Predictors and prognostic stratification for lupus low disease activity state: results from a prospective clinical trial. (27th July 2022)

• Record Type: Journal Article
• Authors: Zhang, Kai; An, Yuan; Zhao, Peng; Huang, Bo; Wang, Yifan; Zhou, Xingyu; Cheng, Gong; Xing, Xiaoyan; Wang, Naidi; Feng, Ruiling; Yu, Siyue; Li, Min; He, Jing; Li, Zhanguo
• Is Part Of: Rheumatology. Volume 62:Number 3(2023)
• Page Start: 1153
• Page End: 1161
• Publication Date: 2022-07-27
• Subjects: SLE -- lupus low disease activity -- prognostic stratification -- predictor; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keac419
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objective: To identify predictors for lupus low disease activity state (LLDAS), early-achieved LLDAS and long-term disease activity, and to refine a prognostic stratification tool for use in active SLE patients. Method: A total of 245 active SLE patients were enrolled, followed up quarterly from 2014 to 2016. LLDAS-50 was defined as the maintenance of LLDAS for ≥50% of the observed time. LLDAS at 3 months after cohort entry (LLDAS-3mo) was considered an early-achieved LLDAS. Multivariate analysis was performed to identify predictors for LLDAS, early-achieved LLDAS and long-term disease activity. Based on the factors associated with LLDAS, a prognostic stratification tool for LLDAS was established. Results: The 2-year probability of achieving LLDAS was 62.9% (154/245). Multivariate analysis-determined renal involvement, haematological involvement and hypocomplementaemia were negative predictors for achieving LLDAS and LLDAS-50. In multivariate logistic analysis, antiphospholipid antibodies positivity, hypocomplementaemia, renal involvement and haematological involvement were identified as negative predictors for achieving LLDAS-3mo. LLDAS-3mo ( P < 0.0001; risk ratio: 47.694; 95% CI: 13.776, 165.127) was a strong predictor for LLDAS-50. The probability of achieving LLDAS, LLDAS-50 and LLDAS-3mo were 88.9% (32/36), 69.4% (25/36) and 41.7% (15/36) in the low-risk group, 65% (65/100), 51.0% (51/100) and 32.0% (32/100) in intermediate-risk group, and 52.8% (57/108), 27.8% (30/108) and 13.0% (14/108) in high-risk group respectively. Significant differences ( P < 0.0001) were observed in the LLDAS Kaplan–Meier estimates for the three risk groups based on the identified risk factors. Conclusion: Renal involvement, haematological involvement and hypocomplementaemia were negative predictors of LLDAS achievement and maintenance. LLDAS-3mo was a positive predictor for the long-term sustainment of LLDAS.