Comparison of clinical features between LN and non-LN of patients in new-onset SLE:a single-center retro-spective study

LI Ning; CHEN Song-yue; WU Qian; GONG Mu-xue; HONG Deng-xiao; FAN Xiao-yun; WANG Tao; MEI Yong-jun; XIE Chang-hao

doi:10.13820/j.cnki.gdyx.20251953

Abstract：Objective To study and analyze the differences in clinical characteristics,treatment plans,and short-term outcomes between patients with lupus nephritis and non-LN patients among first-time systemic lupus erythematosus patients in a real-world setting.Methods A retrospective analysis of 249 first-time SLE patient cases diagnosed at the Department of Rheumatology and Immunology,First Affiliated Hospital of Bengbu Medical University from January 2018 to January 2023.Patients were divided into the LN group(79 cases)and the non-LN group(170 cases)based on whether they had kidney involvement at the time of SLE diagnosis.The clinical features,treatment,and follow-up of both groups were compared.Results At the time of diagnosis,31.7％(79 cases)of the 249 first-time SLE patients developed LN.There were no statistically significant differences between the LN group and the non-LN group in terms of female proportion,age at onset,age at diagnosis,and disease duration(all P＞0.05).However,patients in the LN group had lower levels of hemoglobin,platelet count,serum albumin,complement C3,and complement C4 compared to those in the non-LN group(all P＜0.05).The incidence of arthritis was lower in the LN group than in the non-LN group,while the incidence of infection,pleurisy,and pericarditis was higher in the LN group than in the non-LN group(all P＜0.05).The positive rates of anti-dsDNA antibodies and anti-SSB antibodies were higher in the LN group than in the non-LN group(all P＜0.05).The SLEDAI-2000 score of LN group was higher than that of non-LN group(13.2 vs.7.4,P＜0.001),but the non-kidney SLEDAI-2000 score was lower than that of non-LN group(5.7 vs.7.4,P=0.007).The proportion of patients with severe SLEDAI-2000 score was higher than that of non-LN group,and the proportion of patients with mild SLEDAI-2000 score was lower than that of non-LN group(60.8％vs.12.9％,13.9％vs.55.3％,all P＜0.001).In the induction therapy,54 patients(80.6％)in the LN group and 80 patients(56.7％)in the non-LN group received immunosuppressive therapy,including biologies(80.6％vs.56.7％,P＜0.001).The incidence of adverse events related to infection was higher in the LN group than in the non-LN group within 12 months of treatment(28.4％vs.16.3％,P=0.043).During the follow-up period,the overall renal remission rate was higher in the LN group at 12 months compared to 6 months.At 12 months,43 patients(64.2％)achieved complete renal response,22 patients(32.8％)had partial renal response,and 2 patients(3.0％)showed no renal response.Their hemoglobin,platelet count,serum albumin,complement C3,and complement C4 levels improved significantly com-pared to before treatment(all P＜0.001).There were no statistically significant differences between the two groups in terms of mortality,tumor-related complications,and other follow-up outcomes(all P＞0.05).The proportion and time to achieving a low disease activity state or remission in both groups were not statistically significant,and there were no sig-nificant differences in the proportion and time of lupus disease activity recurrence(all P＞0.05).Conclusion In pa-tients with primary SLE,LN patients showed higher incidence of pericarditis,pleurisy,and infections,as well as higher positivity rates for Anti-dsDNA and Anti-SSB.Conversely,they exhibited lower activity of extrarenal diseases,lower incidence of arthritis,and lower serum albumin levels.After 12 months of induction therapy,LN patients demonstrated significantly improved overall renal response and related laboratory parameters,with short-term prognosis comparable to non-LN patients.