title: Serum IL-18 as biomarker in predicting long-term renal outcome among pediatric-onset systemic lupus erythematosus patients.
abstract: An urge of biomarker identification is needed to better monitor lupus nephritis (LN) disease activity, guide clinical treatment, and predict patient's long-term outcome. With the proinflammatory effect and its association with inflammasomes, the significance of interleukin-18 (IL-18) among pediatric-onset systemic lupus erythematous (pSLE) patient, especially, its importance in predicting long-term renal outcome was investigated.In a pSLE cohort of 96 patients with an average follow-up period of 10.39 ± 3.31 years, clinical data and laboratory workups including serum IL-18 were collected at time of disease onset and 6 months after treatment despite their initial renal status. Through Cox regression analysis, the parameters at baseline and at 6 months posttreatment were carefully analyzed.Average age of all cases was 12.74 ± 3.01 years old and 65 of them underwent renal biopsy at the time of diagnosis. Nine subjects (9.38%) progressed to end-stage renal disease (ESRD) and 2 cases (2.08%) died during follow-up. Through multivariate analysis, serum IL-18 level 6 months posttreatment was found to be the most unfavorable factor associating poor clinical outcome despite patient's initial renal status. In addition, the presentation of serum IL-18 in its correlation with SLE global disease activity as well as the presence and severity of LN were all significant (P < 0.001, P = 0.03, and P = 0.02, respectively). The histological classification of LN, however, was not associated with the level of IL-18 among the pSLE patients (P = 0.64).The role of serum IL-18 as biomarker representing global disease activity and status of renal flares among pSLE population was shown for the first time. Additionally, we have identified IL-18 at 6 months posttreatment a novel marker for long-term renal outcome prediction.
authors.affiliation: Division of Allergy, Asthma, and Rheumatology, Chang Gung Children's Hospital Chang Gung University, College of Medicine Department of Nephrology Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chao-Yi
authors.initials: CY
authors.lastname: Wu
authors.forename: Huang-Yu
authors.initials: HY
authors.lastname: Yang
authors.forename: Tsung-Chieh
authors.initials: TC
authors.lastname: Yao
authors.forename: Su-Hsun
authors.initials: SH
authors.lastname: Liu
authors.forename: Jing-Long
authors.initials: JL
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D020382:Interleukin-18 / Q000378:metabolism*; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis / Q000378:metabolism*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D020382:Interleukin-18