Factors predictive of thrombotic events in LUMINA, a multi-ethnic cohort of SLE patients (LXXII).
OBJECTIVE
Thrombosis is an important cause of morbidity and mortality in SLE. We have explored the factors associated with time to the occurrence of thrombotic events in SLE patients to expand our cohort's previous observations.


METHODS
SLE patients (ACR criteria), age >or=16 years, disease duration <or=5 years at enrollment (T0), African-American, Hispanic (Texan or Puerto Rican) or Caucasian ethnicity, from LUMINA, a longitudinal cohort, were studied. An event was defined as the presence of arterial or venous thrombosis. Time to the first thrombotic event was examined by univariable and multivariable (MV) Cox models adjusting for pertinent baseline clinical and socio-demographic variables.


RESULTS
A total of 643 patients were studied; mean (s.d.) age was 36.4 (12.6) years and disease duration at T0 was 1.4 (1.3) years; 90% were female. After T0, 81 (12.6%) patients had developed a thrombotic event. In the MV model, age [hazard ratio (HR) = 1.06; 95% CI 1.03, 1.08; P < 0.0001], health insurance (HR = 0.53; 95% CI 0.30, 0.94; P = 0.029), smoking (HR = 1.85; 95% CI 1.01, 3.40; P = 0.048), damage (T0) (HR = 1.44; 95% CI 1.20, 1.71; P < 0.0001), aPL (HR = 2.12; 95% CI 1.19, 3.76; P = 0.011) and glucocorticoid (highest dose) (HR = 1.01; 95% CI 1.01, 1.02; P < 0.0001) were significant.


CONCLUSIONS
Age, poverty, smoking, damage accrual, aPL and higher doses of glucocorticoids were independently associated with a shorter time to the first thrombotic event; health insurance had a protective effect. Acting upon modifiable risk factors at the personal (smoking, high-dose glucocorticoids) and societal (poverty, health insurance) levels may prevent these events and improve the long-term outcome of SLE patients.
Burgos
Paula I
PI
Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
McGwin
Gerald
G
Reveille
John D
JD
Vilá
Luis M
LM
Alarcón
Graciela S
GS
D000328:Adult; D001741:Black or African American; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000208:ethnology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013927:Thrombosis / Q000208:ethnology / Q000209:etiology* / Q000401:mortality; D014481:United States; D044465:White People; D055815:Young Adult