1.Pulmonary hypertension in systemic lupus erythematosus: an independent predictor of patient survival.
Hong Ki MIN ; Jae Ho LEE ; Seung Min JUNG ; Jennifer LEE ; Kwi Young KANG ; Seung Ki KWOK ; Ji Hyeon JU ; Kyung Su PARK ; Sung Hwan PARK
The Korean Journal of Internal Medicine 2015;30(2):232-241
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.
Adolescent
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Adult
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Cardiomegaly/diagnosis/epidemiology
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Chi-Square Distribution
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Female
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Humans
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Hypertension, Pulmonary/diagnosis/*mortality
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Kaplan-Meier Estimate
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Lung Diseases, Interstitial/diagnosis/mortality
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Lupus Erythematosus, Systemic/diagnosis/*mortality
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Lupus Nephritis/diagnosis/mortality
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Male
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Multivariate Analysis
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Prognosis
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Proportional Hazards Models
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Raynaud Disease/diagnosis/epidemiology
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Republic of Korea
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Retrospective Studies
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Risk Factors
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Young Adult