Pulmonary hypertension in systemic lupus erythematosus: an independent predictor of patient survival.
10.3904/kjim.2015.30.2.232
- Author:
Hong Ki MIN
1
;
Jae Ho LEE
;
Seung Min JUNG
;
Jennifer LEE
;
Kwi Young KANG
;
Seung Ki KWOK
;
Ji Hyeon JU
;
Kyung Su PARK
;
Sung Hwan PARK
Author Information
1. Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. rapark@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Hypertension, pulmonary;
Lupus erythematosus, systemic;
Mortality;
Survival rate
- MeSH:
Adolescent;
Adult;
Cardiomegaly/diagnosis/epidemiology;
Chi-Square Distribution;
Female;
Humans;
Hypertension, Pulmonary/diagnosis/*mortality;
Kaplan-Meier Estimate;
Lung Diseases, Interstitial/diagnosis/mortality;
Lupus Erythematosus, Systemic/diagnosis/*mortality;
Lupus Nephritis/diagnosis/mortality;
Male;
Multivariate Analysis;
Prognosis;
Proportional Hazards Models;
Raynaud Disease/diagnosis/epidemiology;
Republic of Korea;
Retrospective Studies;
Risk Factors;
Young Adult
- From:The Korean Journal of Internal Medicine
2015;30(2):232-241
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: We investigated whether transthoracic echocardiography-suspected pulmonary hypertension (PH) affects survival in systemic lupus erythematosus (SLE) patients and examined factors associated with PH occurrence and survival. METHODS: This retrospective single-center study included 154 Korean SLE patients fulfilling the American College of Rheumatology criteria (January 1995 to June 2013). Student t test, Mann-Whitney U test, Kaplan-Meier curves, and log-rank tests 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's phenomenon (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 of Rheumatology Damage Index was significantly higher in SLE/PH+ (2.46 +/- 1.245 vs. 1.00 +/- 1.235), whereas survival rates were significantly higher in SLE/PH- in log-rank tests (p = 0.001). In multivariate analysis, the adjusted mortality hazard ratio (HR) for SLE/PH+ patients was 3.10. Subgroup analysis demonstrated a higher 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 HR for SLE/PH+ patients with lupus nephritis was 4.62, whereas the presence of RP decreased 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.
