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Characteristics of patients with initial diagnosis of systemic lupus erythematosus in emergency department and their outcomes: a retrospective single-center study

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Abstract

Study objective

This study aims to investigate the characteristics of patients with an initial diagnosis of systemic lupus erythematosus (SLE) in an emergency department (ED) and their outcomes.

Methods

A total of 147 SLE patients (119 females and 28 males, mean age 26 ± 19 years) who visited the ED of the Peking University People’s Hospital between January 2017 and June 2022 were enrolled in the study. Data on demographic information, clinical characteristics, comorbidities, therapy, and outcomes were collected.

Results

Most patients visit ED because of symptoms related to SLE (74.8%, 110/147). The remaining 37 patients (25.2%) visited ED due to infection (43.2%, 16/37), gastrointestinal bleeding (10.8%, 4/37), coronary heart or cerebrovascular disease (18.9%, 7/37), macrophage activation syndrome or thrombotic microangiopathy (18.9%, 7/37), leukemia (5.4%, 2/37), and hepatic encephalopathy (2.7%, 1/37). Of the patients, 54.4% (80/147) were first diagnosed with SLE at the time of their ED visit. Thrombocytopenia events occurred significantly more frequently in this group of patients (OR 3.664, 95% CI 1.586–8.464, p = 0.002). Pulse steroid therapy was administered to 32.5% (26/80) of the patients with an initial diagnosis of SLE, and 26.3% (21/80) of these patients also received IVIG therapy during their ED visit. SLEDAI scores were significantly decreased after 6 months of therapy. The rate of mortality was 6.8% (10/147) in the 6-month follow-up period, and all the ten deaths happened in patients with disease-established SLE. The main causes of death were infections (two patients) and SLE flare (four patients).

Conclusion

Understanding disease patterns can contribute to physicians providing accurate diagnosis and efficient care for SLE patients in ED.

Key Points

• Systemic lupus erythematosus, a complex autoimmune disorder, can have either a chronic or a relapsing and remitting disease course. The disease can involve acute events or severe comorbidities, and frequent visits to the emergency department (ED) are inevitable.

• It is essential to better understand which comorbidities can lead to emergency department visits. Accurate clinical diagnosis and appropriate interventions from ED physicians can have a strong impact on the prognosis of the disease.

• Hematologic compromise attributed to SLE flare is the most common reason for ED visits. Owing to aggressive treatments, the clinical outcomes in patients with initial diagnosis of SLE have improved notably.

• Our study highlights that early recognition and appropriate management of SLE-related conditions and other comorbidity in ED are crucial.

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Data availability

The original contributions presented in the study are included in the article, and further inquiries can be directed to the corresponding author.

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Funding

This work was supported by Peking University People’s Hospital Research and Development Funds (RDJ2022-18 and RD 2022-66).

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Author notes

  1. Xiaoying Zhang and Xiaojing Song contributed equally to this study.

Authors and Affiliations

  1. Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, China

    Xiaoying Zhang, Yuebo Jin, Jiayang Jin & Miao Shao

  2. Department of Emergency, Peking University People’s Hospital, 11 Xizhimen South St, Beijing, 100044, China

    Xiaojing Song, Su Lv, Jia Li, Jihong Zhu & Cheng Chi

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  1. Xiaoying Zhang
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Contributions

XZ, XS, CC, and JZ were responsible for the study concept and design. SL, JL, YJ, JJ, and MS were responsible for data acquisition. XZ, XS, and CC analyzed and interpreted the data. XZ and XS drafted the manuscript. CC provided statistical expertise. All authors were responsible for critical revisions of the article and for the intellectual content.

Corresponding author

Correspondence to Cheng Chi.

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Ethics approval

Ethical approval was obtained from the ethical committee of the Peking University People’s Hospital (2023PHB178-001). All research adhered to the tenets of the Declaration of Helsinki. The funding organization had no input on how we conducted the study. Patients and hospital staff were not involved in or aware of the study. The data sharing agreement and the research ethics board approval preclude the sharing of original data.

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Zhang, X., Song, X., Lv, S. et al. Characteristics of patients with initial diagnosis of systemic lupus erythematosus in emergency department and their outcomes: a retrospective single-center study. Clin Rheumatol 43, 667–676 (2024). https://doi.org/10.1007/s10067-023-06845-9

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