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Clinical features and risk factors of primary Sjögren’s syndrome complicated with severe pneumonia: a case–control study

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Abstract

Objectives

To analyze clinical characteristics, risk factors, pathogen distribution, and prognostic markers in primary Sjögren’s syndrome (pSS) patients with severe pneumonia (SP) compared to those without severe pneumonia (NSP).

Methods

This case–control study included 24 hospitalized pSS patients with SP and 96 NSP at the first affiliated hospital of Soochow university from June 2014 to May 2023. Data encompassing demographics, comorbidities, treatments, and laboratory results were retrospectively collected. Univariate and multivariate regression analyses, ROC curves, and statistical analyses using SPSS 23.0 assessed risk factors. The study retrospectively analyzed clinical features and risk factors, highlighting distinct parameters between pSS patients with and without SP.

Results

Marked differences were observed in several parameters: pSS activity(P < 0.001), white blood cell (P = 0.043), lymphocyte (P < 0.001), neutrophils (P = 0.042), C-reactive protein (P = 0.042), and CD8+ T cell (P = 0.017). Notably, lymphocyte count and SS activity demonstrated robust discrimination ability (AUC > 0.85). C-reactive protein (CRP), procalcitonin, CD4+ T cell, and IgA showed significant associations with SP; higher CRP levels correlated with increased risk, while lower CD4+ T cell and IgA levels associated with increased risk. SS activity significantly impacted outcomes. Various biomarkers exhibited diverse discriminatory abilities but lacked strong predictive associations with outcomes.

Conclusion

pSS patients with SP exhibited higher disease activity and altered immune profiles compared to those NSP. Lymphocyte count and SS activity emerged as robust discriminators. Higher CRP levels correlated with increased risk of SP, while lower CD4+T cell and IgA levels associated with increased risk. SS activity significantly impacted patient outcomes.

Key Points

• pSS patients with SP exhibited higher disease activity and altered immune profiles compared to those NSP.

• Lymphocyte count and SS activity emerged as robust discriminators.

• Higher CRP levels correlated with increased risk of SP, while lower CD4+ T cell and IgA levels associated with decreased risk.

• SS activity significantly impacted patient outcomes.

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Data availability

The data with regard to this article will be shared on reasonable request to the corresponding author.

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Acknowledgements

The authors would like to thank all the participants of this study who made this research possible.

Funding

This study was financially supported by the National Natural Science Foundation of China (82101893), the First Affiliated Hospital of Soochow University BOXI Clinical Research Project (BXLC016), Fujian provincial health technology project (2023GGA008), and the Gusu District Health Talent Training Project (GSWS2022073).

Author information

Author notes

  1. Bo Cai and Zhiliang Guo contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology and Immunology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China

    Bo Cai, Zhiliang Guo & Xianming Long

  2. Department of Rheumatology and Immunology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China

    Qing Yan

  3. Department of Rheumatology and Immunology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu Province, China

    Hui Li

  4. Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China

    Hua Song

  5. Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu Province, China

    Yan Gong

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  1. Bo Cai
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Contributions

BC and ZLG drafted the manuscript and performed most of the data collection. QY, HL, and HS carried out the data collection and data analysis and revised the paper. YG and XML conceived the study and participated in its design and coordination and interpreted the data. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yan Gong or Xianming Long.

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Ethical approval

All procedures involving human participants conformed to the ethical guidelines of the institutional and national research committee and the 1964 Declaration of Helsinki. The study was approved by the hospital ethics committee (approval ID:2021–023).

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Cai, B., Guo, Z., Yan, Q. et al. Clinical features and risk factors of primary Sjögren’s syndrome complicated with severe pneumonia: a case–control study. Clin Rheumatol 43, 1665–1674 (2024). https://doi.org/10.1007/s10067-024-06942-3

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  • DOI: https://doi.org/10.1007/s10067-024-06942-3

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