AB1082 DAMAGE ACCRUAL AMONG ISRAELI PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IS ASSOCIATED WITH MORTALITY, HOSPITALIZATIONS, AND SEVERE INFECTIONS AND IS PREDICTED BY ANTIPHOSPHOLIPID SYNDROME AND HYPERTENSION
Authors: O. Tayer-Shifman, D. Bar-Ziv, M. Kabaha, Y. Pri-Paz Basson, S. Benchetrit, S. Kivity, K. Cohen-Hagai
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Systemic lupus erythematosus (SLE) may cause irreversible organ damage, which is a major risk factor for poor prognosis, reduced quality of life, and mortality. <h3>Objectives:</h3> This study aims to characterize long-term damage accrual in Israeli patients with SLE and identify variables associated with its presence and severity. <h3>Methods:</h3> A retrospective study including adult patients with SLE from central Israel. Damage was assessed using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (ACR) Damage Index (SDI). Patients were categorized into three groups according to the severity of damage: no damage (SDI 0), mild-moderate damage (SDI 1-2), and severe damage (SDI ≥3). Various variables were assessed including sociodemographic, disease-related characteristics, comorbidities, hospitalization, emergency department (ED) visits, and all-cause mortality. Multivariate logistic regression analysis determined independent predictors of damage. <h3>Results:</h3> A total of 182 patients were followed for a mean duration of 15.6 ± 11.4 years. Seventy-three patients (40.1%) had no damage, 53 (29.1%) had mild-moderate damage, and 56 (30.8%) had severe damage. The mean SDI was 1.88 ± 2.34. Cardiovascular (29.7%), ocular (26.9%), neuropsychiatric (23.1%), and musculoskeletal (21.9%) SDI domains were most commonly affected. Antiphospholipid syndrome (APS) was strongly associated with damage and its severity with prevalence of 44.6% among the severe damage group compared to 28.3% and 4.1% among the mild-moderate and no damage groups; respectively (p&lt;0.0001). Advanced age, hypertension (HTN), EULAR/ACR criteria cumulative score, and hematologic and renal involvement were all significantly associated with damage accrual and its severity. The use of corticosteroids and immunosuppressive medications was associated with damage accrual but no association was found with the use of belimumab. Sex, socioeconomic status, and ethnicity (Jewish/Arabic) were not significantly associated with damage accrual (Table 1). In multivariable analysis, APS and HTN were leading comorbidities predicting damage accrual with an odds ratio of 15.70 (95% CI 4.26-57.89, p&lt;0.001) and 6.46 (95% CI 2.54-16.40, p&lt;0.001), respectively. Mortality rate was highest among the severe damage group with 16.1% deaths, compared to 1.9% in the mild-moderate damage group, and no deaths in the no damage group (p&lt;0.0001) (Table 1, Figure 1). Damage was associated with hospitalizations for severe infections, SLE flares, and cardiovascular events (CVE), as well as emergency department visits (Table 1). <h3>Conclusion:</h3> Antiphospholipid syndrome and HTN are leading comorbidities predicting damage accrual and its severity in Israeli patients with SLE. The presence of damage and its severity are associated with an increased mortality rate, SLE flares, CVE, and severe infections. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Oshrat Tayer-Shifman Abbvie, AstraZeneca, GSK, Dorin Bar-Ziv: None declared, Mohamad Kabaha: None declared, Yael Pri-Paz Basson: None declared, Sydney Benchetrit: None declared, Shaye Kivity Novartis, Abbvie, Keren Cohen-Hagai AstraZeneca, GSK, CTS.