Long-term outcomes and predictive factors of achieving low disease activity in childhood systemic lupus erythematosus: a Chinese bicentric retrospective registered study

Abstract

Abstract Backgroud Explore the clinical value of LDAS in the T2T strategy of pediatric systemic lupus erythematosus (pSLE) and find the risk factors for never reaching low disease activity state (LDAS). Methods Total of 272 children with SLE who were diagnosed and followed up in the Children's Hospital of Chongqing Medical University or Children's Hospital of Nanjing Medical University during the period from January 2012 to December 2019 were involved in this study, and the clinical presentation, pathology, treatment were retrospectively studied. Results Of the 272 patients enrolled in this study. During follow-up, 230 children achieved LDAS, and 42 were never been in. Male (P = 0.018), mucosal ulcer (P = 0.048), liver function damage (P = 0.026), cardiac effusion (P = 0.034), hematuria (P = 0.048), urine red blood cells (P = 0.017), urinary leukocytes (P = 0.032), endothelial cell proliferation (P = 0.004), these indexes have statistical differences between the two groups. Male (P = 0.045) and endothelial cell proliferation (P = 0.010) are independent risk factors for never achieving LDAS by multivariate logistic analysis. Children with biologics achieved LDAS at a higher rate than children without biologics (P = 0.038). The proportion of pSDI ≥ 1 in patients never been in LDAS was significantly higher than that in patients who achieved LDAS (P < 0.001). Conclusions Male and endothelial cell proliferation were independent risk factors for never achieving LDAS. At the end of the follow-up, the organ damage in the remission group was similar to that in the LDAS group, indicating that LDAS can be used as a target for pSLE treatment. Trial registration This study was registered at the Chinese Clinical Trial Registry (ChiCTR2100046357, date: 2021.06.01-2023.06.01) and the National Center for Biotechnology Information (#NCT04942314, date: 2021.07.01-2023.06.01).