Background/Purpose:  To study the effect of the antiphospholipid syndrome (APS) on survival in Chinese patients with SLE

Methods:

A cohort of 679 southern Chinese patients who fulfill at least 4 of the ACR criteria for SLE from 1995 to 2011 was studied.  The status of the patients at last clinical visits (alive or death) was evaluated.  The cumulative survival rate over time was studied by Kaplan-Miere’s plot.  For those who died during the course of their disease, data were censored at the time of their deaths whereas data of other patients were censored at the time of last clinic visits.  APS was defined by the modified Sydney criteria in 2006, ie. The presence of arterial or venous thrombosis, or miscarrages (recurrent abortion or intra-uterine death) plus any one of the following positive twice at least 12 weeks part: (1) lupus anticoagulant; (2) moderate to high titers of anticardiolipin antibodies (IgG or IgM); or (3) beta-2-glycoprotein-I.  Comparison of the survival of patients with and without APS was made.

Results:

679 SLE patients (92% women; age of disease onset 32.5±14 years) were prospectively followed for 9.7±7.3 years.  Sixty-eight (10%) patients died and 33 (4.9%) patients were lost to follow-up.  The main contributing causes of death in these patients were: infection (53%), cardiovascular events (6%), cerebrovascular events (15%), and cancer (9%). Forty-four (6.5%) patients qualified the criteria for APS, manifested as: ischemic stroke (55%), deep venous thrombosis (32%), obstetric morbidity (14%), cardiovascular events (9%) and peripheral vascular disease (9%).  Twenty-three (52%) patients developed APS after the diagnosis of SLE, 16 (36%) patients had concomitant APS diagnosed at the same time as SLE and 5 (11%) patients had APS preceding SLE diagnosis. Nine (20%) APS patients died, which was significantly more frequent than the non-APS SLE patients (59/635[9%]; p=0.02).  Patients with the APS died at an older age than those without APS (54.0±11.4 vs 45.1±18.2; p=0.07).  The duration of SLE at the time of death was also longer in patients with the APS than those without (13.9±10.4 vs 7.47±7.4 years; p=0.11).  The cumulative mortality of patients with APS was 4.6% at 5 years, 7.8% at 10 years and 22.2% at 15 years, which was not significantly higher than that of non-APS patients (5.4% at 5 years, 9.2% at 10 years and 11.3% at 15 years; p=0.14).  However, if only patients with APS caused by arterial thrombosis were considered, the presence of APS was significantly associated with mortality (HR 2.29 [1.13-4.64]; p=0.02).

Conclusion:

The presence of APS increases the mortality risk of patients with SLE, which is mainly contributed by arterial thrombotic events that occur late in the disease course.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-the-antiphospholipid-syndrome-aps-on-survival-in-chinese-patients-with-sle-a-prospective-study-of-679-patients/