Diffuse Alveolar Hemorrhage In Systemic Lupus Erythematosus: A Retrospective Study Of 54 Cases In China

Objective:To determine the clinical features and to explore the risk factors and prognosis factors of systemic lupus erythematosus (SLE) patients with diffuse alveolar hemorrhage (DAH).Methods:The medical records of 54 SLE-DAH patients who admitted to Peking Union Medical College Hospital from January 2004 to January 2015 were reviewed in this retrospective study. Also a case-control study was also conducted to explore the risk factors and prognosis factors of SLE-DAH patients.Results:1. It was found that dyspnea (91%), hypoxemia (89%), cough (87%) and fever (80%), rather than hemoptysis (74%), were the most common symptoms. The most common extra-pulmonary presentation was renal involvement (91%). The mean drop in hemoglobin was (36.1±14.3) g/L. Mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score was (19±7.9). Almost all patients received high dose corticosteroid therapy and most were also given immunosuppressive agents. Age of onset, course of diseases, rates of concomitant nosocomial infection and mechanical ventilation were probably associated with poor prognosis (p<0.05).2.Compared with SLE-NDAH patients, SLE-DAH patients varied in course of diseases, organs involvements, SLEDAI score and hospital mortality.3. The hospital mortality of SLE-DAH was going down since better cognition and understanding of physicians.Conclusion:DAH is a rare and catastrophic event in SLE. DAH can occur at any stage of the disease course. It usually occurs in patients with active SLE, Some patients may have no hemoptysis. Early aggressive management with high-dose steroids and cyclophosphamide is advocated. Age of onset, course of diseases, concomitant nosocomial infection and Mechanical ventilation were probably associated with poor prognosis. Better recognition of physician could be helpful to improve the prognosis.