PMID- 32635880
OWN - NLM
STAT- MEDLINE
DCOM- 20210608
LR  - 20210608
IS  - 1477-0962 (Electronic)
IS  - 0961-2033 (Linking)
VI  - 29
IP  - 10
DP  - 2020 Sep
TI  - Low C4 as a risk factor for severe neuropsychiatric flare in patients with 
      systemic lupus erythematosus.
PG  - 1238-1247
LID - 10.1177/0961203320938453 [doi]
AB  - OBJECTIVE: This study aimed to explore the risk factors for 'severe' 
      neuropsychiatric (NP) flare in patients with systemic lupus erythematosus (SLE). 
      METHODS: This retrospective study comprised newly diagnosed 184 adult SLE 
      patients who visited Hokkaido University Hospital between 2006 and 2017. In this 
      study, severe NP flare was defined as the occurrence of at least one newly 
      developed British Isles Lupus Assessment Group A score in the neurological 
      domain. Overall severe NP flare-free survival was estimated by Kaplan-Meier 
      analysis. Clinical and demographic profiles at SLE diagnosis were assessed as 
      potential risk items in the adjusted multivariate Cox regression model. RESULTS: 
      The median follow-up period was 7.9 years (interquartile range (IQR) 4.6-12.3) 
      years. A total of 28 (15.2%) patients had one or more severe NP flares during the 
      observation period. The median time from patient enrolment date to severe NP 
      flare occurrence was 3.1 years (IQR 0.9-6.3 year). The 2- and 10-year severe NP 
      flare-free survival rates were 92.7% and 86.0%, respectively. Among the 
      manifestations of severe NP flare, psychosis was the most frequent (19.1%). In 
      the multivariate model, low serum levels of C4 (hazard ratio (HR) = 3.67, 
      p = 0.013) and severe NP manifestations at SLE diagnosis (HR = 7.11, p < 0.001) 
      emerged as independent risk factors for developing severe NP flare. CONCLUSION: 
      The first severe NP flare presented early in the course of SLE. Low C4 level and 
      severe NP manifestations at SLE diagnosis could predict the development of severe 
      NP flare.
FAU - Aso, Kuniyuki
AU  - Aso K
AUID- ORCID: 0000-0001-8601-6377
AD  - Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and 
      Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
FAU - Kono, Michihito
AU  - Kono M
AUID- ORCID: 0000-0002-7663-534X
AD  - Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and 
      Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
FAU - Kono, Michihiro
AU  - Kono M
AD  - Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and 
      Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
FAU - Watanabe, Toshiyuki
AU  - Watanabe T
AD  - Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and 
      Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
FAU - Shimizu, Yuka
AU  - Shimizu Y
AD  - Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and 
      Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
FAU - Ogata, Yusuke
AU  - Ogata Y
AD  - Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and 
      Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
FAU - Fujieda, Yuichiro
AU  - Fujieda Y
AUID- ORCID: 0000-0003-4705-341X
AD  - Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and 
      Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
FAU - Kato, Masaru
AU  - Kato M
AD  - Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and 
      Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
FAU - Oku, Kenji
AU  - Oku K
AD  - Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and 
      Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
FAU - Amengual, Olga
AU  - Amengual O
AD  - Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and 
      Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
FAU - Yasuda, Shinsuke
AU  - Yasuda S
AD  - Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and 
      Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
FAU - Atsumi, Tatsuya
AU  - Atsumi T
AD  - Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and 
      Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
LA  - eng
PT  - Journal Article
DEP - 20200707
PL  - England
TA  - Lupus
JT  - Lupus
JID - 9204265
RN  - 0 (Complement C4)
SB  - IM
MH  - Adult
MH  - Complement C4/*metabolism
MH  - Disease Progression
MH  - Female
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Lupus Vasculitis, Central Nervous System/blood/*psychology
MH  - Male
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
OTO - NOTNLM
OT  - Systemic lupus erythematosus
OT  - cerebrovascular disease
OT  - complement
OT  - flare
OT  - neuropsychiatric lupus
OT  - psychosis
EDAT- 2020/07/09 06:00
MHDA- 2021/06/09 06:00
CRDT- 2020/07/09 06:00
PHST- 2020/07/09 06:00 [pubmed]
PHST- 2021/06/09 06:00 [medline]
PHST- 2020/07/09 06:00 [entrez]
AID - 10.1177/0961203320938453 [doi]
PST - ppublish
SO  - Lupus. 2020 Sep;29(10):1238-1247. doi: 10.1177/0961203320938453. Epub 2020 Jul 7.