Predictors of severe hemolytic anemia and its impact on major outcomes in systemic lupus erythematosus: Data from a multiethnic Latin American cohort.

Autor: González LA; División de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia., Alarcón GS; Division of Clinical Immunology and Rheumatology, Department of Medicine, Marnix E. Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.; Department of Medicine, School of Medicine, Universidad Peruana Cayetano, Heredia, Lima, Perú., Harvey GB; Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina., Quintana R; Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina., Pons-Estel GJ; Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina., Ugarte-Gil MF; Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.; Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Científica del Sur, Lima, Perú., Vásquez G; División de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia., Catoggio LJ; Rheumatology Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., García MA; Servicio de Reumatología, HIGA San Martin de La Plata, Buenos Aires, Argentina., Borba EF; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil., Da Silva NA; Rheumatology Unit, Faculdade de Medicina da Universidad e Federal de Goias, Goiania, Brazil., Tavares Brenol JC; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Toledano MG; Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba., Massardo L; Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago de Chile, Chile., Neira O; Sección de Reumatología, Hospital del Salvador, Universidad de Chile, Santiago, Chile., Pascual-Ramos V; Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Ciudad de México, México., Amigo MC; Reumatología, Centro Médico ABC, Ciudad de México, México., Barile-Fabris LA; Hospital Ángeles del Pedregal, Ciudad de México, México., De La Torre IG; Departamento de Inmunología y Reumatología, Hospital General de Occidentede la S.S. y Universidad de Guadalajara, Zapopan, Jalisco, México., Alfaro-Lozano J; Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú., Segami MI; Hospital Nacional 'Edgardo Rebagliati Martins', Essalud, Lima, Perú., Chacón-Díaz R; Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela., Esteva-Spinetti MH; Servicio de Reumatología, Departamento de Medicina, Hospital Central de San Cristóbal, San Cristóbal, Venezuela., Iglesias-Gamarra A; Unidad de Reumatología, Departamento de Medicina Interna, Universidad Nacional de Colombia, Bogotá, Colombia., Pons-Estel BA; Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina.
Jazyk: angličtina
Zdroj: Lupus [Lupus] 2023 Apr; Vol. 32 (5), pp. 658-667. Date of Electronic Publication: 2023 Mar 14.
DOI: 10.1177/09612033231163745
Abstrakt: Objective: To determine the predictors of the occurrence of severe autoimmune hemolytic anemia (AIHA) and its impact on damage accrual and mortality in SLE patients.
Methods: Factors associated with time to severe AIHA (hemoglobin level ≤7 g/dL) occurring from the onset of SLE symptoms were examined by Cox proportional hazards regressions. The association of severe AIHA with mortality was examined by logistic regression analyses while its impact on damage was by negative binomial regression.
Results: Of 1,349 patients, 49 (3.6%) developed severe AIHA over a mean (SD) follow-up time of 5.4 (3.8) years. The median time from the first clinical manifestation to severe AIHA was 111 days (IQR 43-450). By multivariable analysis, male sex (HR 2.26, 95% CI 1.02-4.75, p = 0.044), and higher disease activity at diagnosis (HR 1.04, 95% CI 1.01-1.08, p = 0.025) were associated with a shorter time to severe AIHA occurrence. Of the SLEDAI descriptors, only hematologic (leukopenia and/or thrombocytopenia) showed a certain trend toward significance in the multivariable analysis (HR 2.36, 95% CI 0.91-6.13, p = 0.0772). Severe AIHA contributed neither to damage nor to mortality.
Conclusions: Severe AIHA occurs during the early course of SLE. Male sex and higher disease activity at diagnosis emerged as independent predictors of a shorter time to severe AIHA occurrence. Although not statistically significant, hematological abnormalities at SLE diagnosis could predict the occurrence of severe AIHA in a shorter time. Damage and mortality did not seem to be impacted by the occurrence of severe AIHA.
Databáze: MEDLINE
Externí odkaz: