysis was performed to identify predictors of LN treatment outcome. Patients' survival was estimated by using Kaplan-Meier and Cox proportion regression analysis. P value < 0.05 was considered to declare statistical significance. A total of 200 LN patients were included in the final analysis. Amongst these, the majority of them (91.5%) were females. The median age of the patients was 28 (15-60) years. The mean duration of treatment follow-up was 28 months. The commonly prescribed immunosuppressive drugs during both the induction (49.5%) and maintenance (60%) phases were a combination of mycophenolate mofetil with prednisolone. Complete, partial, and non-responses at the last follow-up visit accounted for 66.5%, 18.0%, and 15.5%, respectively. Patient survival at the last follow-up visit was more than 90% for patients with complete response to the induction therapy. Non-response at the last follow-up visit was significantly associated with severe disease activity index (adjusted odds ratio [AOR] = 6.25, 95% confidence interval [CI] 1.49-26.10), presence of comorbidity (AOR = 0.21, 95% CI 0.05-0.92), baseline leucopenia (AOR = 14.2, 95% CI 1.04-201.3), partial response at the end of induction therapy (AOR = 32.63, 95% CI 1.4-736.0), and duration of induction therapy of greater than 6 months (AOR = 19.47, 95% CI 1.5-258.8). This study unveiled that lower numbers of LN patients were presented with non-response at the last follow-up visit and non-response to induction therapy was associated with lower patients' survival rates compared with complete or partial response.
狼疮性肾炎（LN）是系统性红斑狼疮累及肾脏的一种疾病，其严重程度从轻度到重度不等，发生在 60%的成年患者中。尽管治疗取得了进展，但 LN 的发病率和死亡率仍然很高。在发展中国家，特别是在埃塞俄比亚，关于成人 LN 患者的治疗结果、生存状况和相关因素的数据很少。本研究旨在评估在埃塞俄比亚亚的斯亚贝巴的两家选定的三级医院[提克里克·安贝萨专科医院（TASH）和圣保禄圣保罗医院千年医科大学（SPHMMC）]治疗 LN 的成年患者的治疗结果、生存状况和相关因素。这是一项从 2016 年 1 月 1 日至 2021 年 1 月 1 日进行的基于医院的回顾性横断面多中心研究。从患者的病历中使用结构化摘要检查表收集社会人口统计学、临床和治疗相关数据。适当使用描述性统计来总结定量数据。采用改良的 Aspreva 狼疮管理研究（mALMS）标准将 LN 治疗结果分为完全、部分和无反应。使用多项逻辑回归分析来确定 LN 治疗结果的预测因素。使用 Kaplan-Meier 和 Cox 比例回归分析估计患者的生存情况。p 值<0.05 被认为具有统计学意义。共有 200 名 LN 患者纳入最终分析。其中，大多数（91.5%）是女性。患者的中位年龄为 28 岁（15-60 岁）。治疗随访的平均时间为 28 个月。在诱导期（49.5%）和维持期（60%），最常开的免疫抑制剂是霉酚酸酯联合泼尼松。在最后一次随访时，完全、部分和无反应分别占 66.5%、18.0%和 15.5%。在诱导治疗完全反应的患者中，最后一次随访时的患者生存率超过 90%。无反应与严重疾病活动指数显著相关（调整后的比值比[OR]为 6.25，95%置信区间[CI]为 1.49-26.10）、合并症（OR 为 0.21，95%CI 为 0.05-0.92）、基线白细胞减少症（OR 为 14.2，95%CI 为 1.04-201.3）、诱导治疗结束时部分反应（OR 为 32.63，95%CI 为 1.4-736.0）和诱导治疗时间大于 6 个月（OR 为 19.47，95%CI 为 1.5-258.8）。本研究表明，较少的 LN 患者在最后一次随访时表现为无反应，与完全或部分反应相比，无反应与较低的患者生存率相关。
