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FRI0346 Neutropenia in systemic lupus: prevalence, specific features and clinical consequences. results from the large upper rhine database lbbr
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  1. A. Meyer1,
  2. P.-E. Gavand1,
  3. G. Blaison2,
  4. T. Martin1,
  5. A.-S. Korganow1,
  6. A. Guffroy1,
  7. on behalf of LBBR Study Group
  1. 1Clinical Immunology, CHRU Strasbourg, Strasbourg
  2. 2Internal Medicine, CH Colmar, Colmar, France

Abstract

Background The prevalence, pathophysiology and underlying causes or consequences of neutropenia in systemic lupus erythematosus (SLE) are still not well defined even if neutropenia seems to be rather common in this disease.1

Objectives To evaluate the prevalence of neutropenia in a large cohort of SLE patients and to identify correlation between neutropenia and other socio-demographical, clinical, serological or therapeutic factors.

To precise the influence of chronicity or severity of neutropenia in the course of SLE.

Methods We used the LBBR database, a cross-sectional collection of detailed socio-demographic, clinical, serological and therapeutic data from 1,078 SLE patients (14 french or german Upper Rhine Hospitals).

Neutropenia was defined by the presence of less than 1800 circulating neutrophils×109/L. Patients with and without neutropenia were compared considering 47 variables.

The second part of the study focused on a subgroup of SLE LBBR patients for which full data were available about the duration and depth of neutropenia. Chronic neutropenia was defined by neutrophils count less than 1,500×109/L during at least 6 months and moderate and severe neutropenias were defined by neutrophils count less than 1,000×109/L.

Results Among 1078 SLE patients, 223 (20.7%) were registered with neutropenia during their history. Mean age and sex ratio were comparable to the whole SLE cohort and to patients without neutropenia (mean age: 43.9 years old, sex ratio: 194 F/28 M). In multivariate analysis, neutropenia was associated with lymphopenia (OR=3.44 (2.48–4.80), p=0.0002) and thrombopenia (OR=3.59 (2.55–5.06), p=0.0002). There was no association with susceptibility to infections (OR 0.97 (0.52–1.80), p=0.6640), neither with SLEDAI score, SLE treatments or other ACR criteria.

Sixty-five patients out of 223, for which deepness and duration of neutropenia were available, were compared with patients without neutropenia. Moderate and severe neutropenias were again statistically associated with lymphopenia (OR 11.25 (2.60–48.61), p=0.0468) and thrombopenia (OR 8.1 (3.28–19.99), p=0.0014). There was again no association with susceptibility to infections or with treatment at sampling. In this group, using multivariate analysis, chronic neutropenia was statistically associated with lymphopenia (OR 9.48 (2.83–31.71), p=0.0177), low C3 (OR 3.81 (1.59–9.14), p=0.0053), anti-SSA antibodies (OR 2.40 (1.07–5.39), p=0.0042) and Sjögren syndrome (2.56 (0.93–7.03), p=0.0435).

Conclusions The large LBBR cohort allows an approach of neutropenia prevalence and characteristics in SLE. Neutropenia concerns about 20% of SLE patients. Considering multivariate analysis, it is not directly linked to treatment and appears separated from infections occurrence, even when severe. Neutropenia in SLE is significantly associated with thrombopenia and lymphopenia, defining a subtype of SLE patients with haematological features and suggesting possible common pathophysiology.

Reference [1] Carli L, Tani C, Vagnani S, et al. Leukopenia, lymphopenia, and neutropenia in systemic lupus erythematosus: Prevalence and clinical impact – A systematic literature review. Semin Arthritis Rheum2015;45(2):190–4.

Disclosure of Interest None declared

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