Identification of clinical predictors of flare in systemic lupus erythematosus patients: a 24-month prospective cohort study
Identification of clinical predictors of flare in systemic lupus erythematosus patients: a 24-month prospective cohort study
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DOI：
10.1093/rheumatology/ket322
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发表时间：
2014-01-01
期刊：
影响因子：
5.5
通讯作者：
da Silva, Jose Antonio P.
中科院分区：
文献类型：
--
作者：
Ines, Luis;Duarte, Catia;da Silva, Jose Antonio P.
目标。SLE有一个复发缓解的过程，疾病活动随着时间的推移而加剧。本研究旨在确定SLE发作的临床预测因素。这项为期24个月的前瞻性队列研究包括在一家学术狼疮诊所随访的所有SLE患者。耀斑的定义为SLEDAI-2K评分增加epsilon 4分。基线临床和人口学参数比较使用生存分析的时间到耀斑结果与单变量对数秩检验。对差异显著的变量进行进一步的预测评估，采用多变量Cox回归模型调整潜在的混杂或促成因素，并计算风险比（HR）。共纳入202例SLE患者。在随访期间，记录了1083次就诊，16.8%的患者出现了耀斑。在多变量分析中，以下参数被认为是病情恶化的预测因素：25岁前的SLE诊断（HR = 2.14, P = 0.03），基线就诊前的狼疮肾炎（HR = 4.78, P < 0.0001）和严重SLE的免疫抑制剂治疗（HR = 3.22, P < 0.001）。基线疾病活动度、病程、泼尼松或HCQ治疗均不是预测因素。在25岁之前诊断为SLE的患者，狼疮肾炎或免疫抑制剂治疗严重SLE的患者出现更高的耀斑hr，提示需要更严格的临床监测。目前的免疫抑制策略在提供耀斑预防方面似乎效率低下。
Objective. SLE has a relapsing-remitting course with disease activity flares over time. This study aims to identify clinical predictors of SLE flares.Methods. This prospective cohort study over 24 months included all SLE patients on follow-up at one academic lupus clinic. Flare was defined as an increase in SLEDAI-2K score epsilon 4 points. Baseline clinical and demographic parameters were compared using survival analysis for time-to-flare outcome with univariate log-rank tests. Variables with significant differences were further evaluated as predictors with multivariate Cox regression models adjusting for potential confounding or contributing factors and hazard ratio (HR) calculation.Results. A total of 202 SLE patients were included. Over the follow-up period, 1083 visits were documented and 16.8% of patients presented with flares. In multivariate analysis, the following parameters emerged as flare predictors: SLE diagnosis up to 25 years of age (HR = 2.14, P = 0.03), lupus nephritis previous to baseline visit (HR = 4.78, P < 0.0001) and immunosuppressor treatment for severe SLE (HR = 3.22, P < 0.001). Baseline disease activity, disease duration and treatment with prednisone or HCQ were not predictive factors.Conclusion. Patients with an SLE diagnosis before age 25 years, lupus nephritis or immunosuppressor treatment for severe SLE present greater HRs for flares, suggesting the need for tighter clinical monitoring. Current immunosuppressive strategies seem to be inefficient in providing flare prevention.