scholarly journals Association between organ damage and mortality in systemic lupus erythematosus: a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e031850 ◽  
Author(s):  
Irene B Murimi-Worstell ◽  
Dora H Lin ◽  
Henk Nab ◽  
Hong J Kan ◽  
Oluwadamilola Onasanya ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systemic Lupus Erythematosus ◽  
Latin American ◽  
Lupus Erythematosus ◽  
Meta Analysis ◽  
Damage Index ◽  
Organ Damage ◽  
Cochrane Library ◽  
Systemic Lupus ◽  
Cross Sectional

ObjectiveAt least half of patients with systemic lupus erythematosus (SLE) develop organ damage as a consequence of autoimmune disease or long-term therapeutic steroid use. This study synthesised evidence on the association between organ damage and mortality in patients with SLE.DesignSystematic review and meta-analysis.MethodsElectronic searches were performed in PubMed, Embase, Cochrane Library and Latin American and Caribbean Health Sciences Literature for observational (cohort, case-control and cross-sectional) studies published between January 2000 and February 2017. Included studies reported HRs or ORs on the association between organ damage (measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score) and mortality. Study quality was assessed using the modified Newcastle-Ottawa assessment. Pooled HRs were obtained using the DerSimonian and Laird random-effects model. Heterogeneity was assessed using the Cochrane Q (Q) and I2 statistics.ResultsThe search yielded 10 420 articles, from which 21 longitudinal studies were selected. Most studies (85%) were of high quality. For 10 studies evaluating organ damage (SDI) as a continuous variable and reporting HR as a measure of association, a 1-unit increase in SDI was associated with increased mortality; pooled HR was 1.34 (95% CI: 1.24 to 1.44, p<0.001; Q p=0.027, I2=52.1%). Exclusion of one potential outlying study reduced heterogeneity with minimal impact on pooled HR (1.33 (95% CI: 1.25 to 1.42), p<0.001, Q p=0.087, I2=42.0%). The 11 remaining studies, although they could not be aggregated because of their varying patient populations and analyses, consistently demonstrated that greater SDI was associated with increased mortality.ConclusionsOrgan damage in SLE is consistently associated with increased mortality across studies from various countries. Modifying the disease course with effective therapies and steroid-sparing regimens may reduce organ damage, improve outcomes and decrease mortality for patients with SLE.

scholarly journals Systemic lupus erythematosus; stroke and myocardial infarction risk: a systematic review and meta-analysis

RMD Open ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e001247
Author(s):  
Jinoos Yazdany ◽  
Nick Pooley ◽  
Julia Langham ◽  
Lindsay Nicholson ◽  
Sue Langham ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Meta Analysis ◽  
Adult Patients ◽  
Sensitivity Analyses ◽  
Future Research ◽  
Systemic Lupus ◽  
Cross Sectional

ObjectiveTo evaluate the risk of stroke and myocardial infarction (MI) in adult patients with systemic lupus erythematosus (SLE) through a systematic review and meta-analysis.MethodsWe searched MEDLINE and EMBASE from inception to May 2020 to identify observational studies (cohort and cross-sectional) that evaluated risk of stroke and MI in adult patients with SLE compared with the general population or healthy controls. Studies were included if they reported effect-size estimates that could be used for calculating pooled-effect estimates. Random-effects models were used to calculate pooled risk ratios (RRs) and 95% CIs for stroke and MI. Heterogeneity quantified by the I2 test and sensitivity analyses assessed bias.ResultsIn total, 26 studies were included in this meta-analysis: 14, 5 and 7 studies on stroke, MI and both stroke and MI, respectively. The pooled RR for ischaemic stroke was 2.18 (95% CI 1.78 to 2.67; I2 75%), intracerebral haemorrhage 1.84 (95% CI 1.16 to 2.90; I2 67%), subarachnoid haemorrhage 1.95 (95% CI 0.69 to 5.52; I2 94%), composite stroke 2.13 (95% CI 1.73 to 2.61; I2 88%) and MI 2.99 (95% CI 2.34 to 3.82; I2 85%). There was no evidence for publication bias, and sensitivity analyses confirmed the robustness of the results.ConclusionsOverall, patients with SLE were identified to have a twofold to threefold higher risk of stroke and MI. Future research on the interaction between known SLE-specific modifiable risk factors and risk of stroke and MI to support development of prevention and treatment strategies are needed.PROSPERO registration numberCRD42018098690.

scholarly journals Cardiovascular Disease in Latin American Patients with Systemic Lupus Erythematosus: A Cross-Sectional Study and a Systematic Review

2013 ◽  
Vol 2013 ◽  
pp. 1-20 ◽  
Author(s):  
Jenny Amaya-Amaya ◽  
Juan Camilo Sarmiento-Monroy ◽  
Julián Caro-Moreno ◽  
Nicolás Molano-González ◽  
Rubén D. Mantilla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Latin American ◽  
Lupus Erythematosus ◽  
Coffee Consumption ◽  
Independent Effect ◽  
Systemic Lupus ◽  
Cross Sectional

Objective. This study was performed to determine the prevalence of and associated risk factors for cardiovascular disease (CVD) in Latin American (LA) patients with systemic lupus erythematosus (SLE).Methods. First, a cross-sectional analytical study was conducted in 310 Colombian patients with SLE in whom CVD was assessed. Associated factors were examined by multivariate regression analyses. Second, a systematic review of the literature on CVD in SLE in LA was performed.Results. There were 133 (36.5%) Colombian SLE patients with CVD. Dyslipidemia, smoking, coffee consumption, and pleural effusion were positively associated with CVD. An independent effect of coffee consumption and cigarette on CVD was found regardless of gender and duration of disease. In the systematic review, 60 articles fulfilling the eligibility criteria were included. A wide range of CVD prevalence was found (4%–79.5%). Several studies reported ancestry, genetic factors, and polyautoimmunity as novel risk factors for such a condition.Conclusions. A high rate of CVD is observed in LA patients with SLE. Awareness of the observed risk factors should encourage preventive population strategies for CVD in patients with SLE aimed at facilitating the suppression of cigarette smoking and coffee consumption as well as at the tight control of dyslipidemia and other modifiable risk factors.

The relationship between pemphigus and systemic lupus erythematosus: a cross-sectional study, systematic review, and meta-analysis

2019 ◽  
Vol 67 (1) ◽  
pp. 116-122
Author(s):  
Khalaf Kridin ◽  
Rimma Laufer-Britva ◽  
Mouhammad Kridin ◽  
Doron Comaneshter ◽  
Erez Batat ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Meta Analysis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
The Relationship

Low-dose glucocorticoid should be withdrawn or continued in systemic lupus erythematosus? A systematic review and meta-analysis on risk of flare and damage accrual

Rheumatology ◽  
2021 ◽  
Author(s):  
Lanlan Ji ◽  
Wenhui Xie ◽  
Zhuoli Zhang
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Low Dose ◽  
Meta Analysis ◽  
Organ Damage ◽  
Cochrane Library ◽  
Systemic Lupus ◽  
Major Flare ◽  
Increased Risk ◽  
Damage Accrual

Abstract Objective To assess the risk of flare and damage accrual after low dose glucocorticoids (GC) discontinuation in systemic lupus erythematosus (SLE). Methods We performed a comprehensive literature search of PubMed, EMBASE, Cochrane library and Scopus databases from inception to July 2020 for studies concerning relapses/damage accrual in SLE patients. Pooled incidence rates of flare and time to flare with their 95% confidence intervals (CI) after GC withdrawal were calculated. Summary risk ratio (RR) and 95% CI of flare/organ damage accrual risk were computed using a random or fixed effects model. Results 738 SLE patients with GC discontinuation in 17 publications were eligible for the final analysis. In the primary meta-analysis, the pooled incidence of flare was 24% (95% CI 21-27%) and 13% (95% CI 8-18%) for global and major flare respectively. Pooled time to flare was 21.08 (95% CI 9.32-32.85) months. In the secondary meta-analysis, GC discontinuation showed an increased risk of flare comparing with GC continuation [RR (95% CI) =1.38 (1.01-1.89)], but the risk of major flares was not increased (RR = 1.77, 95% CI 0.40-7.83). Moreover, GC withdrawal was associated with a borderline reduction of risk in SDI increase in comparison with GC continuation (RR = 0.64, 95% CI 0.38 - 1.09). Conclusion GC discontinuation leads to a slightly increased risk of flare, however no increase in major flare and a borderline reduction of risk in further damage in SLE patients. Baseline screening for candidate patients and long-term follow up after GC withdrawal are needed to reliably evaluate the organ damage increase.

scholarly journals Neuro-psychiatric manifestations in patients with systemic lupus erythematosus: A systematic review and results from the Swiss lupus cohort study

Lupus ◽  
2021 ◽  
pp. 096120332110256
Author(s):  
Aline L Meier ◽  
Nicolas S Bodmer ◽  
Carla Wirth ◽  
Lucas M Bachmann ◽  
Camillo Ribi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
Lupus Erythematosus ◽  
Meta Analysis ◽  
Systemic Autoimmune Disease ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Study Characteristics ◽  
Diagnostic Work

Objectives Systemic lupus erythematosus (SLE) is a systemic autoimmune disease associated with neuro-psychiatric (NP) manifestations. Frequency and patterns of neuro-psychiatric systemic lupus erythematosus (NPSLE) vary substantially between patients. We conducted a systematic review (SR) of the literature and examined prevalence and characteristics of NPSLE in the Swiss SLE cohort study (SSCS). Methods The SR search was performed between January 1999 and January 2020. We included prospective/cross-sectional studies focusing on NPSLE. We secured study characteristics, cohort compositions and frequencies of NP manifestations, assessed heterogeneity across reports and investigated sources of variation using meta-regression models. Regarding the SSCS, we reviewed all patients included and classified NP manifestations. Results The SR searches identified 530 studies. We included 22 studies in our meta-analysis, the mean frequency of NPSLE ranged from 10.6% to 96.4%. The frequency of NPSLE in the SSCS was 28.1%. Severe events including cerebrovascular insults, seizures and psychosis appeared in 7.1%, 5.3% and 6.5% respectively. There was a linear relationship between duration of SLE and cumulative incidence of NPSLE. Conclusions The spectrum of NPSLE is very broad. The diagnostic work-up and rates of reported manifestations varied substantially across studies. We call for concerted efforts and consensus regarding definitions of NPSLE that will facilitate accurate diagnosis and attribution to SLE, particularly with a view to timely intervention and patient outcomes.

scholarly journals Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL)

RMD Open ◽  
2020 ◽  
Vol 6 (3) ◽  
pp. e001299
Author(s):  
Cristina Reátegui-Sokolova ◽  
Manuel F Ugarte-Gil ◽  
Guillermina B Harvey ◽  
Daniel Wojdyla ◽  
Guillermo J Pons-Estel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Latin American ◽  
Lupus Erythematosus ◽  
Renal Damage ◽  
Cox Regression ◽  
Damage Index ◽  
Early Response ◽  
Male Gender ◽  
Systemic Lupus

AimA decrease in proteinuria has been considered protective from renal damage in lupus nephritis (LN), but a cut-off point has yet to be established. The aim of this study was to identify the predictors of renal damage in patients with LN and to determine the best cut-off point for a decrease in proteinuria.MethodsWe included patients with LN defined clinically or histologically. Possible predictors of renal damage at the time of LN diagnosis were examined: proteinuria, low complement, anti-double-stranded DNA antibodies, red cell casts, creatinine level, hypertension, renal activity (assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)), prednisone dose, immunosuppressive drugs and antimalarial use. Sociodemographic variables were included at baseline. Proteinuria was assessed at baseline and at 12 months, to determine if early response (proteinuria <0.8 g/day within 12 months since LN diagnosis) is protective of renal damage occurrence. Renal damage was defined as an increase of one or more points in the renal domain of The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). Cox regression models using a backward selection method were performed.ResultsFive hundred and two patients with systemic lupus erythematosus patients were included; 120 patients (23.9%) accrued renal damage during their follow-up. Early response to treatment (HR=0.58), antimalarial use (HR=0.54) and a high SES (HR=0.25) were protective of renal damage occurrence, whereas male gender (HR=1.83), hypertension (HR=1.86) and the renal component of the SLEDAI (HR=2.02) were risk factors for its occurrence.ConclusionsEarly response, antimalarial use and high SES were protective of renal damage, while male gender, hypertension and higher renal activity were risk factors for its occurrence in patients with LN.

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