Routine Clinical Pathology Measurements Are Predictive of the Risk of Organ Damage Accrual in SLE

Eric Morand¹, Kevin Zhang ¹, Sarah Boyd ¹, Francois Petitjean ¹, Alberta Hoi ², Rachel Koelmeyer ¹ and Hieu Nim ¹, ¹Monash University, Melbourne, Victoria, Australia, ²School of Clinical Sciences, Monash University, Meloburne, Victoria, Australia

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: damage and laboratory tests, Disease Activity, Systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 11, 2019

Title: SLE – Clinical Poster II: Comorbidities

Session Type: Poster Session (Monday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Prevention of permanent organ damage, a major predictor of morbidity and mortality, is a key goal in the treatment of SLE. Physician-measured disease activity scores have only weak predictive value for damage accrual risk, and are in part subjective. Routine pathology laboratory measurements provide objective, continuous biological data, but their association with damage accrual risk in SLE has not been studied.

Methods: Longitudinal data were collected prospectively in a single centre SLE patient cohort between 2007-2017. Variables recorded at each visit included disease activity (SLEDAI-2k), drug treatment and routine pathology measurements. Organ damage (SLICC-SDI) was measured annually. Longitudinal patient data were split into annual periods, and each visit was assigned as being in a “damage transition” or “non-damage transition” period based on whether SDI increased at the subsequent annual measure. Time-adjusted means (TAMs) of laboratory variables were calculated for each period, and multivariable logistic regression analysis of the association with damage accrual (adjusting for age, gender, race, previous organ damage and prednisolone dose) was performed, with Holm-Bonferroni correction.

Results: 893 annual periods, comprising 5082 visits from 245 patients (85.6% female, 50.2% Caucasian), were analysed. Five of 16 routine laboratory variables were significantly associated with risk of damage accrual: estimated glomerular filtration rate (eGFR) (p< 0.01), creatinine (p< 0.01), urine protein:creatinine ratio (p< 0.01), ESR (p< 0.001), and haemoglobin (p< 0.001). Moreover, the odds of damage increase were proportional to the deviation of each of these variables from its respective normal range (Figure). SLEDAI-2k was also significantly associated with damage accrual (p< 0.001), but the association of SLEDAI-2k with damage did not exhibit this proportionality.

Conclusion: Routine pathology measures are proportionally associated with organ damage risk in SLE. These measures have potential as biomarkers for identifying patients at risk of organ damage from SLE.

Ln -natural log- odds ratio for damage transition vs time-adjusted mean of laboratory variables. Red region -95%CI- lying above the y=0 line indicates the risk is statistically significant -p<0.05-. Regression lines -blue- indicate the risk of damage increase is approximately proportional with the distance from normal pathology measure range.

Disclosure: E. Morand, AstraZeneca, 2, 5, 8, Bristol Myers Squibb, 2, Eli Lilly, 5, Janssen, 2, 5, Merck Serono, 2, 5, UCB, 2; K. Zhang, None; S. Boyd, None; F. Petitjean, None; A. Hoi, Merck, 2; R. Koelmeyer, None; H. Nim, None.

To cite this abstract in AMA style:

Morand E, Zhang K, Boyd S, Petitjean F, Hoi A, Koelmeyer R, Nim H. Routine Clinical Pathology Measurements Are Predictive of the Risk of Organ Damage Accrual in SLE [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/routine-clinical-pathology-measurements-are-predictive-of-the-risk-of-organ-damage-accrual-in-sle/. Accessed .

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