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Atsumi T, Bae SC, Gu H, Huang WN, Li M, Nikpour M, Okada M, Prior D, Atanasov P, Jiang X, Wilson L, Bloomfield P, Wu DBC, Makanji Y. Risk Factors for Pulmonary Arterial Hypertension in Patients With Systemic Lupus Erythematosus: A Systematic Review and Expert Consensus. ACR Open Rheumatol 2023. [PMID: 37794618 DOI: 10.1002/acr2.11611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE This study aimed to identify risk factors associated with the development of pulmonary arterial hypertension (PAH) in patients with systemic lupus erythematosus (SLE). METHODS We conducted a systematic literature review of studies focusing on adult patients classified as having SLE-related PAH by searching the electronic databases Embase, Medline, Medline in-progress, Wanfang, China National Knowledge Infrastructure, Ichushi Web, Kmbase, and KoreaMed. Based on the findings, we conducted a Delphi survey to build expert consensus on issues related to screening for PAH in patients with SLE and on the importance and feasibility of measuring the identified factors in clinical practice. RESULTS We included 21 eligible studies for data synthesis. Sixteen factors were associated with an increased risk of SLE-PAH: pericardial effusion, serositis, longer duration of SLE, arthritis, acute and subacute cutaneous lupus, scleroderma pattern on nailfold capillaroscopy, diffusion capacity of carbon monoxide in the lungs (DLCO) <70% predicted, interstitial lung disease, thrombocytopenia, and seven serological factors. Six factors were associated with a decreased risk of SLE-PAH: malar/acute rash, hematologic disorder, renal disorder, higher Systemic Lupus Erythematosus Disease Activity Index score, and two serological factors. Among these, there were six risk factors on which the panelists reached strong or general consensus (peak tricuspid regurgitation velocity on echocardiography >2.8 m/s, pericardial effusion, DLCO <70% predicted, scleroderma pattern on nailfold capillaroscopy, brain natriuretic peptide >50 ng/l, and N-terminal pro-brain natriuretic peptide >300 ng/l). The Delphi panel confirmed the need for a screening tool to identify patients with SLE at high risk of developing PAH and provided consensus on the importance and/or practicality of measuring the identified factors. CONCLUSION The risk factors we identified could be used in a screening algorithm to identify patients with SLE with a high risk of developing PAH to facilitate early diagnosis, which could improve prognosis and management of these patients.
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Affiliation(s)
| | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology Research, and Hanyang Institute of Bioscience and Biotechnology, Seoul, Republic of Korea
| | - Hong Gu
- Beijing Anzhen Hospital, Beijing, China
| | - Wen-Nan Huang
- Taichung Veterans General Hospital, Ling-Tung University, and College of Medicine National Chung Hsing University, Taichung, Taiwan, and School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mengtao Li
- Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, and Ministry of Education, Beijing, China
| | - Mandana Nikpour
- St. Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | | | - David Prior
- St. Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | | | | | | | | | - David Bin-Chia Wu
- Janssen Pharmaceuticals Asia Pacific and Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Sawaya RD, El Zahran T, Mrad S, Abdul Massih C, Shaya S, Makki M, Tamim H, Majdalani M. Comparing febrile children presenting on and off antibiotics to the emergency department: a retrospective cohort study. BMC Pediatr 2020; 20:117. [PMID: 32164611 PMCID: PMC7069000 DOI: 10.1186/s12887-020-2007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/26/2020] [Indexed: 11/15/2022] Open
Abstract
Background It is not yet known how antibiotics may affect Serious Bacterial Infections (SBI). Our aim is to describe the presentation, management, and serious bacterial infections (SBI) of febrile children on or off antibiotics. Methods Retrospective, cohort study of febrile Emergency Department patients, 0–36 months of age, at a single institution, between 2009and 2012. Results Seven hundred fifty-three patients were included: 584 in the No-Antibiotics group and 169 (22%) in the Antibiotics group. Age and abnormal lung sounds were predictors for being on antibiotics (OR 2.00 [95% CI 1.23–3.25] and OR 1.04 [95% CI 1.02–1.06] respectively) while female gender, and lower temperatures were negative predictors (OR 0.68 [95%0.47–0.98] and OR 0.47 [95% CI 0.32–0.67] respectively). Antibiotics were prescribed by a physician 89% of the time; the most common one being Amoxicillin/Clavulanic Acid (39%). The antibiotic group got more blood tests (57% vs 45%) and Chest X-Rays (37% vs 25%). Overall, the percent of SBIs (and pneumonias) was statistically the same in both groups (6.5% in the No-antibiotic group VS 3.6%). Conclusions Children presenting on antibiotics and off antibiotics were significantly different in their presentation and management, although the overall percentages of SBI were similar in each group. Further investigations into this subgroup of febrile children are needed.
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Affiliation(s)
- R D Sawaya
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - T El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Mrad
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - C Abdul Massih
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Shaya
- Department of Emergency Medicine, Henry Ford University, Detroit, MI, USA
| | - M Makki
- Clinical Research Institute, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh/ Beirut, 1107 2020, Lebanon
| | - H Tamim
- Clinical Research Institute, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh/ Beirut, 1107 2020, Lebanon.
| | - M Majdalani
- Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon.
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Mizus M, Li J, Goldman D, Petri MA. Autoantibody clustering of lupus-associated pulmonary hypertension. Lupus Sci Med 2020; 6:e000356. [PMID: 31908817 PMCID: PMC6928462 DOI: 10.1136/lupus-2019-000356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/31/2019] [Accepted: 11/15/2019] [Indexed: 11/21/2022]
Abstract
Objective To define the SLE phenotype associated with pulmonary hypertension using multiple autoantibodies. Methods 207 (8%) patients with SLE with pulmonary hypertension, defined as a right ventricular systolic pressure greater than 40 mm Hg on transthoracic echocardiogram or as pulmonary artery dilatation on CT of the chest, were identified from the Hopkins Lupus Cohort (94.2% female; 56.5% African–American, 39% Caucasian; mean age 45.6 years). 53 patients were excluded from the clustering analysis due to incomplete autoantibody profiles. Agglomerative hierarchical clustering algorithm with Ward’s method was used to cluster the patients with pulmonary hypertension, based on their autoantibodies. Autoantibodies used in the clustering analysis included lupus anticoagulant, anticardiolipin, anti-beta 2 glycoprotein I, antidouble-stranded DNA, anti-Sm (anti-Smith), antiribonucleoprotein, false positive-rapid plasma reagin, anti-Ro, anti-La and hypocomplementaemia (C3 ever low or C4 ever low). The Dunn index was used to internally validate the clusters. Bootstrap resampling derived the mean Jaccard coefficient for each cluster. All analyses were performed in R V.3.6.1 using the packages cluster, fpc and gplots. Results A significantly higher prevalence of pulmonary hypertension in African–American patients with SLE, compared with Caucasian patients with SLE (11.5% vs 5.9%, p<0.0001), was found. Based on equivalent Dunn indices, the 154 patients with SLE-associated pulmonary hypertension with complete autoantibody data were divided into five clusters, three of which had mean Jaccard coefficients greater than 0.6. Hypocomplementaemia, renal disorder and age at diagnosis significantly differed across clusters. One cluster was defined by antiphospholipid antibodies. One cluster was defined by anti-Ro and anti-La. One cluster had low frequencies of all antibodies. Conclusion SLE-associated pulmonary hypertension disproportionately affects African–American patients. Pulmonary hypertension in SLE is defined by five autoantibody clusters. Antiphospholipid antibodies, anti-Ro and anti-La positivity, serological activity, and age at pulmonary hypertension diagnosis significantly differed across clusters, possibly indicating different pathophysiological mechanisms.
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Affiliation(s)
- Marisa Mizus
- Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Li
- Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Goldman
- Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle A Petri
- Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Sun L, Wang Y, Dong Y, Song S, Luo R, Li G. Assessment of Right Atrium Function in Patients With Systemic Lupus Erythematosus With Different Pulmonary Artery Systolic Pressures by 2-Dimensional Speckle-Tracking Echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2345-2351. [PMID: 29480580 DOI: 10.1002/jum.14582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/13/2017] [Accepted: 12/15/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess right atrium (RA) function of patients with systemic lupus erythematosus (SLE) and pulmonary artery hypertension (PAH) by 2-dimensional speckle-tracking echocardiography. METHODS Thirty matched healthy adults were selected as group A. Then, 102 patients with SLE were divided into 3 groups according to the severity of PAH. Group B included 37 patients without PAH (pulmonary artery [PA] systolic pressure ≤ 30 mm Hg); group C included 34 patients with PAH (PA systolic pressure of 30-50 mm Hg); and group D included 31 patients with PAH (PA systolic pressure ≥ 50 mm Hg). Parameters evaluated included RA maximum volume, minimum volume, preatrial contraction volume, passive ejection fraction (EF), and active EF. The global peak longitudinal systolic strain rate and early and late diastolic strain rates of the RA were obtained by 2-dimensional speckle-tracking echocardiography. RESULTS No significant differences were found in all parameters between groups B and A (P > .05). The RA maximum volume, minimum volume, preatrial contraction volume, active EF, and late diastolic strain rate in groups C and D were significantly increased compared with those in groups A and B, and the parameters in group D were significantly higher than those in group C (P < .05). Although the RA passive EF, early diastolic strain rate, and systolic strain rate in groups C and D were significantly decreased compared with those in groups A and B, those in group D were significantly lower than those in group C (P < .05). CONCLUSIONS Two-dimensional speckle-tracking echocardiography could effectively assess RA function in patients with SLE who have different severities of PAH.
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Affiliation(s)
- Lihua Sun
- Department of Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Wang
- Department of Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yu Dong
- Department of Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shengda Song
- Department of Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Runlan Luo
- Department of Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guangsen Li
- Department of Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Strand TE, Khiabani HZ, Boico A, Radiloff D, Zhao Y, Hamilton KL, Christians U, Klawitter J, Noveck RJ, Piantadosi CA, Bell C, Irwin D, Schroeder T. The novel combination of theophylline and bambuterol as a potential treatment of hypoxemia in humans. Can J Physiol Pharmacol 2017; 95:1009-1018. [PMID: 28467859 DOI: 10.1139/cjpp-2016-0635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Hypoxemia can be life-threatening, both acutely and chronically. Because hypoxemia causes vascular dysregulation that further restricts oxygen availability to tissue, it can be pharmacologically addressed. We hypothesized that theophylline can be safely combined with the β2-adrenergic vasodilator bambuterol to improve oxygen availability in hypoxemic patients. Ergogenicity and hemodynamic effects of bambuterol and theophylline were measured in rats under hypobaric and normobaric hypoxia (12% O2). Feasibility in humans was assessed using randomized, double-blind testing of the influence of combined slow-release theophylline (300 mg) and bambuterol (20 mg) on adverse events (AEs), plasma K+, pulse, blood pressure, and drug interaction. Both drugs and their combination significantly improved hypoxic endurance in rats. In humans, common AEs were low K+ (<3.5 mmol/L; bambuterol: 12, theophylline: 4, combination: 13 episodes) and tremors (10, 0, 14 episodes). No exacerbation or serious AE occurred when drugs were combined. A drop in plasma K+ coincided with peak bambuterol plasma concentrations. Bambuterol increased heart rate by approximately 13 bpm. Drug interaction was present but small. We report promise, feasibility, and relative safety of combined theophylline and bambuterol as a treatment of hypoxemia in humans. Cardiac safety and blood K+ will be important safety endpoints when testing these drugs in hypoxemic subjects.
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Affiliation(s)
- Trond-Eirik Strand
- a Norwegian Armed Forces Medical Services, Institute of Aviation Medicine, 0313 Oslo, Norway
| | - Hasse Z Khiabani
- b Department of Pharmacology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway
| | - Alina Boico
- c Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Yulin Zhao
- c Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
| | - Karyn L Hamilton
- e Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA
| | - Uwe Christians
- f iC42 Integrated Solutions in Clinical Research and Development, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jelena Klawitter
- f iC42 Integrated Solutions in Clinical Research and Development, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Robert J Noveck
- g Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Christopher Bell
- e Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA
| | - David Irwin
- i Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Thies Schroeder
- i Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA.,j Department of Biochemistry and Pharmacology, University of Mainz, 55128 Mainz, Germany
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Wang J, Qian J, Wang Y, Zhao J, Wang Q, Tian Z, Li M, Zeng X. Serological biomarkers as risk factors of SLE-associated pulmonary arterial hypertension: a systematic review and meta-analysis. Lupus 2017; 26:1390-1400. [PMID: 28409522 DOI: 10.1177/0961203317702255] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective This article aims to determine the serological biomarkers which can be considered as risk factors of systemic lupus erythematosus (SLE)-associated pulmonary arterial hypertension by a systematic review and meta-analysis. Methods This study was conducted in accordance with the PRISMA statement. The search database included MEDLINE, EMBASE, Cochrane Library and Scopus. The Newcastle-Ottawa scale was used for the quality assessment. The odds ratio was the primary measure of effect of the risk factors. Results Twelve studies were included in this meta-analysis. The results identified the anti-RNP antibody and anti-Sm antibody as risk factors for SLE-associated pulmonary arterial hypertension with the pooled odds ratios 3.68 (95% confidence interval 2.04-6.63, P < 0.0001) and 1.71 (95% confidence interval 1.06-2.76, P = 0.03), respectively. Conclusion Pulmonary arterial hypertension is a serious complication of SLE with a worse prognosis than SLE patients without pulmonary arterial hypertension. The early recognition of pulmonary arterial hypertension with transthoracic echocardiography routinely performed in SLE patients with risk factors is necessary, especially in Asian patients.
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Affiliation(s)
- J Wang
- 1 Department of Rheumatology, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - J Qian
- 1 Department of Rheumatology, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Y Wang
- 2 Department of Epidemiology and Biostatistics, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - J Zhao
- 1 Department of Rheumatology, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Q Wang
- 1 Department of Rheumatology, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Z Tian
- 3 Department of Cardiology, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - M Li
- 1 Department of Rheumatology, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - X Zeng
- 1 Department of Rheumatology, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
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Mathew R, Huang J, Wu JM, Fallon JT, Gewitz MH. Hematological disorders and pulmonary hypertension. World J Cardiol 2016; 8:703-718. [PMID: 28070238 PMCID: PMC5183970 DOI: 10.4330/wjc.v8.i12.703] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/07/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
Pulmonary hypertension (PH), a serious disorder with a high morbidity and mortality rate, is known to occur in a number of unrelated systemic diseases. Several hematological disorders such as sickle cell disease, thalassemia and myeloproliferative diseases develop PH which worsens the prognosis. Associated oxidant injury and vascular inflammation cause endothelial damage and dysfunction. Pulmonary vascular endothelial damage/dysfunction is an early event in PH resulting in the loss of vascular reactivity, activation of proliferative and antiapoptotic pathways leading to vascular remodeling, elevated pulmonary artery pressure, right ventricular hypertrophy and premature death. Hemolysis observed in hematological disorders leads to free hemoglobin which rapidly scavenges nitric oxide (NO), limiting its bioavailability, and leading to endothelial dysfunction. In addition, hemolysis releases arginase into the circulation which converts L-arginine to ornithine, thus bypassing NO production. Furthermore, treatments for hematological disorders such as immunosuppressive therapy, splenectomy, bone marrow transplantation, and radiation have been shown to contribute to the development of PH. Recent studies have shown deregulated iron homeostasis in patients with cardiopulmonary diseases including pulmonary arterial hypertension (PAH). Several studies have reported low iron levels in patients with idiopathic PAH, and iron deficiency is an important risk factor. This article reviews PH associated with hematological disorders and its mechanism; and iron homeostasis and its relevance to PH.
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Parallel Aspects of the Microenvironment in Cancer and Autoimmune Disease. Mediators Inflamm 2016; 2016:4375120. [PMID: 26997761 PMCID: PMC4779817 DOI: 10.1155/2016/4375120] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/13/2016] [Indexed: 02/07/2023] Open
Abstract
Cancer and autoimmune diseases are fundamentally different pathological conditions. In cancer, the immune response is suppressed and unable to eradicate the transformed self-cells, while in autoimmune diseases it is hyperactivated against a self-antigen, leading to tissue injury. Yet, mechanistically, similarities in the triggering of the immune responses can be observed. In this review, we highlight some parallel aspects of the microenvironment in cancer and autoimmune diseases, especially hypoxia, and the role of macrophages, neutrophils, and their interaction. Macrophages, owing to their plastic mode of activation, can generate a pro- or antitumoral microenvironment. Similarly, in autoimmune diseases, macrophages tip the Th1/Th2 balance via various effector cytokines. The contribution of neutrophils, an additional plastic innate immune cell population, to the microenvironment and disease progression is recently gaining more prominence in both cancer and autoimmune diseases, as they can secrete cytokines, chemokines, and reactive oxygen species (ROS), as well as acquire an enhanced ability to produce neutrophil extracellular traps (NETs) that are now considered important initiators of autoimmune diseases. Understanding the contribution of macrophages and neutrophils to the cancerous or autoimmune microenvironment, as well as the role their interaction and cooperation play, may help identify new targets and improve therapeutic strategies.
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