Pulmonary hypertension in systemic lupus erythematosus: an independent predictor of patient survival
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Background/Aims: We investigated whether transthoracic echocardiographysuspectedpulmonary hypertension (PH) affects survival in systemic lupus erythematosus(SLE) patients and examined factors associated with PH occurrenceand survival. Methods: This retrospective single-center study included 154 Korean SLE patientsfulfilling the American College of Rheumatology criteria (January 1995 to June2013). Student t test, Mann-Whitney U test, Kaplan-Meier curves, and log-ranktests were used for comparisons. Results: A total of 35 SLE patients with PH (SLE/PH+) and 119 without PH (SLE/PH−) were analyzed. Higher percentages of interstitial lung disease, Raynaud’sphenomenon (RP), World Health Organization functional classification III/IV,and cardiomegaly were found in SLE/PH+ compared to SLE/PH−. Furthermore,the Systemic Lupus International Collaborating Clinics/American College ofRheumatology Damage Index was significantly higher in SLE/PH+ (2.46 ± 1.245vs. 1.00 ± 1.235), whereas survival rates were significantly higher in SLE/PH− inlog-rank tests (p = 0.001). In multivariate analysis, the adjusted mortality hazardratio (HR) for SLE/PH+ patients was 3.10. Subgroup analysis demonstrated ahigher percentage of lupus nephritis in the SLE/PH+ patients who died (p = 0.039)and low complement-3 levels (p = 0.007). In univariate analysis, the mortality HRfor SLE/PH+ patients with lupus nephritis was 4.62, whereas the presence of RPdecreased the mortality risk in multivariate analysis; adjusted HR, 0.10. Conclusions: PH is an independent factor predicting survival in SLE patients. The presence of lupus nephritis resulted in an increased trend for mortality,whereas coexistence of RP was associated with a better survival prognosis in SLE/PH+ patients.
Abstract
Background/Aims: We investigated whether transthoracic echocardiographysuspectedpulmonary hypertension (PH) affects survival in systemic lupus erythematosus(SLE) patients and examined factors associated with PH occurrenceand survival. Methods: This retrospective single-center study included 154 Korean SLE patientsfulfilling the American College of Rheumatology criteria (January 1995 to June2013). Student t test, Mann-Whitney U test, Kaplan-Meier curves, and log-ranktests were used for comparisons. Results: A total of 35 SLE patients with PH (SLE/PH+) and 119 without PH (SLE/PH−) were analyzed. Higher percentages of interstitial lung disease, Raynaud’sphenomenon (RP), World Health Organization functional classification III/IV,and cardiomegaly were found in SLE/PH+ compared to SLE/PH−. Furthermore,the Systemic Lupus International Collaborating Clinics/American College ofRheumatology Damage Index was significantly higher in SLE/PH+ (2.46 ± 1.245vs. 1.00 ± 1.235), whereas survival rates were significantly higher in SLE/PH− inlog-rank tests (p = 0.001). In multivariate analysis, the adjusted mortality hazardratio (HR) for SLE/PH+ patients was 3.10. Subgroup analysis demonstrated ahigher percentage of lupus nephritis in the SLE/PH+ patients who died (p = 0.039)and low complement-3 levels (p = 0.007). In univariate analysis, the mortality HRfor SLE/PH+ patients with lupus nephritis was 4.62, whereas the presence of RPdecreased the mortality risk in multivariate analysis; adjusted HR, 0.10. Conclusions: PH is an independent factor predicting survival in SLE patients. The presence of lupus nephritis resulted in an increased trend for mortality,whereas coexistence of RP was associated with a better survival prognosis in SLE/PH+ patients.
참고문헌 (23)
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