Session Information
Date: Sunday, October 21, 2018
Title: Systemic Lupus Erythematosus – Clinical Poster I: Clinical Manifestations and Comorbidity
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Myocarditis is a severe manifestation of systemic lupus erythematosus (SLE). Ethnicity is believed to play an important role in influencing the outcome.We aimed to describe the clinical features and outcomes of lupus patients with myocarditis in a North Indian population.
Methods: Clinical records of SLE patients fulfilling 2012 SLICC criteria presenting to the Rheumatology Clinic and inpatient services (from November 2014 to November 2017) were screened for a clinical and laboratory diagnosis consistent with lupus myocarditis (LVEF <50%, absence of massive pericardial effusion, severe pulmonary artery hypertension, significant regional wall motion abnormality or primary valvular disease). Demographic data, clinical features and echocardiography findings were noted. Cardiac outcomes as well as survival were assessed using Kaplan Meier survival analysis and Cox regression analysis.
Results: 37 patients with SLE who had features consistent with lupus myocarditis were included. The median duration of follow up was six and half months. 12 patients (32%) presented with lupus myocarditis at first presentation; the median duration between the diagnosis of SLE and diagnosis of myocarditis was seven and half months. All patients received corticosteroids and hydroxychloroquine while 27 patients received additional cyclophosphamide. Ten deaths (27.7%) were noted, of these 9 died during the initial presentation while one patient died two months’ later of disseminated varicella infection. The deaths were attributed to disease activity alone in 2 patients, activity with infection in 5 patients and infection alone in remaining 3 patients. Among the survivors, mean ejection fraction rose from 33 ±8% at baseline to 48 ±11% at last follow up in 70% of patients (n=20). Raised serum procalcitonin at presentation (> 0.9 ng/ml) (p=0.049), higher blood urea (p=0.038) and low serum complement C3 (< 50mg/dl) (0.002) were associated with increased mortality. Patients with raised serum procalcitonin at presentation had reduced survival (mean survival 2.5 months, C.I. 0.1 to 4.8 months) as compared to those without (mean survival 49.2 months, C.I. 38.2 to 60.2 months) (p=0.014).
Conclusion: Lupus myocarditis is associated with high mortality in Indian SLE patients. Elevated serum procalcitonin at presentation is associated with reduced survival in these patients.
Table1 showing baseline characteristics of all patients with myocarditis.
|
Results |
|
|
Duration of symptoms in days |
15 (71) |
|
Time from diagnosis of SLE to myocarditis in months [median (range)] |
7.5 (0-84) |
|
Follow up in months [median (range)] |
6.5 (0-60) |
|
dsDNA positivity |
26/37 (70.2%) |
|
Crackles on auscultation |
17/23 |
|
Anemia (<10g/dl) |
26/33 |
|
Thrombocytopenia (<150 X 109/L) |
10/33 |
|
Leucopenia (<4 X 109/L) |
6/33 |
|
Hypoalbuminemia (<35g/L) |
32/34 |
|
Proteinuria (>0.5gm/24hr or dipstick >2+) |
22/28 |
|
Raised serum creatinine (>1.4 mg/dl) |
13/36 |
|
Raised procal ( >0.9ng/ml) |
8/26 |
|
Low C 3 (50-150 mg/dl) |
10/22 |
|
Low C4 (16-38 mg/dl) |
16/22 |
|
SELENA-SLEDAI No flare (≤ 3) Mild or moderate flare (3-12) Severe flare (>12) |
N=30 3 14 13 |
To cite this abstract in AMA style:
Dhooria A, Gawalkar A, Santosh K, MB A, Sharma A, Sharma S, Jain S, Dhir V. Elevated Serum Procalcitonin at Baseline Correlates with Reduced Survival in Patients with Lupus Myocarditis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/elevated-serum-procalcitonin-at-baseline-correlates-with-reduced-survival-in-patients-with-lupus-myocarditis/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/elevated-serum-procalcitonin-at-baseline-correlates-with-reduced-survival-in-patients-with-lupus-myocarditis/