Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort.
Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort.
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DOI：
10.1136/annrheumdis-2013-205171
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发表时间：
2015-09
影响因子：
27.4
通讯作者：
Urowitz MB
中科院分区：
文献类型：
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作者：
Bruce IN;O'Keeffe AG;Farewell V;Hanly JG;Manzi S;Su L;Gladman DD;Bae SC;Sanchez-Guerrero J;Romero-Diaz J;Gordon C;Wallace DJ;Clarke AE;Bernatsky S;Ginzler EM;Isenberg DA;Rahman A;Merrill JT;Alarcón GS;Fessler BJ;Fortin PR;Petri M;Steinsson K;Dooley MA;Khamashta MA;Ramsey-Goldman R;Zoma AA;Sturfelt GK;Nived O;Aranow C;Mackay M;Ramos-Casals M;van Vollenhoven RF;Kalunian KC;Ruiz-Irastorza G;Lim S;Kamen DL;Peschken CA;Inanc M;Urowitz MB
我们在一个国际性的系统性红斑狼疮（SLE）患者队列中研究了损害的累积和决定损害发展和进展的因素。系统性狼疮国际合作诊所（SLICC）初始队列招募了15个月内制定4个或更多1997年美国流变学学会（ACR）SLE标准的患者;每年测量SLICC/ACR损伤指数（SDI）。 我们在一个多状态模型中使用最大似然估计来评估相对转换率。Kaplan-Meier方法估计了SDI评分首次增加的时间概率，考克斯回归分析用于评估死亡率。我们招募了1722例患者;入组时平均（SD）年龄为35.0（13.4）岁。在入组时有损伤的患者更有可能发生SDI进一步恶化（SDI 0 vs ≥1; p<0.001）。年龄、美国非洲人种/种族、SLEDAI-2K评分、类固醇使用和高血压与从无损伤到损伤的转变以及既存损伤的增加相关。男性（相对转换率（95% CI）1.48（1.06 - 2.08））和美国高加索人种/种族（1.63（1.08 - 2.47））与SDI 0至≥1转换相关;亚洲人种/种族患者新发损伤的发生率较低（0.60（0.39 - 0.93））。抗疟药的使用与先前存在的损害增加率较低相关（0.63（0.44至0.89））。损伤与未来死亡率相关（每个SDI点的HR（95% CI）1.46（1.18 - 1.81））。SLE的损害可预测未来损害的累积和死亡率。我们确定了几个潜在的可改变的损害累积的风险因素，解决这些问题的综合战略可能会改善长期的结果。
We studied damage accrual and factors determining development and progression of damage in an international cohort of systemic lupus erythematosus (SLE) patients. The Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort recruited patients within 15 months of developing four or more 1997 American College of Rheumatology (ACR) criteria for SLE; the SLICC/ACR damage index (SDI) was measured annually. We assessed relative rates of transition using maximum likelihood estimation in a multistate model. The Kaplan–Meier method estimated the probabilities for time to first increase in SDI score and Cox regression analysis was used to assess mortality. We recruited 1722 patients; mean (SD) age 35.0 (13.4) years at cohort entry. Patients with damage at enrolment were more likely to have further worsening of SDI (SDI 0 vs ≥1; p<0.001). Age, USA African race/ethnicity, SLEDAI-2K score, steroid use and hypertension were associated with transition from no damage to damage, and increase(s) in pre-existing damage. Male gender (relative transition rates (95% CI) 1.48 (1.06 to 2.08)) and USA Caucasian race/ethnicity (1.63 (1.08 to 2.47)) were associated with SDI 0 to ≥1 transitions; Asian race/ethnicity patients had lower rates of new damage (0.60 (0.39 to 0.93)). Antimalarial use was associated with lower rates of increases in pre-existing damage (0.63 (0.44 to 0.89)). Damage was associated with future mortality (HR (95% CI) 1.46 (1.18 to 1.81) per SDI point). Damage in SLE predicts future damage accrual and mortality. We identified several potentially modifiable risk factors for damage accrual; an integrated strategy to address these may improve long-term outcomes.