Clinical Features and Outcomes of Neuropsychiatric Systemic Lupus Erythematosus in China.

Abstract

OBJECTIVE:

To identify the clinical characteristics, magnetic resonance imaging (MRI) results, and prognostic factors of neuropsychiatric (NP) systemic lupus erythematosus (SLE; NPSLE) in a relatively large patient series in China.

METHODS:

Data of patients with NPSLE at Peking Union Medical College Hospital (PUMCH) were collected retrospectively from June 2012 to June 2016. NPSLE patients were compared with 220 non-NPSLE patients. Survival rates were evaluated using the Kaplan-Meier curves, log-rank test, and Cox proportional hazards modeling. Cranial MRI results were also studied.

RESULTS:

Of the 194 included patients, sixteen subtypes of NPSLE were identified, and the most common manifestations were seizure (36.6%), acute confusional state (25.3%), and cerebral vascular disease (15.5%). Compared with the non-NPSLE group, NPSLE patients were significantly more likely to have typical lupus symptoms, higher Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) scores (P = 0.002), and positive rate of anti-ribosomal P protein antibodies (P = 0.008). Patients with seizure were more likely to have higher SLEDAI-2K scores and positive anti-β2GP1 than non-NPSLE patients. Sixteen patients died during follow-up. The most common cause of death was infection (37.5%). NPSLE significantly decreased survival rates of SLE patients. Patients with elevated serum creatinine (P = 0.001), hypocomplementemia (P = 0.031), and SLEDAI - 2K scores ≥ 15 (P = 0.014) had shorter survival periods. Eighty-two patients underwent detailed cranial MRI analysis; of these, 50 (61.0%) had abnormal results. Small vessel disease was the most common abnormal finding, followed by inflammatory-like lesions and large vessel disease.

CONCLUSIONS:

High disease activity and positive rate of anti-ribosomal P protein antibodies may be risk factors for NPSLE. NPSLE decreases survival rates of SLE patients. Renal insufficiency and high disease activity are predictive of poor prognoses for NPSLE patients.

• Authors: Shangzhu Zhang, Meng Li, Li Zhang, Ziqian Wang, Qiang Wang, Hui You, Yanhong Wang, Mengtao Li, Xiaofeng Zeng
• Journal: Journal of immunology research (J Immunol Res) Vol. 2021 Pg. 1349042 ( 2021) ISSN: 2314-7156 [Electronic] Egypt
• PMID: 33532504 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Shangzhu Zhang et al.

Chemical References

• Biomarkers

Topics

• Adult
• Biomarkers
• China (epidemiology)
• Female
• Humans
• Kaplan-Meier Estimate
• Lupus Vasculitis, Central Nervous System (diagnosis, epidemiology)
• Magnetic Resonance Imaging (methods)
• Male
• Neuroimaging (methods)
• Patient Outcome Assessment
• Phenotype
• Prognosis
• Proportional Hazards Models
• Public Health Surveillance
• Severity of Illness Index
• Symptom Assessment
• Young Adult