J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 17, Number 1, January 2025, pages 35-43

Organ Damage and Its Associated Factors in Systemic Lupus Erythematosus Patients: A Retrospective Cohort Study

Figure 1. Distribution of involved organ systems in SLE patients with positive SDI scores (n = 76). SDI: Systemic Damage Index; SLE: systemic lupus erythematosus.

**Table 1.** Clinical and Demographic Profile of the Studied SLE Patients (n = 196)
Characteristic	n (%)
BMI: body mass index; ESRD: end-stage renal disease; SD: standard deviation; SDI: Systemic Damage Index; SLE: systemic lupus erythematosus; SLEDAI-2K: Systemic Lupus Erythematosus Disease Activity Index 2000.
Gender
Female	182 (92.9%)
Male	14 (7.1%)
Age (years), mean ± SD	36.2 ± 11.3
Age at diagnosis (years), mean ± SD	27.3 ± 10.8
Duration of the disease (years), mean ± SD	8.95 ± 5.6
BMI
Normal	58 (29.6%)
Overweight	49 (25.0%)
Obese	37 (18.9%)
Morbidly obese	30 (15.3%)
Underweight	22 (11.2%)
Comorbidities
Dyslipidemia	75 (38.3%)
Hypertension	32 (16.3%)
Diabetes mellitus	13 (6.6%)
Smoker	1 (0.5%)
SDI score
Negative (SDI of 0)	120 (61.2%)
Positive (SDI of 1 or more)	76 (38.8%)
Current medications used
Hydroxychloroquine	183 (93.4%)
200 mg/day	65 (35.5%)
300 mg/day	24 (13.1%)
400 mg/day	94 (51.4%)
Corticosteroids	91 (46.4%)
1 - 9 mg/day	69 (75.8%)
10 - 19 mg/day	16 (17.6%)
≥ 20 mg/day	6 (6.6%)
Mycophenolate mofetil	86 (44.1%)
Azathioprine	78 (39.8%)
Cyclophosphamide	26 (13.4%)
Belimumab	16 (8.2%)
Cyclosporin	0 (0%)
Lupus nephritis	72 (36.7%)
Active	71 (98.6%)
ESRD	1 (1.4%)
SLEDAI-2K score
No disease activity (< 3)	104 (53.1%)
Disease flares (≥ 3)	92 (46.9%)

Table 1. Clinical and Demographic Profile of the Studied SLE Patients (n = 196)

Characteristic

n (%)

BMI: body mass index; ESRD: end-stage renal disease; SD: standard deviation; SDI: Systemic Damage Index; SLE: systemic lupus erythematosus; SLEDAI-2K: Systemic Lupus Erythematosus Disease Activity Index 2000.

Gender

Female

182 (92.9%)

Male

14 (7.1%)

Age (years), mean ± SD

36.2 ± 11.3

Age at diagnosis (years), mean ± SD

27.3 ± 10.8

Duration of the disease (years), mean ± SD

8.95 ± 5.6

BMI

Normal

58 (29.6%)

Overweight

49 (25.0%)

Obese

37 (18.9%)

Morbidly obese

30 (15.3%)

Underweight

22 (11.2%)

Comorbidities

Dyslipidemia

75 (38.3%)

Hypertension

32 (16.3%)

Diabetes mellitus

13 (6.6%)

Smoker

1 (0.5%)

SDI score

Negative (SDI of 0)

120 (61.2%)

Positive (SDI of 1 or more)

76 (38.8%)

Current medications used

Hydroxychloroquine

183 (93.4%)

200 mg/day

65 (35.5%)

300 mg/day

24 (13.1%)

400 mg/day

94 (51.4%)

Corticosteroids

91 (46.4%)

1 - 9 mg/day

69 (75.8%)

10 - 19 mg/day

16 (17.6%)

≥ 20 mg/day

6 (6.6%)

Mycophenolate mofetil

86 (44.1%)

Azathioprine

78 (39.8%)

Cyclophosphamide

26 (13.4%)

Belimumab

16 (8.2%)

Cyclosporin

0 (0%)

Lupus nephritis

72 (36.7%)

Active

71 (98.6%)

ESRD

1 (1.4%)

SLEDAI-2K score

No disease activity (< 3)

104 (53.1%)

Disease flares (≥ 3)

92 (46.9%)

**Table 2.** Laboratory and Radiological Findings of the Studied SLE Patients (n = 196)
Variables	n (%)
DEXA: dual-energy X-ray absorptiometry; SLE: systemic lupus erythematosus; WBC: white blood cell.
WBC count
Normal	128 (65.3%)
Low	68 (34.7%)
Hemoglobin level
Normal	99 (50.5%)
Low	97 (49.5%)
Platelet count
Normal	169 (86.2%)
Low	21 (10.7%)
High	6 (3.1%)
Anti-double stranded DNA
Positive	113 (57.7%)
Negative	83 (42.3%)
C3 complement level
Normal	117 (59.7%)
Low	79 (40.3%)
C4 complement level
Normal	167 (85.2%)
Low	29 (14.8%)
Antiphospholipid antibody
Negative	159 (81.1%)
Positive	37 (18.9%)
Erythrocyte sedimentation rate
Normal	108 (55.1%)
High	88 (44.9%)
C-reactive protein
Normal	139 (70.9%)
High	57 (29.1%)
DEXA scan
Normal	180 (91.8%)
Osteoporosis	11 (5.6%)
Osteopenia	5 (2.6%)

Table 2. Laboratory and Radiological Findings of the Studied SLE Patients (n = 196)

Variables

n (%)

DEXA: dual-energy X-ray absorptiometry; SLE: systemic lupus erythematosus; WBC: white blood cell.

WBC count

Normal

128 (65.3%)

Low

68 (34.7%)

Hemoglobin level

Normal

99 (50.5%)

Low

97 (49.5%)

Platelet count

Normal

169 (86.2%)

Low

21 (10.7%)

High

6 (3.1%)

Anti-double stranded DNA

Positive

113 (57.7%)

Negative

83 (42.3%)

C3 complement level

Normal

117 (59.7%)

Low

79 (40.3%)

C4 complement level

Normal

167 (85.2%)

Low

29 (14.8%)

Antiphospholipid antibody

Negative

159 (81.1%)

Positive

37 (18.9%)

Erythrocyte sedimentation rate

Normal

108 (55.1%)

High

88 (44.9%)

C-reactive protein

Normal

139 (70.9%)

High

57 (29.1%)

DEXA scan

Normal

180 (91.8%)

Osteoporosis

11 (5.6%)

Osteopenia

5 (2.6%)

**Table 3.** Comparison of Different Variables According to SDI Scores in the Studied SLE Patients (n = 196)
Variables	Positive SDI (n = 76)	Negative SDI (n = 120)	P-value
*Statistically significant. BMI: body mass index; ESR: erythrocyte sedimentation rate; SD: standard deviation; SDI: Systemic Damage Index; SLE: systemic lupus erythematosus.
Age (years), mean ± SD	38.93 ± 10.7	34.45 ± 11.4	0.007*
Age at diagnosis (years), mean ± SD	28.64 ± 10.5	26.37 ± 11.0	0.154
Duration of the disease (years), mean ± SD	10.29 ± 5.59	8.11 ± 5.4	0.002*
Gender, n (%)			0.371
Male	7 (5.8%)	7 (9.2%)
Female	113 (94.2%)	69 (90.8%)
Comorbidities, n (%)
Diabetes	11 (14.5%)	2 (1.7%)	< 0.001*
Hypertension	20 (26.3%)	12 (10.0%)	0.003*
Dyslipidemia	33 (43.4%)	42 (35.0%)	0.237
BMI categories, n (%)			0.415
Normal	22 (28.9%)	36 (30.0%)
Overweight	15 (19.7%)	34 (28.3%)
Obese	19 (25.0%)	18 (15.0%)
Morbidly obese	12 (15.8%)	18 (15.0%)
Underweight	8 (10.5%)	14 (11.7%)
Medications, n (%)
Hydroxychloroquine	70 (92.1%)	113 (94.2%)	0.572
Corticosteroid	39 (51.3%)	52 (43.3%)	0.275
Mycophenolate mofetil	36 (47.4%)	50 (41.7%)	0.433
Azathioprine	28 (36.8%)	50 (41.7%)	0.501
Cyclophosphamide	10 (13.2%)	16 (13.3%)	0.972
Belimumab	5 (6.6%)	11 (9.2%)	0.519
WBC count, n (%)			0.098
Normal	55 (72.4%)	73 (60.8%)
Low	21 (27.6%)	47 (39.2%)
Platelet count, n (%)			0.066
Normal	65 (85.5%)	104 (86.7%)
Low	11 (14.5%)	10 (8.3%)
High	0	6 (5.0%)
Hemoglobin, n (%)			0.444
Normal	41 (53.9%)	58 (48.3%)
Low	35 (46.1%)	62 (51.7%)
Anti-dsDNA, n (%)			0.001*
Positive	33 (43.4%)	80 (66.7%)
Negative	43 (56.6%)	40 (33.3%)
C3 complement, n (%)			0.630
Normal	47 (61.8%)	70 (58.3%)
Low	29 (38.2%)	50 (41.7%)
C4 complement, n (%)			0.180
Normal	68 (89.5%)	99 (82.5%)
Low	8 (10.5%)	21 (17.5%)
Antiphospholipid antibody, n (%)			0.320
Positive	17 (22.4%)	20 (16.7%)
Negative	59 (77.6%)	100 (83.3%)
ESR, n (%)			0.796
Normal	41 (53.9%)	67 (55.8%)
High	35 (46.1%)	53 (44.2%)

Table 3. Comparison of Different Variables According to SDI Scores in the Studied SLE Patients (n = 196)

Variables

Positive SDI (n = 76)

Negative SDI (n = 120)

P-value

*Statistically significant. BMI: body mass index; ESR: erythrocyte sedimentation rate; SD: standard deviation; SDI: Systemic Damage Index; SLE: systemic lupus erythematosus.

Age (years), mean ± SD

38.93 ± 10.7

34.45 ± 11.4

0.007*

Age at diagnosis (years), mean ± SD

28.64 ± 10.5

26.37 ± 11.0

0.154

Duration of the disease (years), mean ± SD

10.29 ± 5.59

8.11 ± 5.4

0.002*

Gender, n (%)

0.371

Male

7 (5.8%)

7 (9.2%)

Female

113 (94.2%)

69 (90.8%)

Comorbidities, n (%)

Diabetes

11 (14.5%)

2 (1.7%)

< 0.001*

Hypertension

20 (26.3%)

12 (10.0%)

0.003*

Dyslipidemia

33 (43.4%)

42 (35.0%)

0.237

BMI categories, n (%)

0.415

Normal

22 (28.9%)

36 (30.0%)

Overweight

15 (19.7%)

34 (28.3%)

Obese

19 (25.0%)

18 (15.0%)

Morbidly obese

12 (15.8%)

18 (15.0%)

Underweight

8 (10.5%)

14 (11.7%)

Medications, n (%)

Hydroxychloroquine

70 (92.1%)

113 (94.2%)

0.572

Corticosteroid

39 (51.3%)

52 (43.3%)

0.275

Mycophenolate mofetil

36 (47.4%)

50 (41.7%)

0.433

Azathioprine

28 (36.8%)

50 (41.7%)

0.501

Cyclophosphamide

10 (13.2%)

16 (13.3%)

0.972

Belimumab

5 (6.6%)

11 (9.2%)

0.519

WBC count, n (%)

0.098

Normal

55 (72.4%)

73 (60.8%)

Low

21 (27.6%)

47 (39.2%)

Platelet count, n (%)

0.066

Normal

65 (85.5%)

104 (86.7%)

Low

11 (14.5%)

10 (8.3%)

High

6 (5.0%)

Hemoglobin, n (%)

0.444

Normal

41 (53.9%)

58 (48.3%)

Low

35 (46.1%)

62 (51.7%)

Anti-dsDNA, n (%)

0.001*

Positive

33 (43.4%)

80 (66.7%)

Negative

43 (56.6%)

40 (33.3%)

C3 complement, n (%)

0.630

Normal

47 (61.8%)

70 (58.3%)

Low

29 (38.2%)

50 (41.7%)

C4 complement, n (%)

0.180

Normal

68 (89.5%)

99 (82.5%)

Low

8 (10.5%)

21 (17.5%)

Antiphospholipid antibody, n (%)

0.320

Positive

17 (22.4%)

20 (16.7%)

Negative

59 (77.6%)

100 (83.3%)

ESR, n (%)

0.796

Normal

41 (53.9%)

67 (55.8%)

High

35 (46.1%)

53 (44.2%)

**Table 4.** Multivariate Binary Logistic Regression to Predict Organ Damage (Positive SDI) in the Studied SLE Patients (n = 196)
Variable	OR	95% CI	P-value
*Statistically significant. CI: confidence interval; OR: odds ratio; SDI: Systemic Damage Index; SLE: systemic lupus erythematosus.
Age	1.01	0.98 - 1.04	0.680
Duration of disease	1.05	1.00 - 1.12	0.074
Diabetes	5.30	1.16 - 37.9	0.049*
Hypertension	2.29	0.93 - 5.66	0.070
Positive anti-dsDNA	0.39	0.20 - 0.73	0.004*

Table 4. Multivariate Binary Logistic Regression to Predict Organ Damage (Positive SDI) in the Studied SLE Patients (n = 196)

Variable

95% CI

P-value

*Statistically significant. CI: confidence interval; OR: odds ratio; SDI: Systemic Damage Index; SLE: systemic lupus erythematosus.

Age

1.01

0.98 - 1.04

0.680

Duration of disease

1.05

1.00 - 1.12

0.074

Diabetes

5.30

1.16 - 37.9

0.049*

Hypertension

2.29

0.93 - 5.66

0.070

Positive anti-dsDNA

0.39

0.20 - 0.73

0.004*