Chinese SLE Treatment and Research group (CSTAR) registry: Clinical significance of thrombocytopenia in Chinese patients with systemic lupus erythematosus

PLoS One. 2019 Nov 20;14(11):e0225516. doi: 10.1371/journal.pone.0225516. eCollection 2019.

Abstract

Objectives: To investigate the prevalence, clinical characteristics, and prognosis of thrombocytopenia (TP) in Chinese patients with systemic lupus erythematosus (SLE).

Methods: The study was conducted based on the Chinese SLE Treatment and Research group (CSTAR) registry. Thrombocytopenia was defined as the platelet count<100,000/mm3 at enrollment. Severe thrombocytopenia was defined as the platelet count<50,000/mm3. The prevalence of SLE-related TP, the associations of thrombocytopenia with demographic data, organ involvements, laboratory findings, disease activity, damage, and mortality were investigated.

Results: Of 2104 patients with SLE, 342 patients (16.3%) were diagnosed with thrombocytopenia. The prevalence of neuropsychiatric SLE, vasculitis, myositis, nephritis, mucocutaneous lesions, pleuritis, fever, leukocytopenia and hypocomplementemia were significantly higher in patients with thrombocytopenia (p<0.05). SLE disease activity index (SLEDAI) was significantly higher in patients with thrombocytopenia (p<0.05). Multivariate analysis showed that leukocytopenia (OR = 2.644), lupus nephritis (OR = 1.539), hypocomplementemia (OR = 1.497) and elevated SLEDAI (OR = 1.318) were independently associated with thrombocytopenia (p<0.05). Long disease duration (OR = 1.006) was an independent risk factor of severe thrombocytopenia, while anti-rRNP (OR = 0.208) was an independent protective factor of severe thrombocytopenia (p<0.05). Long disease duration was an independent risk factor of mortality in patients with thrombocytopenia (RR = 1.006). The 6-year survival of patients with thrombocytopenia was significantly lower than patients without thrombocytopenia (88.2% vs. 95.5%).

Conclusions: Thrombocytopenia was a common manifestation of SLE and was associated with leukocytopenia, nephritis and severe disease activity. Severe thrombocytopenia tended to occur in long-term and relatively inactive SLE. Patients with SLE-related thrombocytopenia has a decreased long-term survival rate. Long disease duration was an independent risk factor of mortality in patients with thrombocytopenia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Asian People
  • China / epidemiology
  • Female
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Lupus Erythematosus, Systemic / complications
  • Lupus Erythematosus, Systemic / mortality
  • Lupus Erythematosus, Systemic / pathology*
  • Male
  • Middle Aged
  • Platelet Count
  • Prevalence
  • Prognosis
  • Proportional Hazards Models
  • Registries
  • Risk Factors
  • Severity of Illness Index
  • Survival Rate
  • Thrombocytopenia / complications
  • Thrombocytopenia / diagnosis*
  • Thrombocytopenia / epidemiology
  • Young Adult

Grants and funding

This study was supported by grant numbers: 2017YFC0907601, 2017YFC0907602, 2017YFC0907603, 2008BAI59B02, 2012AA02A513, to Dr X Zeng, from Chinese National Key Technology R&D Program, Chinese National High Technology Research and Development Program, Ministry of Science and Technology of People's Republic of China, http://www.most.gov.cn/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.