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.


Predictors of Mortality in Diffuse Alveolar Haemorrhage (DAH) Associated with Systemic Lupus Erythematosus.

Martinez-Martinez2,  Marco U., Hernandez-Nunez3,  Eufrates, Cuevas-Orta3,  Enrique, Moreno-Valdes3,  Ricardo, Saldana-Barnad3,  Martin, Magana-Aquino3,  Martin, Rizo-Rodriguez2,  Juan C.

Rheumatology Unit, Hospital Central and Faculty of Medicine, University of San Luis Potosí, San Luis Potosi, Mexico
Rheumatology Unit, Hospital Central and Faculty of Medicine, University of San Luis Potosí (México)
Rheumatology Unit, Hospital Central and Faculty of Medicine, University of San Luis Potosí (Mexico)

Objectives:

Evaluation of clinical, demographic and treatment-associated mortality factors in patients with DAH associated with SLE.

Methods:

Clinical, laboratory test, SLEDAI-2K, predictors of mortality (APACHE II) and different treatments including cyclophosphamide, methylprednisolone and rituximab were evaluated in SLE patients who were diagnosed with DAH, to determine potential association with factors that could be predictive of mortality.

Results:

Twenty nine episodes of DAH in 22 SLE patients were included (one patient with 4 episodes, 4 patients with two episodes (7 recurrences)), 15 died. Mean age was 25.1 years and 1.5 years of SLE evolution with haemoglobin drop 3.4 g/dl. In 4 of 22 patients, the DAH diagnosis was confirmed by autopsy. Six episodes were in patients under 18 years of age (2 patients with recurrence). DAH was the initial manifestation of SLE in 10 patients. Of the 22 patients, 17 were women and 22/29 DAH episodes. Through evaluation of all included factors, only thrombocytopenia, renal failure, requirement for mechanical ventilation and high APACHE II were associated with higher mortality. In 3 patients mycoses were diagnosed, all died. There is benefit using cyclophosphamide in selected patients (not statistically differences). Table 1 show the main characteristics evaluated in the 29 episodes.

Table 1. Characteristics evaluated at admission.

 All (mean ± SD)Alive (mean)Deceased (mean)p
hsCRP (*)9.9 ± 8.17.312.40.137
Leukocytes (†)10.8 ± 8.910.411.10.832
Lymphocytes (†)‡0.72 (0.1–4.6)0.980.540.252
Haemoglobin (§)6.9 ± 1.77.06.80.772
Platelets (†)‡162 (4–496)2241440.055
Creatinine (*)‡1.2 (0.3–31.9)0.792.540.016
GFR ([par])73.4 ± 51.9104.142.90.001
SLEDAI-2K17.1 ± 7.515.918.30.416
APACHE II18.4 ± 6.115.721.10.015
Renal failure (%)41.46.934.50.004
Haemodialysis (%)27.66.920.70.215
MV (%)72.424.148.30.014
Cyclophosphamide (%)58.634.524.10.176
(*): mg/dl(†): × 103/mm3‡ Median (minimum-maximum)(§): g/dl([par]): ml/min/1.73 m2, SD: standard deviation, hsCRP: high sensitivity C reactive protein, GFR: Glomerular filtration rate, SLEDAI-2K: Systemic Lupus Erythematosus Disease Activity Index 2000, APACHE II: Acute Physiology And Chronic Health Evaluation. MV: Mechanical ventilation

Conclusions:

Mortality of DAH associated with SLE has continued being high in spite of intensive treatment. Thrombocytopenia, renal failure, requirement of mechanical ventilation and high APACHE II are factors associated with higher mortality. Cyclophosphamide would be useful to diminish mortality related to DAH associated with SLE. Patients should receive therapy against prevalent and opportunistic infectious agents.

To cite this abstract, please use the following information:
Martinez-Martinez, Marco U., Hernandez-Nunez, Eufrates, Cuevas-Orta, Enrique, Moreno-Valdes, Ricardo, Saldana-Barnad, Martin, Magana-Aquino, Martin, et al; Predictors of Mortality in Diffuse Alveolar Haemorrhage (DAH) Associated with Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1166
DOI: 10.1002/art.28932

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