Session Information
Date: Sunday, November 8, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session I
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: The Coombs test is now one of the SLICC classification criteria for SLE classification. We investigated the association of the Coombs test with other clinical manifestations, in particular with autoimmune hemolytic anemia.
Methods: 2417 patients with SLE (age 50.8 +/- 14.3, 92.4% females) in a longitudinal cohort were included. The direct Coombs test was determined at cohort entry. Patients were then followed quarterly.
Results: 20% had a positive coombs test. The association of the direct Coombs test with other clinical and laboratory manifestations is shown in Table 1.
Table 1:
|
Odds Ratio (95% CI) |
p-value |
|
|
Fever |
1.45 (1.16,1.82) |
0.0011 |
|
Lymphadenophathy |
1.68 (1.34,2.11) |
<.0001 |
|
Mouth Ulcers |
0.69 (0.55,0.85) |
<.0001 |
|
Vasculitis |
2.01 (1.51,2.67) |
<.0001 |
|
Leg Ulcers |
2.44 (1.34,4.42) |
0.0034 |
|
Panniculitis |
0.97 (0.48,1.94) |
0.9217 |
|
Pleuritis |
1.46 (1.17,1.82) |
<.0001 |
|
Pericarditis |
1.46 (1.13,1.87) |
0.0032 |
|
Proteinuria |
2.59 (2.06,3.25) |
<.0001 |
|
Nephrotic Syndrome |
1.91 (1.48,2.48) |
<.0001 |
|
Hematuria |
2.08 (1.65,2.62) |
<.0001 |
|
Renal Insufficiency |
1.97 (1.53,2.53) |
<.0001 |
|
Seizure |
1.57 (1.11,2.21) |
0.0099 |
|
Psychosis |
1.94 (1.14,3.3) |
0.0149 |
|
Hemolytic Anemia |
12.76 (9.34,17.44) |
<.0001 |
|
Leukopenia <4 |
1.78 (1.42,2.22) |
<.0001 |
|
Platelet<100 |
2.19 (1.72,2.8) |
<.0001 |
|
LAC (RVVT) |
2.14 (1.7,2.71) |
<.0001 |
|
Anticardiolipin |
1.63 (1.3,2.04) |
<.0001 |
|
Anti B2 glycoprotein |
1.9 (1.43,2.52) |
<.0001 |
|
Sjogren’s Syndrome |
0.52 (0.38,0.72) |
<.0001 |
|
Hepatomegaly |
2.86 (1.7,4.82) |
<.0001 |
|
Splenomegaly |
2.75 (1.75,4.33) |
<.0001 |
|
Anti-dsDNA |
3.19 (2.43,4.18) |
<.0001 |
|
Anti-Sm |
1.81 (1.41,2.32) |
<.0001 |
|
Anti-Ro |
1.66 (1.32,2.09) |
<.0001 |
|
Anti-La |
1.63 (1.21,2.19) |
0.0013 |
|
Anti-RNP |
1.71 (1.35,2.16) |
<.0001 |
|
Low CH50 |
2.34 (1.73,3.15) |
<.0001 |
|
Low C3 |
3.17 (2.47,4.08) |
<.0001 |
|
Low C4 |
3.32 (2.61,4.22) |
<.0001 |
|
ESR |
4.68 (3.23,6.8) |
<.0001 |
Only 38% of those with the direct Coombs test ever developed an autoimmune hemolytic anemia. Those who did develop hemolytic anemia were significantly more likely to have renal and CNS-SLE (Table 2).
Table 2:
|
|
OR (95% CI) |
P-value |
|
High School Education |
0.26 (0.13,0.53) |
0.0001 |
|
Fever |
1.94 (1.28,2.93) |
0.0017 |
|
Pericarditis |
1.75 (1.12,2.74) |
0.0137 |
|
Nephrotic Syndrome |
1.72 (1.09,2.71) |
0.0192 |
|
Renal Insufficiency |
1.94 (1.25,3.02) |
0.0031 |
|
Renal Failure |
3.02 (1.61,5.66) |
0.0006 |
|
Seizure |
2.41 (1.33,4.37) |
0.0039 |
|
Meningitis |
3.92 (1,15.38) |
0.0505 |
|
Stroke |
3.28 (1.35,7.93) |
0.0085 |
|
Thrombocytopenia |
1.95 (1.27,3) |
0.0023 |
|
Anticardiolipin |
0.59 (0.39,0.89) |
0.0132 |
|
Heart Murmur |
2.14 (1.41,3.23) |
0.0003 |
|
Hepatomegaly |
5.75 (2.24,14.76) |
0.0003 |
|
Splenomegaly |
2.73 (1.32,5.68) |
0.0070 |
Conclusion: The direct Coombs test is strongly associated with hemolytic anemia but only 38% develop hemolytic anemia. Those who do develop hemolytic anemia are more likely to have had renal or CNS-SLE. Direct Coombs positivity that leads to hemolytic anemia portends a particularly poor prognosis.
To cite this abstract in AMA style:
Abou Assalie N, Fu W, Petri M. Direct Coombs Positivity in SLE [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/direct-coombs-positivity-in-sle/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/direct-coombs-positivity-in-sle/