Final Outcome Analysis of Hospitalized Patients with Suspected NPSLE: A Retrospective Single-Center Study

Abstract

Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) is a serious complication in SLE, and distinguishing these manifestations from other neuropsychiatric disorders is challenging. Method: This was a retrospective single-center study. NP manifestations were attributed to SLE according to clinical experts’ opinions. Demographic and clinical data were obtained in patients with and without NP manifestations attributed to SLE. And antibodies profiles were included for hierarchical cluster analysis, analyze the correlation between different antibody clusters and clinical manifestations of SLE. Results: The final analysis group included 176 patients, of which 151 (85.8%) had NP manifestations attributed by SLE. 1, The positive rates of anti-nuclear antibodies (ANA) and anti-SSB of NPSLE patients and the levels of immunoglobulin G (IgG) were significantly higher in comparison with those NP symptoms not attributed to SLE (non-NPSLE) patients [145 (96.0%) vs 18 (72.0%), P [Formula: see text] 0.001; 23 (15.2%) vs 0 (0.0%), P=0.048; median 23.5 vs 9.6 points, IQR 10.00, 48.25 vs 7.58,15.83 points, P [Formula: see text] 0.01; respectively]. The levels of C4 and the proportion of patients with concomitant hemolytic anemia were lower than non-NPSLE [median 0.09 vs 0.15 points, IQR 0.05, 0.14 vs 0.07, 0.17 points, P [Formula: see text] 0.01; 9 (6.0%) vs 7 (28.0%), P [Formula: see text] 0.005; respectively]; 2, NP manifestations in the central nervous system were the most frequent (86.9%). In patients with NPSLE, cerebrovascular disease, seizures, headche occurred most often; Among non-NPSLE, common causes included infection, non-specific cerebrovascular disease, hematological disease; 3, Four clusters among 151 NPSLE patients were identified. Cluster 1 comprised patients with triple aPLs (antiphospholipid antibodies) positivity and demonstrates a high incidence of cerebrovascular disease, seizure, Cluster 2 was characterized by high positive rates of anti-SSA and anti-SSB, with high risk of system damage such as mucocutaneous, renal. Cluster 3 was characterized by a high positive rate of anti Sm, mainly present with aseptic meningitis and polyneuropathy, often accompanied by renal and hematological involvement. Cluster 4 was characterized by high positive rates of anti Ro52, anti RNP (ribosome P protein), includes seizure and demyelinating syndrome. Conclusion: Four characterized antibody clusters are identified in NPSLE patients in this study. Different clusters are associated with certain clinical features and complications of NPSLE. However, the correlations found in this study need to be investigated further in larger populations.