title: Clinical implications and prognostic significance of thrombocytopenia in Tunisian patients with systemic lupus erythematosus.
abstract: OBJECTIVE
  The objective of this study was to determine the role of thrombocytopenia in terms of disease manifestations, disease activity and prognostic impact in a cohort of Tunisian systemic lupus erythematosus (SLE) patients.
  
  
  METHODS
  The charts of 182 SLE patients diagnosed between 1996 and 2009 were retrospectively reviewed. The clinical manifestations, immunological profiles, disease activity, SLE relapses and survival rate at the time of follow-up were recorded.
  
  
  RESULTS
  Thrombocytopenia (<100,000/mm(3)) and severe thrombocytopenia (<20,000/mm(3)) was observed in 19.2% and 4.4%, respectively. Hemorrhagic manifestations were observed in 11 patients (31.4%). Thrombocytopenia was significantly associated with splenomegaly, renal disorders, neurologic manifestations, arterial thrombosis, leucopenia, low C3 level at SLE diagnosis, SLE relapses and infectious complications. Using multivariate logistic regression, thrombocytopenia was independently associated with splenomegaly (odds ratio [OR] = 9.36, p = 0.001), neurologic manifestations (OR = 4.6, p = 0.006) and renal disease (OR = 4.15, p = 0.02). By multivariable Cox proportional hazard regression analyses, thrombocytopenia was associated with the occurrence of mortality after adjusting for variables known to influence it (hazard ratio [HR] = 1.79, p = 0.045). The cause of death was unrelated to hemorrhagic complications in all patients.
  
  
  CONCLUSIONS
  Our results, concerning North-African SLE patients, confirm the findings of previous studies which suggest that thrombocytopenia correlates with more severe disease and has a negative impact on the survival of lupus patients.
authors.affiliation: Department of Internal Medicine, Hedi Chaker University Hospital, Sfax, Tunisia. jallouli5moez@yahoo.fr
authors.forename: M
authors.initials: M
authors.lastname: Jallouli
authors.forename: M
authors.initials: M
authors.lastname: Frigui
authors.forename: S
authors.initials: S
authors.lastname: Marzouk
authors.forename: M
authors.initials: M
authors.lastname: Snoussi
authors.forename: M
authors.initials: M
authors.lastname: Kechaou
authors.forename: N
authors.initials: N
authors.lastname: Kaddour
authors.forename: H
authors.initials: H
authors.lastname: Masmoudi
authors.forename: M
authors.initials: M
authors.lastname: Elloumi
authors.forename: Z
authors.initials: Z
authors.lastname: Bahloul
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013921:Thrombocytopenia / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D014416:Tunisia