Molnár Adél, Juha Márk, Bulajcsík Klaudia, Tabák Ádám Gy, Tislér András, Ledó Nóra
Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary.
Institute of Preventive Medicine and Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary.
Front Immunol. 2024 Jul 24;15:1405463. doi: 10.3389/fimmu.2024.1405463. eCollection 2024.
Patients with systemic lupus erythematosus are prone to develop cardiovascular disease (CVD), and have increased morbidity and mortality.
We conducted a retrospective analysis on lupus nephritis patients to assess the occurrence and predictors of major adverse cardiovascular events (MACE). Data were collected from patients who underwent kidney biopsy between 2005 and 2020. Statistical analysis was performed to unveil correlations.
91 patients were analyzed in this period, with a mean age of 37.3 ± 12.3 years and 86% being female. The mean follow-up time was 62 ± 48 months. 15.38% of the patients underwent at least one MACE. Two patients deceased of CVD. Increased age (35.81 ± 11.14 vs 45.5 ± 15.11 years, p=0.012) entailed a higher occurrence of MACEs. Neutrophil count (5.15 ± 2.83 vs 7.3 ± 2.99 Giga/L, p=0.001) was higher, whereas diastolic blood pressure (DBP) was lower (89.51 ± 10.96 vs 78.43 ± 6.9 mmHg, p<0.001) at the time of the biopsy in patients with MACE. Age, neutrophil count, and DBP proved to be independent predictors of MACEs. We propose a new model (CANDE - Cardiovascular risk based on Age, Neutrophil count, and Diastolic blood pressure Estimation score) calculated from these variables, which predicts the probability of MACE occurrence.
This study underscores the importance of actively screening for cardiovascular risks in this vulnerable patient population. Age, neutrophil count, and diastolic blood pressure have been established as independent risk factors for MACE in lupus nephritis. The CANDE score derived from these parameters may serve as a prompt, cost-effective, and easily accessible estimation tool for assessing the likelihood of major adverse cardiovascular risk. These findings emphasize the necessity for comprehensive management strategies addressing both immune dysregulation and cardiovascular risk factors in systemic lupus erythematosus to mitigate adverse outcomes.
系统性红斑狼疮患者易患心血管疾病（CVD），其发病率和死亡率均有所增加。
我们对狼疮性肾炎患者进行了回顾性分析，以评估主要不良心血管事件（MACE）的发生情况及预测因素。数据收集自2005年至2020年间接受肾活检的患者。进行统计分析以揭示相关性。
在此期间分析了91例患者，平均年龄为37.3±12.3岁，86%为女性。平均随访时间为62±48个月。15.38%的患者发生了至少一次MACE。两名患者死于CVD。年龄增加（35.81±11.14岁对45.5±15.11岁，p = 0.012）导致MACE发生率更高。发生MACE的患者在活检时中性粒细胞计数更高（5.15±2.83对7.3±2.99千兆/L，p = 0.001），而舒张压（DBP）更低（89.51±10.96对78.43±6.9 mmHg，p<0.001）。年龄、中性粒细胞计数和DBP被证明是MACE的独立预测因素。我们根据这些变量提出了一种新模型（CANDE——基于年龄、中性粒细胞计数和舒张压估计评分的心血管风险模型），该模型可预测MACE发生的概率。
本研究强调了在这一脆弱患者群体中积极筛查心血管风险的重要性。年龄、中性粒细胞计数和舒张压已被确定为狼疮性肾炎中MACE的独立危险因素。由这些参数得出的CANDE评分可作为一种快速、经济有效且易于获取的估计工具，用于评估主要不良心血管风险的可能性。这些发现强调了在系统性红斑狼疮中制定综合管理策略以解决免疫失调和心血管危险因素从而减轻不良后果的必要性。
