Background Systemic lupus erythematosus (SLE) with thrombotic microangiopathy (TMA) has been reported in numerous patients with high mortality and poor renal prognosis. The risk factors and prognoses of these patients remain unknown.
Objectives The aim of this study is to investigate the predictive risk factors of TMA in SLE patients and analyze the prognoses.
Methods Clinical and laboratory parameters of 42 patients (SLE with TMA) and 84 patients (active lupus patients without TMA) were retrospectively analyzed. Clinical and laboratory data was also compared between 17 patients with renal-limited TMA and 25 patients with TTP-HUS. Logistic regression and Kaplan-Meier survival curves were statistically tested with the logrank test. HRs and their 95% CIs were calculated using the multivariate Cox proportional-hazards model.
Results SLE patients with TMA suffered more neurological and cardiac involvements, as well as poor renal function. More plasma was exchanged (42.9% vs. 2.4%) and infused (64.3% vs. 40.5%) in these patients. Serological creatinine and C-reactive protein were independent risk factors for TMA. TMA patients presented poorer outcome (P=0.024), while a longer survival was expected in renal-limited TMA patients (P=0.046). In lupus patients with TMA, serum creatinine value (hazard ratio=1.005, P=0.014) and C-reactive protein levels (hazard ratio=1.009, P=0.058) predicted poor outcome.
Conclusions Serum creatinine value and C-reactive protein levels were predictive for lupus with TMA. Renal-limited TMA patients presented relatively better outcome than patients with TTP-HUS.
Song D, Wu LH, Wang FM, Yang XW, Zhu D, Chen M, et al. The spectrum of renal thrombotic microangiopathy in lupus nephritis. Arthritis Res Ther 2013;15:R12.
Hamasaki K, Mimura T, Kanda H, Kubo K, Setoguchi K, Satoh T, et al. Systemic lupus erythematosus and thrombotic thrombocytopenic purpura: a case report and literature review. Clin Rheumatol 2003;22:355–8.
Acknowledgement The authors would like to thank doctor Guangtao Li and Yanjie Hao for statistic analysis guidance in Peking University First Hospital. The authors also thank to Professor Feng Yu and Doctor Yun Pang for their follow-up of these patients in Nephrology Department of Peking University First Hospital.
Disclosure of Interest None declared