Clinical features and outcomes of patients with antineutrophil cytoplasmic antibody-positive systemic lupus erythematosus

Abstract

Purpose

To investigate the clinical characteristics, pathological features, and outcomes of patients with antineutrophil cytoplasmic antibody (ANCA)-positive systemic lupus erythematosus (SLE) in northwest China.

Methods

This retrospective study included 491 patients with SLE tested for ANCA antibodies and 171 patients with ANCA-associated vasculitis (AAV) as controls. Subgroup analysis limited to those with renal involvement, and by ANCA antibody subtype (PR3 vs MPO). To compare the proteinuria remission rates between ANCA-positive and ANCA-negative lupus nephritis (LN) groups, a logistic regression model was used for propensity score matching based on age, hemoglobin, and baseline estimated glomerular filtration rate (eGFR).

Results

Compared to ANCA-negative SLE (n = 442), ANCA-positive SLE (n = 46) occur in older patients; however, these patients were younger than those with AAV (n = 167). The eGFR of patients with ANCA-positive LN (n = 25) was higher than that of patients having AAV with renal involvement (n = 56) but lower than that of patients with ANCA-negative LN (n = 163). Patients with SLE who had MPO-ANCA (n = 16) had higher levels of serum creatinine compared to those with PR3-ANCA (n = 30) (156.5 µmol/L vs. 45.5 µmol/L, p = 0.005). During the follow-up period, the remission rate of proteinuria in patients with ANCA-positive LN was lower than that of patients with ANCA-negative LN (50% vs. 75%, p = 0.008).

Conclusion

Patients with ANCA-positive LN may have worse baseline renal function and lower protein remission rates compared to patients with ANCA-negative LN. ANCA titers should be regularly monitored throughout the follow-up period in patients with SLE, especially in cases of renal involvement.

Keywords:

• Anti-neutrophil cytoplasmic antibodies
• clinicopathological characteristics
• lupus nephritis
• systemic lupus erythematosus

Acknowledgments

We thank the Research Square platform for accepting our following article as a preprint: Wang, Y., Yu, X.Y, Xie, X.F, et al. Clinical features and outcomes of patients with antineutrophil cytoplasmic antibody-positive systemic lupus erythematosus; 09 May 2022, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-1624967/v1]. We also thank Bullet Edits for the linguistic editing and proofreading of this manuscript.

Authors’ contributions

Xinfang Xie and Wanhong Lu designed the study, Ying Wang and Xiaoyang Yu wrote the initial draft of the paper, Wei Yang and Yu Liang collected the data, and Huixian Li and Ying Wang conducted the statistical analysis.

Ethical approval

This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital of Xi’an Jiaotong University (XJTU1AF2021LSK-214). Owing to the retrospective nature of the study, the requirement for obtaining informed consent from the participants was waived by the Research Ethics Committee of the First Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, China.

Disclosure statement

All authors declare no competing interests.

Additional information

Funding

This study was supported by the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University, China (XJTU1AF-CRF-2017-018) and the Key Research and Development Program of Shaanxi Province, China (2019 KW-040).