Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Platelet C4d Is Associated with All-Cause Mortality in Patients with Systemic Lupus Erythematosus.
McBurney5, Christine A., Kao2, Amy H., Sattar3, Abdus, Lertratanakul6, Apinya, Wilson4, Nicole L., Sarah6, Rutman, Paul6, Barbara
Allegheny Singer Research Institute, Pittsburgh, PA
Case Western University
Magee Womens Hospital of UPMC, Pittsburgh, PA
University of Pittsburgh Medical Center, Pittsburgh, PA
University of Pittsburgh School of the Health Sciences
West Penn Allegheny Health System, Pittsburgh, PA
Platelets bearing complement C4d (P-C4d) are reported to be specific for a diagnosis of systemic lupus erythematosus (SLE) and are associated with ischemic stroke. We investigated the association of P-C4d with all-cause mortality and prevalent cardiovascular disease (CVD) events in our longitudinal cohort of patients with SLE.
We recruited 356 consecutive outpatients or inpatients with SLE since July 2001. Outcomes were all-cause mortality and cardiovascular events including myocardial infarction, coronary artery bypass graft, percutaneous coronary transluminal angioplasty, stroke, pulmonary embolism, deep vein thrombosis or other thrombosis. P-C4d status was determined by flow cytometry.
Mean age was 44.4 years (range: 18 81 years), 92% were female, and 81% were Caucasian. Seventy SLE patients (20%) had positive P-C4d at baseline. PC4d-positive patients were more likely to have a history of renal disease, seizure disorder, hemolytic anemia, thrombocytopenia, anti-double stranded DNA (dsDNA) and/or antiphospholipid antibodies. Overall CVD event frequency was 21.6%. SLE patients with positive P-C4d had significantly more CVD events compared to those with negative P-C4d (35.7% vs. 18.2%, p=0.001). Positive P-C4d at baseline was associated with stroke, but not with other cardiovascular events (odds ratio 4.96, 95% confidence interval 1.7514.06, p=0.003) after adjusting for age, race, smoking history, SLE disease duration, renal disease, dsDNA and antiphospholipid antibodies. The overall mortality was 3.9%. Causes of death were infection (n=4), cardiac arrest (n=2), congestive heart failure (n=1), cancer (n=2), hemorrhage (n=1), and unknown (n=4). Six of these 14 deceased patients had a history of cancer (ovarian carcinoma, lymphoma, lung cancer, anal squamous cell carcinoma). Positive P-C4d at baseline was associated with all-cause mortality (hazard ratio 7.92, 95% CI 2.1329.48, p=0.002) after adjusting for age, race, sex, SLE disease duration, renal disease, cardiovascular event, cancer, dsDNA and antiphospholipid antibodies.
Platelet C4d is associated with all-cause mortality and stroke. Platelet C4d may be a prognostic biomarker as well as a pathogenic clue that links systemic inflammation, complement activation, and thrombosis and may represent a subset of patients with poor clinical outcomes.
To cite this abstract, please use the following information:
McBurney, Christine A., Kao, Amy H., Sattar, Abdus, Lertratanakul, Apinya, Wilson, Nicole L., Sarah, Rutman, et al; Platelet C4d Is Associated with All-Cause Mortality in Patients with Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :620