Persistent thrombocytopenia predicts poor long-term survival in patients with antiphospholipid syndrome: a 38-year follow-up study
| Autor: | José Pardos-Gea, Jaume Alijotas-Reig, José Ordi-Ros, Segundo Bujan, Joana Rita Marques-Soares |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty 030204 cardiovascular system & hematology Asymptomatic Gastroenterology Young Adult 03 medical and health sciences 0302 clinical medicine Rheumatology Antiphospholipid syndrome Internal medicine medicine Humans Pharmacology (medical) In patient Platelet Myocardial infarction Retrospective Studies 030203 arthritis & rheumatology business.industry Hazard ratio Middle Aged Antiphospholipid Syndrome medicine.disease Thrombocytopenia Thrombosis Cohort Female medicine.symptom business Follow-Up Studies |
| Zdroj: | Rheumatology. 61:1053-1061 |
| ISSN: | 1462-0332 1462-0324 |
| DOI: | 10.1093/rheumatology/keab475 |
| Popis: | Objectives To investigate the impact of thrombocytopenia on survival in patients with APS. Methods Thrombocytopenia and other predictors of outcome were retrospectively evaluated in an aPL-positive and APS cohort with 38-year follow-up (1980–2018). Thrombocytopenia was defined as Results Among 114 patients, 64% had primary APS, 25% secondary APS and 10% asymptomatic aPL. Mean follow-up was 19 (range 5–38) years. ANA [hazard ratio (HR) 1.8, 95% CI 0.8, 3.6, P = 0.10], arterial thrombotic events (HR 7.0, 95% CI 1.4, 3.5, P = 0.016), myocardial infarction (HR 8.3, 95% CI 1.1, 59, P = 0.03), intracardiac thrombosis (HR 17, 95% CI 1, 279, P = 0.04) and thrombocytopenia (HR 2.9, 95% CI 1.4, 6.1, P = 0.004) were risk factors for all-cause mortality, but in multivariate analysis only thrombocytopenia (HR 2.7, 95% CI 1.3, 6.0, P = 0.01) remained significant. Persistent (HR 4.4, 95% CI 2.1, 9.2, P = 0.001) and low–moderate thrombocytopenia (HR 2.8, 95% CI 1.2, 6.4, P = 0.01) were associated with a significant increase in mortality compared with acute (HR 1.6, 95% CI 0.5, 5.3, P = 0.40) and severe (HR 2.1, 95% CI 0.5, 9.2, P = 0.30) forms. APS patients with vs without thrombocytopenia were more frequently male (58 vs 24%, P = 0.001) with arterial thrombosis (55 vs 32%, P = 0.04), LA positivity (100 vs 87%, P = 0.04), type I aPL profile (89% vs 71%, P = 0.05) and anticoagulant treatment (89 vs 63%, P = 0.01). Thrombosis caused 13% of deaths in thrombocytopenic patients and 1% in those without (P = 0.01). Conclusion Thrombocytopenia is an aPL-related manifestation that identifies patients with severe disease phenotype and high thrombotic risk. Persistent low–moderate thrombocytopenia is associated with a reduced long-term survival. |
| Databáze: | OpenAIRE |
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