Cargando…
Serum interferon-alpha predicts in-hospital mortality in patients hospitalised with acute severe lupus
OBJECTIVES: Dysregulation of interferon-alpha (IFN-α) is considered central to the immunological abnormalities observed in SLE. Short-term mortality during high disease activity in lupus is up to 30%. Adenovirus vector-introduced IFN-α into a lupus-prone mouse causes the development of glomeruloneph...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10481835/ https://www.ncbi.nlm.nih.gov/pubmed/37666572 http://dx.doi.org/10.1136/lupus-2023-000933 |
_version_ | 1785102061549912064 |
---|---|
author | Yerram, Keerthi Vardhan Baisya, Ritasman Kumar, Phani Mylavarapu, Rammohan Rajasekhar, Liza |
author_facet | Yerram, Keerthi Vardhan Baisya, Ritasman Kumar, Phani Mylavarapu, Rammohan Rajasekhar, Liza |
author_sort | Yerram, Keerthi Vardhan |
collection | PubMed |
description | OBJECTIVES: Dysregulation of interferon-alpha (IFN-α) is considered central to the immunological abnormalities observed in SLE. Short-term mortality during high disease activity in lupus is up to 30%. Adenovirus vector-introduced IFN-α into a lupus-prone mouse causes the development of glomerulonephritis and death within weeks. We studied serum IFN-α as a biomarker of in-hospital mortality in patients of SLE with high disease activity. METHODS: Serum IFN-α (ELISA) was measured in patients hospitalised for acute severe lupus in a tertiary care rheumatology unit in India and the levels were compared between survivors and non-survivors. Serum IFN-α was compared with traditional clinical and serological markers associated with disease activity to assess which better prognosticates survival. RESULTS: In a cohort of 90 patients with a mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) of 19.3 (±5.5), the mean serum IFN-α was 88±144 pg/dL. Levels were undetectable in patients with inactive disease. SLEDAI, anti double stranded DNA (dsDNA) antibody titres and serum IFN-α levels were higher and serum complement (C3) lower in non-survivors (p=0.003, p=0.017, p<0.001, p=0.029, respectively). Serum IFN-α level of 140 pg/mL had a sensitivity of 86.7%, specificity of 94.6%, positive predictive value of 76% and negative predictive value of 83.3% (p<0.001) in predicting mortality. The area under the curve for predicting in-hospital mortality was 0.25 for C3, 0.72 for dsDNA, 0.77 for SLEDAI and 0.92 for serum IFN-α. CONCLUSIONS: Serum IFN-α was better in predicting in-hospital mortality compared with conventional measures of disease activity such as anti-dsDNA, complements and SLEDAI. |
format | Online Article Text |
id | pubmed-10481835 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-104818352023-09-07 Serum interferon-alpha predicts in-hospital mortality in patients hospitalised with acute severe lupus Yerram, Keerthi Vardhan Baisya, Ritasman Kumar, Phani Mylavarapu, Rammohan Rajasekhar, Liza Lupus Sci Med Biomarker Studies OBJECTIVES: Dysregulation of interferon-alpha (IFN-α) is considered central to the immunological abnormalities observed in SLE. Short-term mortality during high disease activity in lupus is up to 30%. Adenovirus vector-introduced IFN-α into a lupus-prone mouse causes the development of glomerulonephritis and death within weeks. We studied serum IFN-α as a biomarker of in-hospital mortality in patients of SLE with high disease activity. METHODS: Serum IFN-α (ELISA) was measured in patients hospitalised for acute severe lupus in a tertiary care rheumatology unit in India and the levels were compared between survivors and non-survivors. Serum IFN-α was compared with traditional clinical and serological markers associated with disease activity to assess which better prognosticates survival. RESULTS: In a cohort of 90 patients with a mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) of 19.3 (±5.5), the mean serum IFN-α was 88±144 pg/dL. Levels were undetectable in patients with inactive disease. SLEDAI, anti double stranded DNA (dsDNA) antibody titres and serum IFN-α levels were higher and serum complement (C3) lower in non-survivors (p=0.003, p=0.017, p<0.001, p=0.029, respectively). Serum IFN-α level of 140 pg/mL had a sensitivity of 86.7%, specificity of 94.6%, positive predictive value of 76% and negative predictive value of 83.3% (p<0.001) in predicting mortality. The area under the curve for predicting in-hospital mortality was 0.25 for C3, 0.72 for dsDNA, 0.77 for SLEDAI and 0.92 for serum IFN-α. CONCLUSIONS: Serum IFN-α was better in predicting in-hospital mortality compared with conventional measures of disease activity such as anti-dsDNA, complements and SLEDAI. BMJ Publishing Group 2023-09-04 /pmc/articles/PMC10481835/ /pubmed/37666572 http://dx.doi.org/10.1136/lupus-2023-000933 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Biomarker Studies Yerram, Keerthi Vardhan Baisya, Ritasman Kumar, Phani Mylavarapu, Rammohan Rajasekhar, Liza Serum interferon-alpha predicts in-hospital mortality in patients hospitalised with acute severe lupus |
title | Serum interferon-alpha predicts in-hospital mortality in patients hospitalised with acute severe lupus |
title_full | Serum interferon-alpha predicts in-hospital mortality in patients hospitalised with acute severe lupus |
title_fullStr | Serum interferon-alpha predicts in-hospital mortality in patients hospitalised with acute severe lupus |
title_full_unstemmed | Serum interferon-alpha predicts in-hospital mortality in patients hospitalised with acute severe lupus |
title_short | Serum interferon-alpha predicts in-hospital mortality in patients hospitalised with acute severe lupus |
title_sort | serum interferon-alpha predicts in-hospital mortality in patients hospitalised with acute severe lupus |
topic | Biomarker Studies |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10481835/ https://www.ncbi.nlm.nih.gov/pubmed/37666572 http://dx.doi.org/10.1136/lupus-2023-000933 |
work_keys_str_mv | AT yerramkeerthivardhan seruminterferonalphapredictsinhospitalmortalityinpatientshospitalisedwithacuteseverelupus AT baisyaritasman seruminterferonalphapredictsinhospitalmortalityinpatientshospitalisedwithacuteseverelupus AT kumarphani seruminterferonalphapredictsinhospitalmortalityinpatientshospitalisedwithacuteseverelupus AT mylavarapurammohan seruminterferonalphapredictsinhospitalmortalityinpatientshospitalisedwithacuteseverelupus AT rajasekharliza seruminterferonalphapredictsinhospitalmortalityinpatientshospitalisedwithacuteseverelupus |