Risk Factors For Diffuse Alveolar Hemorrhage In Patients With Syetemic Lupus Erythematosus:a Meta-Analysis

Objective To investigate the risk factors for diffuse alveolar hemorrhage(DAH)in patients with systemic lupus erythematosus(SLE).Provide evidence-based medical evidence for early detection and early diagnosis of diffuse alveolar hemorrhage in patients with systemic lupus erythematosus.Methods To search PubMed,Embase,and China National Knowledge Infrastructure(CNKI)for e-journals that are secondary to risk factors for DAH in SLE patients.The publication time is limited to databases creation time until December 2017.The language of the article is not limited.Case-control studies on SLE-DAH are collected.RevMan 5.3 software was used to quantify the literatures included in the study.Count data used the odds ratio(OR)and 95% confidence interval(95% CI)for possible risk factors for inclusion in the study: gender,age of onset,system involvement,autoantibodies,complement,and systemic lupus erythematosus disease activity index score(SLEDAI)and other statistics and data analysis.Measured data were analyzed using weighted mean difference(WMD)or standardized mean difference(SMD)and 95% CIResults 1.Gender and age of onset: There was no significant difference in the risk of SLE-DAH among women compared with men with SLE-DAH [OR = 1.30,95% CI(0.56,2.98),P> 0.05].The age of onset of SLE in the SLE-DAH group compared with the SLE without DAH group,younger SLE patients were more likely to have secondary DAH [MD =-2.59,95% CI(-3.77,-1.41),P <0.0001].2.Results of system involvement analysis: Lupus nephritis(LN)was more common in the SLE-DAH group than in the SLE without DAH group,with a statistically significant difference [OR = 3.88,95% CI(2.18,6.91),P <0.00001].Neuropsychiatric lupus(NP)was statistically significant in the SLE-DAH group compared with the SLE without DAH group [OR = 3.74,95% CI(1.18,11.89),P <0.05].3.Results of antibody analysis: There was no significant difference in anti-Sm antibody,anti-ds-DNA antibody,anti-RNP antibody,anti-β2-GP1-IgG between SLE-DAH group and SLE without DAH group。The analysis results were corresponding to [OR = 0.98,95% CI(0.57,1.68),P> 0.05],[OR = 1.32,95% CI(0.64,2.72),P> 0.05],[OR = 1.12,95% CI(0.68,1.82),P> 0.05],[OR = 0.41,95% CI(0.13,1.28),P> 0.05].4.Results of complement C3 levels analysis: Compared with SLE without DAH group,the SLE-DAH group had lower levels of complement C3,with statistically significant differences [MD =-19.3,95% CI(-21.4,-17.46),P <0.00001].5.Results of SLEDAI analysis: In the SLE-DAH group,compared with the SLE without DAH group,the SLEDAI score was higher in the SLE-DAH group,with a statistically significant difference [MD = 5.40,95% CI(2.85,7.95),P <0.0001].Conclusion The risk factors for DAH in SLE patients are low age of onset,lupus nephritis,high SLEDAI score,neuropsychiatric lupus,and low complement C3 levels.