Diffuse Alveolar Hemorrhage in Patients with Systemic Lupus Erythematosus: A Single Center Retrospective Study in Malaysia
Background: The objective of this study was to evaluate demographic characteristics, clinical presentation, laboratory findings, treatments, and their impact on the outcome of systemic lupus erythematosus (SLE)-related diffuse alveolar hemorrhage (DAH) in our local setting. Methods: A total of seven...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
World Scientific Publishing
2024-12-01
|
| Series: | Journal of Clinical Rheumatology and Immunology |
| Subjects: | |
| Online Access: | https://www.worldscientific.com/doi/10.1142/S2661341724500056 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832539873521696768 |
|---|---|
| author | Piem Jie Leong Anna Farazilah Mohd Salleh |
| author_facet | Piem Jie Leong Anna Farazilah Mohd Salleh |
| author_sort | Piem Jie Leong |
| collection | DOAJ |
| description | Background: The objective of this study was to evaluate demographic characteristics, clinical presentation, laboratory findings, treatments, and their impact on the outcome of systemic lupus erythematosus (SLE)-related diffuse alveolar hemorrhage (DAH) in our local setting. Methods: A total of seven patients were selected from our hospital’s local SLE database between 2013 and 2024 based on the inclusion criteria. Various variables were captured and analyzed using the Mann-Whitney [Formula: see text] test or Fisher’s exact test for comparison where appropriate. Results: All seven patients were female, with a median age of 26 years, and the median duration of SLE before DAH was 3 months. More than half were presented with all three symptoms: fever (57%), dyspnea (71.4%), and hemoptysis (85.7%). Kidney involvement was present in all cases. All patients received methylprednisolone as initial treatment with 71.4% subsequently received plasmapheresis, 57% received cyclophosphamide, 28.6% received intravenous immunoglobulin, and 14.3% received rituximab. Five out of the seven patients required invasive mechanical ventilation. The mortality rate was 57%. Two out of three survivors received a combination of multiple immunosuppressive agents. Non-survivors had significantly higher acute physiology and chronic health evaluation II (APACHE II) scores ([Formula: see text] = 0.034), while other variables were not statistically linked to mortality. In spite of that, all patients with nosocomial infection did not survive. Conclusion: Our observational study showed that a higher APACHE-II score was associated with a higher mortality rate. The efficacy of these treatment modalities cannot be conclusively determined due to the small sample size of this study. However, a combination of multiple immunosuppressive agents appeared to be associated with better outcomes in some patients. |
| format | Article |
| id | doaj-art-15e8dfba05694dd0a0d1cbb8151caede |
| institution | Kabale University |
| issn | 2661-3417 2661-3425 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | World Scientific Publishing |
| record_format | Article |
| series | Journal of Clinical Rheumatology and Immunology |
| spelling | doaj-art-15e8dfba05694dd0a0d1cbb8151caede2025-02-05T07:39:34ZengWorld Scientific PublishingJournal of Clinical Rheumatology and Immunology2661-34172661-34252024-12-012402606710.1142/S2661341724500056Diffuse Alveolar Hemorrhage in Patients with Systemic Lupus Erythematosus: A Single Center Retrospective Study in MalaysiaPiem Jie Leong0Anna Farazilah Mohd Salleh1Rheumatology Division, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, MalaysiaRheumatology Division, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, MalaysiaBackground: The objective of this study was to evaluate demographic characteristics, clinical presentation, laboratory findings, treatments, and their impact on the outcome of systemic lupus erythematosus (SLE)-related diffuse alveolar hemorrhage (DAH) in our local setting. Methods: A total of seven patients were selected from our hospital’s local SLE database between 2013 and 2024 based on the inclusion criteria. Various variables were captured and analyzed using the Mann-Whitney [Formula: see text] test or Fisher’s exact test for comparison where appropriate. Results: All seven patients were female, with a median age of 26 years, and the median duration of SLE before DAH was 3 months. More than half were presented with all three symptoms: fever (57%), dyspnea (71.4%), and hemoptysis (85.7%). Kidney involvement was present in all cases. All patients received methylprednisolone as initial treatment with 71.4% subsequently received plasmapheresis, 57% received cyclophosphamide, 28.6% received intravenous immunoglobulin, and 14.3% received rituximab. Five out of the seven patients required invasive mechanical ventilation. The mortality rate was 57%. Two out of three survivors received a combination of multiple immunosuppressive agents. Non-survivors had significantly higher acute physiology and chronic health evaluation II (APACHE II) scores ([Formula: see text] = 0.034), while other variables were not statistically linked to mortality. In spite of that, all patients with nosocomial infection did not survive. Conclusion: Our observational study showed that a higher APACHE-II score was associated with a higher mortality rate. The efficacy of these treatment modalities cannot be conclusively determined due to the small sample size of this study. However, a combination of multiple immunosuppressive agents appeared to be associated with better outcomes in some patients.https://www.worldscientific.com/doi/10.1142/S2661341724500056Diffuse Alveolar HemorrhageSystemic Lupus ErythematosusPulmonary Hemorrhage |
| spellingShingle | Piem Jie Leong Anna Farazilah Mohd Salleh Diffuse Alveolar Hemorrhage in Patients with Systemic Lupus Erythematosus: A Single Center Retrospective Study in Malaysia Journal of Clinical Rheumatology and Immunology Diffuse Alveolar Hemorrhage Systemic Lupus Erythematosus Pulmonary Hemorrhage |
| title | Diffuse Alveolar Hemorrhage in Patients with Systemic Lupus Erythematosus: A Single Center Retrospective Study in Malaysia |
| title_full | Diffuse Alveolar Hemorrhage in Patients with Systemic Lupus Erythematosus: A Single Center Retrospective Study in Malaysia |
| title_fullStr | Diffuse Alveolar Hemorrhage in Patients with Systemic Lupus Erythematosus: A Single Center Retrospective Study in Malaysia |
| title_full_unstemmed | Diffuse Alveolar Hemorrhage in Patients with Systemic Lupus Erythematosus: A Single Center Retrospective Study in Malaysia |
| title_short | Diffuse Alveolar Hemorrhage in Patients with Systemic Lupus Erythematosus: A Single Center Retrospective Study in Malaysia |
| title_sort | diffuse alveolar hemorrhage in patients with systemic lupus erythematosus a single center retrospective study in malaysia |
| topic | Diffuse Alveolar Hemorrhage Systemic Lupus Erythematosus Pulmonary Hemorrhage |
| url | https://www.worldscientific.com/doi/10.1142/S2661341724500056 |
| work_keys_str_mv | AT piemjieleong diffusealveolarhemorrhageinpatientswithsystemiclupuserythematosusasinglecenterretrospectivestudyinmalaysia AT annafarazilahmohdsalleh diffusealveolarhemorrhageinpatientswithsystemiclupuserythematosusasinglecenterretrospectivestudyinmalaysia |