AB0489 HYPONATREMIA AS AN INFLAMMATORY MARKER OF LUPUS DISEASE: FACT OR FAD

Background Premature atherosclerosis is clearly described in systemic lupus erythematosus as a main cause of poor outcomes and mortality(1). The pleiotropic adipokines including adiponectin and visfatin are implicated in the inflammatory process of lupus disease that promote the interleukins and cytokines signaling leading accelerated endothelial disruption(2) Objectives: To evaluate the endothelial dysfunction by measuring serum Visfatin, adiponectin, leptin and HOMA-insulin Index as reliable biomarkers of the atherosclerosis & by estimating the FMD of brachial artery among lupus patients and correlating these parameters with clinical characteristics. Methods A case-control study in which 150 systemic lupus patients who were fulfilling American College of Rheumatology revised classification were recruited consecutively from Internal Medicine department at Cairo University, They were compared to 90 age & sex matched healthy controls. Patients who were pregnant, smoker, diabetic, those with hepatic and renal dysfunction, hypothyroidism, and familial dyslipidemia were excluded.Adiponectin, leptin,visfatin and HOMAIR were evaluated. Flow mediated dilatation of brachial artery was calculated as the maximum percent increase in artery diameter after cuff release compared to baseline Results The data revealed elevated levels of adiponectin, leptin, visfatin and HOMA IR in lupus cases compared to controls with reduced FMD percent. Clinical and laboratory background are summarized in table (1). Table 1 Characteristics CasesN=150 ControlsN=90 p-value Age(yr) 25.15±5.78 24.84±5.84 0.256 Female(N.%)Male(N,%) 125(84.66%)25(16.44%) 65(73%)25(27%) 0.34 Disease duration in months 10±6 BMI(Kg/m2) 25.56±3.66 22.74±2.13 <0.001 Clinical characteristic(N,%)- Mucocutaneous- Arthritis/arthralgia- Renal disease- Central nervous disease- Cardiovascular disease- Vascular occlusion 60(40%)123(82%)100(75%)12(8%)68 (41.5%)49(32.66%) Lab characteristicsFasting glucose(mg/dl)Hemoglobin% (gm/dl)Triglycerides (mg/dl)Total Cholesterol(mg/dl)LDL(mg/dl)HDL(mg/dl)ESR (mm/hr) 97±810.6±2.9126±59187±44118.2±33.748±1442±11 89±412.8±0.794±18143±864.6±749±34±3 <0.001<0.001<0.001<0.001<0.0010. 138<0.001 HOMA IR 10.6±5.2 4.0±0.3 <0.001 Plasma Adiponectin (ng/ml) 16.5±3.2 12.2±0.3 <0.001 Serum Leptin(ng/ml) 25.4±10.7 7.8±0.5 <0.001 Serum Visfatin (ng/ml) 18.0±5.6 10±1.5 <0.001 FMD of brachial artery% 8.82±1.99 11.60±1.2 <0.001 None of adipokines is correlated to age, BMI, Disease duration or activity. There is an inverse correlation between FMD of the brachial artery and total cholesterol, visfatin, adiponectin, leptin and HOMAIR (r-value= -0.523, - 0.35,- 0.27, -0.45, -0.56 respectively) with P <0.05. Adipokines and FMD did not differ regarding clinical presentations especially cardiovascular. Roc curve analyses studied the performance of adipokines. Adiponectin and visfatin are better to predict reduced FMD. Table 2 Variable AUC Cut-off point P value Sensitivity Specificity Asymptotic 95% CI Homatest IR 0.466 12.15 0.718 50.7% 50.0% 0.268 0.663 Plasma Adiponectin 0.890 15.85 0.000 82.1% 80.0% 0.827 0.952 Serum Leptin 0.139 5.45 0.000 22.9% 20.0% 0.059 0.218 Serum Visfatin 0.890 17.50 0.000 82.1% 80.0% 0.828 0.952 Conclusion Endothelial dysfunction is evident in SLE.Reduced FMD of brachial artery and increased adipokines and HOMAIR are noted. Adiponectin and visfatin could be predictors of atherosclerosis in lupus. References [1] Nassef S, Essam M, Abdelfattah D, Elsehemy D, Abouelezz S. Evaluation of Impact of Interferon-Induced Helicase C Domain-Containing Protein 1 Gene in Egyptian Systemic Lupus Erythematosus Patients and its Relationship With Vascular Manifestations of the Disease. Arch Rheumatol 2018;33(2):181–9. [2] Li H, Zhang T, Leng R, Li X. Emerging role of adipokines in systemic lupus erythematosus. Immunol Res. Springer US; 2016;64(4):820–30. Disclosure of Interests None declared