Advertisement

Rheumatology International

, Volume 36, Issue 2, pp 271–276 | Cite as

Splenectomy increases the subsequent risk of systemic lupus erythematosus

  • Chao-Yu Hsu
  • Hsuan-Ju Chen
  • Chung Y. Hsu
  • Chia-Hung KaoEmail author
Original Article - Observational Research

Abstract

Splenectomy may be necessary to treat systemic lupus erythematosus (SLE) patients with thrombocytopenia; however, whether performing a splenectomy on patients without SLE increases the subsequent risk of SLE remains unknown. Therefore, this study was conducted to determine the association between splenectomy and SLE. We conducted a cohort study by using data from the Taiwan National Health Institute Research Database to identify 10,298 patients with received a splenectomy between 2000 and 2006 and 41,192 participants without received a splenectomy who were selected by frequency matched based on sex, age, and the index year. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of developing SLE associated with splenectomy compared with patients who did not receive a splenectomy. During the study period, the overall incidence density rate of SLE was higher in the splenectomy cohort than in the non-splenectomy cohort (adjusted HR 10.55; 95 % CI 50.55–20.05). The incidence density rates of SLE in women and men who received a splenectomy were higher than those of patients who did not receive a splenectomy. Non-traumatic splenectomy increases the subsequent risk of SLE. The risk of SLE should be considered before performing a splenectomy, particularly in women and younger patients.

Keywords

Splenectomy Systemic lupus erythematosus Non-traumatic 

Abbreviations

SLE

Systemic lupus erythematosus

NHIRD

National Health Insurance Research Database

ICD-9-CM

International Classification of Diseases, Ninth Revision, Clinical Modification

HRs

Hazard ratios

CIs

Confidence interval

Notes

Acknowledgments

This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW104-TDU-B-212-113002); China Medical University Hospital, Academia Sinica Taiwan Biobank, Stroke Biosignature Project (BM104010092); NRPB Stroke Clinical Trial Consortium (MOST 103-2325-B-039 -006); Tseng-Lien Lin Foundation, Taichung, Taiwan; Taiwan Brain Disease Foundation, Taipei, Taiwan; Katsuzo and Kiyo Aoshima Memorial Funds, Japan; and CMU under the Aim for Top University Plan of the Ministry of Education, Taiwan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding received for this study.

Author contribution

All authors have contributed substantially to, and are in agreement with the content of, the manuscript: Conception/Design: Chao-Yu Hsu, Chia-Hung Kao; Provision of study materials: Chia-Hung Kao; Collection and/or assembly of data: all authors; Data analysis and interpretation: all authors; Manuscript preparation: All authors; Final approval of manuscript: All authors. The guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article: Chia-Hung Kao.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest.

References

  1. 1.
    Tsokos G (2011) Systemic lupus erythematosus. N Engl J Med 365:2110–2121CrossRefPubMedGoogle Scholar
  2. 2.
    Jarukitsopa S, Hoganson DD, Crowson CS et al (2015) Epidemiology of systemic lupus erythematosus and cutaneous lupus in a predominantly white population in the United States. Arthritis Care Res (Hoboken) 67(6):817–28Google Scholar
  3. 3.
    Somers EC, Marder W, Cagnoli P et al (2014) Population-based incidence and prevalence of systemic lupus erythematosus: the michigan lupus epidemiology and surveillance program. Arthritis Rheumatol 66:369–378PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Danchenko N, Satia J, Anthony M (2006) Epidemiology of systemic lupus erythematosus: a comparison of worldwide disease burden. Lupus 15:308–318CrossRefPubMedGoogle Scholar
  5. 5.
    Jallouli M, Frigui M, Marzouk S et al (2012) Clinical implications and prognostic significance of thrombocytopenia in Tunisian patients with systemic lupus erythematosus. Lupus 21:682–687CrossRefPubMedGoogle Scholar
  6. 6.
    Ktona E, Barbullushi M, Backa T, Idrizi A, Shpata V, Roshi E (2014) Evaluation of thrombocytopenia in systemic lupus erythematosus and correlation with different organs damages. Mater Sociomedica 26:122–124CrossRefGoogle Scholar
  7. 7.
    Domiciano DS, Shinjo SK (2010) Autoimmune hemolytic anemia in systemic lupus erythematosus: association with thrombocytopenia. Clin Rheumatol 29:1427–1431CrossRefPubMedGoogle Scholar
  8. 8.
    Li R, Liu G, Wang K et al (2011) Splenectomy for thrombocytopenia associated with systemic lupus erythematosus in 11 Chinese patients. Rheumatol Int 31:9–15CrossRefPubMedGoogle Scholar
  9. 9.
    Zhou J, Wu Z, Zhou Z et al (2013) Efficacy and safety of laparoscopic splenectomy in thrombocytopenia secondary to systemic lupus erythematosus. Clin Rheumatol 32:1131–1138CrossRefPubMedGoogle Scholar
  10. 10.
    Liu CY, Hung Y, Chuang Y et al (2006) Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manag 4:1–22Google Scholar
  11. 11.
    Sánchez-Pérez M, Romero-Hernández T, Blanco-Benavides R (2008) Splenectomy incidence in a specialized care hospital. Rev Med Inst Mex Seguro Soc 46:435–438PubMedGoogle Scholar
  12. 12.
    Rose AT, Newman M, Debelak J et al (2000) The incidence of splenectomy is decreasing: lessons learned from trauma experience. Am Surg 66:481–486PubMedGoogle Scholar
  13. 13.
    Rosati C, Ata A, Siskin GP, Megna D, Bonville DJ, Stain SC (2015) Management of splenic trauma: a single institution’s 8-year experience. Am J Surg 209:308–314CrossRefPubMedGoogle Scholar
  14. 14.
    Pardhan A, Hameed A, Zafar H, Mazahir S, Murtaza G (2014) Outcomes of splenectomy for idiopathic thrombocytopenic purpura in adults: a developing country perspective. J Pak Med Assoc 64:1240–1243PubMedGoogle Scholar
  15. 15.
    Mehta N, Babu S, Venugopal K (2014) An experience with blunt abdominal trauma: evaluation, management and outcome. Clin Pract 4:599PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Ramos-Casals M, Brito-Zerón P, Kostov BA et al (2015) Google-driven search for big data in autoimmune geoepidemiology: analysis of 394,827 patients with systemic autoimmune diseases. Autoimmun Rev 14(8):670–679Google Scholar
  17. 17.
    Arnaud L, Fagot JP, Mathian A, Paita M, Fagot-Campagna A, Amoura Z (2014) Prevalence and incidence of systemic lupus erythematosus in France: a 2010 nation-wide population-based study. Autoimmun Rev 13:1082–1089CrossRefPubMedGoogle Scholar
  18. 18.
    Rees F, Doherty M, Grainge M, Davenport G, Lanyon P, Zhang W (2014) The incidence and prevalence of systemic lupus erythematosus in the UK, 1999–2012. Ann Rheum Dis. doi: 10.1136/annrheumdis-2014-206334
  19. 19.
    Elfving P, Puolakka K, Kautiainen H, Virta L, Pohjolainen T, Kaipiainen-Seppänen O (2014) Incidence of systemic lupus erythematosus in Finland, 2000–2007, a nationwide study. Clin Exp Rheumatol 32:953–955PubMedGoogle Scholar
  20. 20.
    Khan D, Dai R, Ahmed SA (2015) Sex differences and estrogen regulation of miRNAs in lupus, a prototypical autoimmune disease. Cell Immunol 294:70–79CrossRefPubMedGoogle Scholar
  21. 21.
    Syplyviy V, Andreyeshchev S, Akymenko A, Dotsenko V, Evtushenko O (2014) Immune status of patients after splenectomy, performed for the spleen traumatic injury in remote terms and choice of preparations for its correction. Klinichna Khirurgiya 12:43–47Google Scholar
  22. 22.
    Kim MT, Harty JT (2014) Splenectomy alters distribution and turnover but not numbers or protective capacity of de novo generated memory CD8 T-cells. Front Immunol 5:568PubMedCentralPubMedGoogle Scholar
  23. 23.
    Wu L, Parekh VV, Hsiao J, Kitamura D, Van Kaer L (2014) Spleen supports a pool of innate-like B cells in white adipose tissue that protects against obesity-associated insulin resistance. Proc Natl Acad Sci USA 111:E4638–E4647PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Lipsky PE (2001) Systemic lupus erythematosus: an autoimmune disease of B cell hyperactivity. Nat Immunol 2:764–766CrossRefPubMedGoogle Scholar
  25. 25.
    Dörner T, Giesecke C, Lipsky PE (2011) Mechanisms of B cell autoimmunity in SLE. Arthritis Res Ther 13:243PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Alexander T, Radbruch A, Hiepe F (2015) Pathogenesis of systemic lupus erythematosus. Z Rheumatol 74:183–190CrossRefPubMedGoogle Scholar
  27. 27.
    Adams SG Jr, Dammers PM, Saia TL, Brantley PJ, Gaydos GR (1994) Stress, depression, and anxiety predict average symptom severity and daily symptom fluctuation in systemic lupus erythematosus. J Behav Med 17:459–477CrossRefPubMedGoogle Scholar
  28. 28.
    Tsai JD, Lin CL, Lin CC, Sung FC, Lue KH (2014) Risk of epilepsy in patients with systemic lupus erythematosus: a retrospective cohort study. Neuropsychiatr Dis Treat 10:1635–1643PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Chao-Yu Hsu
    • 1
    • 2
    • 3
    • 4
    • 5
  • Hsuan-Ju Chen
    • 6
    • 7
  • Chung Y. Hsu
    • 8
  • Chia-Hung Kao
    • 8
    • 9
    Email author
  1. 1.Department of Medical Education and ResearchPuli Christian HospitalPuliTaiwan
  2. 2.Department of OptometryCentral Taiwan University of Science and TechnologyTaichungTaiwan
  3. 3.Center for General EducationNational Taichung University of Science and TechnologyTaichungTaiwan
  4. 4.The General Education CenterChaoyang University of TechnologyTaichungTaiwan
  5. 5.Department of General EducationNational Chin-Yi University of TechnologyTaichungTaiwan
  6. 6.Management Office for Health DataChina Medical University HospitalTaichungTaiwan
  7. 7.College of MedicineChina Medical UniversityTaichungTaiwan
  8. 8.Graduate Institute of Clinical Medical Science and School of Medicine, College of MedicineChina Medical UniversityTaichungTaiwan
  9. 9.Department of Nuclear Medicine and PET CenterChina Medical University HospitalTaichungTaiwan

Personalised recommendations