The Role of Thrombocytopenia as an Independent Predictor of Cardiovascular and Renal Damage in Patients with Systemic Lupus Erythematosus
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- Category: Vol. 77, March 2009
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The Role of Thrombocytopenia as an Independent Predictor of Cardiovascular and Renal Damage in Patients with Systemic Lupus Erythematosus,MOHAMAD S. ABDEL BAKI, IMAN A. HAFEZ, IMAN E. IBRAHIM, REEM A.M. HABIB and GHADA M. ELGOHARY
Abstract
Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disorder in which the body's immune system incorrectly attacks the body's own tissues and organs, leading to inflammation and damage. Thrombocytopenia (defined as platelet count less than 100 x 109/liter) is rather common in SLE. The incidence ranges from 15-50% and it represents a predictor of a worse prognosis.
Aim of the Work: To study the role of thrombocytopenia as an independent predictor of organ damage (renal and cardiac) in SLE patients.
Patients and Methods: Our study was conducted on 40 SLE Patients from Ain Shams University Hospitals, classified into 2 groups; group I including 20 patients with thrombocy-topenia and group II including 20 patients without thromb-ocytopenia. All patients were subjected to medical history, clinical examination, laboratory investigations including, serological markers antinuclear antibody (ANA), anti-double stranded DNA (anti ds-DNA), renal biopsy.
Transthoracic echocardiography for assessment of cardiac affection, evaluating cardiac function, valvular lesion and presence of any pericardial disease.
Results: We found that there was no significant statistical difference between the two groups as regard their ages. Echocardiography was done for all patients, there were sig-nificant echocardiographic findings in group I compared to group II (p.value 0.027). As 40% of the patients in group I had pericardial effusion, 35% had mitral regurgitation, 10% had mitral stenosis, 20% had aortic regurgitation and 15% had tricuspid regurgitation. Among the patients in group II, 20% had pericardial effusion, 25% had mitral regurgitation, 10% had tricuspid regurgitation and no one of them had aortic valve disease. As regard renal damage, we found that 50% of thrombocytopenic SLE patients had proteinuria >3.5 gm/24h, in contrast to non thrombocytopenic patients in which only 25% of them had proteinuria. Also in thrombocytopenic patients 5% had ESRD, while no ESRD was found between non thrombocytopenic groups. While comparing the two groups regarding the pathological pattern of kidney affection assessed by renal biopsy according to WHO classification
system, we found no significant statistical differences among the two groups (p.value=0.38).
Conclusion: We concluded that thrombocytopenia emerged as one of the most important predictors of damage also it is a qualitative marker of impending damage in lupus patients and that thrombocytopenic SLE patients are at high risk of developing proteinuria, pericardial and valvular disease.