Should Heparin Be Used to Treat Patients With Severe Sepsis?*:

Effects of Disease Activity and Inflammatory Response on Hypercoagulability in Patients with Systemic Lupus Erythematosus

BACKGROUND AND AIMS

The aim of the study was to (1) investigate the possible relationships of clinical manifestations and laboratory abnormalities with hypercoagulability in systemic lupus erythematosus (SLE) patients; (2) analyze the interaction effect between SLE disease activity and erythrocyte sedimentation rate (ESR) as well as between C3 and ESR on hypercoagulability.

METHODS

The medical records of 1677 SLE patients were collected. Data on demographic characteristics, clinical manifestations, laboratory abnormalities and immunosuppressive agents use were obtained by medical record review. Coagulation score was calculated based on D-dimer and fibrinogen.

RESULTS

Coagulation score was associated with the presence of lupus nephritis (β-coefficient [β]: 0.046; 95% confidence interval [CI]: 0.021-0.071; p <0.001), pleuritis (β: 0.113; 95% CI: 0.074-0.151; p <0.001), pericarditis (β: 0.075; 95% CI: 0.031-0.119; p = 0.001), fever (≥38°C) (β: 0.119; 95% CI: 0.083-0.155; p <0.001), active disease (β: 0.070; 95% CI: 0.044-0.096; p <0.001) and increased ESR (β: 0.199; 95% CI: 0.171-0.226; p <0.001) in multivariate linear regression models. A significant effect on coagulation score by the interaction between SLE disease activity and ESR was found (p <0.001). In contrast, there was no significant interaction effect between C3 and ESR (p = 0.248).

CONCLUSIONS

Lupus nephritis, pleuritis, pericarditis, fever (≥38°C), active disease and increased ESR were associated with hypercoagulability in SLE. There was a significant interaction between active disease and increased ESR for hypercoagulability in SLE.