Predictors of mortality in diffuse alveolar hemorrhage in systemic lupus erythematosus

Abstract

Background: Diffuse alveolar hemorrhage (DAH) in systemic lupus erythematosus (SLE) is not very common but is associated with high mortality. No studies from India report on DAH in SLE. Materials and Methods: From the electronic database of SLE patients, data of those with unequivocal DAH between January 2008 and March 2017 were retrieved. Clinical, laboratory, treatment, and outcome details were noted. Univariate analysis and multivariate analysis were carried out with survival as an outcome measure. Results: Twenty-four (1.31%) of 1828 SLE patients had DAH. Ten patients had DAH at diagnosis of lupus. The median interquartile range age was 23 (19.7–30) years, the median duration of hospital stay was 14 (10–22) days, and the mean SLE disease activity index was 19.5 ± 8.29. The most common clinical symptom was dyspnea followed by hemoptysis. Nephritis was the most common extrapulmonary organ involvement in 18. Hypocomplementemia was noted in 19/20, double-stranded DNA positivity in 20 patients. The mean erythrocyte sedimentation rate (ESR) was 62.17 ± 39.92 mm 1st h. Concomitant infection was seen in eight patients and raised serum procalcitonin in four/15 patients. All patients received intravenous (IV) methylprednisolone pulses, cyclophosphamide in 20, IV immunoglobulin in 4, rituximab in 2, and plasmapheresis in 2. Twelve patients (50%) died. High ESR and mechanical ventilation were independent risk factors for mortality in patients with DAH. Conclusion: DAH in SLE is infrequent but is often associated with infection and high mortality. Mechanical ventilation and high ESR are associated with higher mortality.

Keywords

• diffuse alveolar hemorrhage
• immunosuppression
• lupus
• systemic lupus erythematosus disease activity index
• survivors
• systemic lupus erythematosus