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Clinical spectrum and prognosis of SLE-associated severe thrombopenia: A single-center review of 162 treatment-naïve patients


 Background

Severe thrombocytopenia (TP) is a common manifestation of systemic lupus erythematosus (SLE) that increases the risk of accruing damage and mortality. This study aimed to describe the demographic features, clinical characteristics, laboratory findings and outcomes of a large series of treatment-naïve SLE patients with severe TP and explore the factors influencing prognosis in patients with SLE-associated TP.
Methods

The study enrolled treatment-naïve SLE patients complicated with severe TP who were older than 14 years old and admitted to our hospital between November 2010 and November 2018. Demographic, clinical and laboratory data were collected retrospectively between October 2019 and February 2020.
Results

TP occurred in 31.83% of SLE patients, of whom 37.80% had severe TP. 162 treatment-naïve SLE patients complicated with severe TP were included in the analysis, including 17 males. The clinical and laboratory features are shown in Table 1–2. The treatment responses are displayed in Table 3–4, and the parallel program model is shown in Fig. 1. Multivariate analysis of the risk factors is shown in Table 5.
Conclusions

In patients with SLE-associated TP, male and older age predicted the lack of a response, serositis predicted the lack of a complete response, and anti-Sm antibodies predicted a response in week 1. Advanced age predicted the lack of a complete response at week 4, and anti-nRNP antibodies and anti-SSB antibodies predicted a complete response. Advanced age, myositis and anti-Ro antibodies predicted the lack of a response at week 24, and leukocytopenia predicted the lack of a complete response. Pulmonary arterial hypertension was predictive of serious infections. Myositis and leukopenia were predictive of mortality. Advanced age and mucocutaneous hemorrhage predicted the lack of a low-dose glucocorticoid complete response (LDG-CR), while anti-nRNP antibodies were predictive of LDG-CR.