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P88 Baseline factors associated with subsequent development of incident nephritis in patients with systemic lupus erythematosus: a retrospective cohort study
  1. Spyridon Katechis1,
  2. Dionysis Nikolopoulos2,
  3. Sofia Flouda2,
  4. Katerina Chavatza2,
  5. Noemin Kapsala2,
  6. Pelagia Katsimbri2,
  7. Dimitrios T Boumpas2 and
  8. Antonis Fanouriakis2
  1. 1Rheumatology Dept., Asklepieion Voulas, Athens, Greece
  2. 2Rheumatology and Clinical Immunology Unit, 4th Dept. of Internal Medicine, Attikon University Hospital, Athens, Greece

Abstract

Objective To discern predictive factors for the development of incident lupus nephritis (LN) in systemic lupus erythematosus (SLE) patients.

Methods Patients with SLE, according to American College of Rheumatology 1997 criteria and/or the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) 2012 criteria, from a mixed prevalent and incident cohort (‘Attikon’ Lupus cohort) were followed for development of biopsy-proven nephritis. Demographics, clinical characteristics and laboratory values at baseline were compared against patients who did not develop LN. LN-free survival curves were generated using the Kaplan-Meier method and a multivariate Cox proportional hazards model was used to identify independent predictors of LN, after adjusting for potential confounders.

Results Of 570 patients, 59 manifested LN as presenting clinical manifestation and 66 developed LN during follow-up (total 21.9% of the entire cohort). On univariate analysis, male sex, younger age at disease onset, low C3 and/or C4 and high anti-dsDNA titre at baseline were associated with a higher risk of LN. On multivariate analysis, baseline factors predictive of future nephritis were male sex (aHR 3.79, 95% CI: 1.61–8.91, p < 0.01), younger age of SLE diagnosis (aHR per year 0.94, 95% CI: 0.91–0.98, p < 0.01), low C3 and/or C4 (aHR 3.64, 95% CI: 1.06–12.5, p < 0.05) and high anti-dsDNA titre (although not statistically significant, a clear trend was evident, aHR 2.45, 95% CI: 0.96–6.25, p = 0.062) (figure 1). Of note, combined serologic activity at baseline conferred the most pronounced risk, underscoring the additive effect of each factor (figure 2).

Conclusions Male sex, younger age and -especially combined- serologic activity at the time of SLE diagnosis are strongly associated with LN development. Vigilant surveillance for early signs of nephritis is particularly warranted in these subsets of patients.

Abstract P88 Figure 1

Adjusted hazard ratios after multivariate analysis of lupus nephritis predictive factors

Abstract P88 Figure 2

Cumulative lupus nephritis incidence according to serologic activity at baseline

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