Distinct risk factors for thrombosis in systemic lupus erythematosus and primary Sjögren's syndrome: A large Chinese cohort study with arterial-venous distinction.
6 affiliations
- 1Department of Clinical Laboratory Medicine, The Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, 226001, China.
- 2Department of Clinical Laboratory Medicine, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
- 3Department of Clinical Laboratory Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
- 4School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, 212013, China.
- 5Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China.
- 6Nantong Stomatological Hospital, Nantong, Jiangsu Province, 226006, China.
Abstract
This study aimed to compare the overall incidence and arterial-venous distribution of thrombosis, identify independent predictors of total and subtype-specific events, develop a prediction model, and evaluate the discriminative performance of risk factors in systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS). This retrospective study included 955 SLE patients and 558 pSS patients from a single center. Cox proportional hazards regression was used to determine independent risk factors for thrombosis. Discriminative ability was assessed using the time-dependent area under the curve (AUC) and Harrell's concordance index (C-index). Median follow-up was 10 years (interquartile range [IQR] 8-12) for SLE and 9 years (IQR 7-12) for pSS. In multivariable analysis, independent risk factors for total thrombosis in SLE were hypertension (hazard ratio [HR] 1.523, 95% confidence interval [CI] 1.213-2.135, P = 0.03), lupus nephritis (HR 1.822, 95% CI 1.225-2.883, P < 0.0001), smoking history (HR 3.613, 95% CI 2.426-4.631, P < 0.0001), and positive lupus anticoagulant (LA) (HR 3.213, 95% CI 2.311-4.157, P < 0.0001); for pSS, they were diabetes (HR 1.913, 95% CI 1.112-3.245, P = 0.023), elevated platelet count (HR 3.115, 95% CI 1.672-6.779, P = 0.006), and positive LA (HR 2.611, 95% CI 1.697-3.782, P < 0.0001). The SLE prediction model yielded a C-index of 0.752 (95% CI 0.71-0.79), with 3-, 5-, and 10-year time-dependent AUCs of 0.778, 0.761, and 0.755. Beyond conventional discriminative metrics, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were calculated to evaluate the clinical practicality of the prediction models. In pSS, the combined discriminative capacity was limited, with a C-index of 0.665 (95% CI 0.587-0.743) and corresponding AUCs of 0.600, 0.606, and 0.639. The underlying risk-factor profiles differ fundamentally between SLE and pSS. The SLE prediction model demonstrates acceptable-good discriminative performance and may serve as a guide for thrombotic risk stratification. Routine LA screening, alongside standardized management of modifiable cardiovascular risk factors, should be incorporated into long-term thromboprophylaxis strategies for both diseases.
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BibTeX
@article{xia2026distinct,
title = {{Distinct risk factors for thrombosis in systemic lupus erythematosus and primary Sjögren's syndrome: A large Chinese cohort study with arterial-venous distinction.}},
author = {Mao Xia and Daibao Peng and Hui Xie and Guanghao Song and Guiting Zhang and Sijia He and Haixuan Sun and Zhiming Ding and Han Shen and Fei Chen},
journal = {Journal of translational autoimmunity},
year = {2026},
month = oct,
doi = {10.1016/j.jtauto.2026.100409},
url = {https://europepmc.org/article/MED/42997061},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Distinct risk factors for thrombosis in systemic lupus erythematosus and primary Sjögren's syndrome: A large Chinese cohort study with arterial-venous distinction.
AU - Mao Xia
AU - Daibao Peng
AU - Hui Xie
AU - Guanghao Song
AU - Guiting Zhang
AU - Sijia He
AU - Haixuan Sun
AU - Zhiming Ding
AU - Han Shen
AU - Fei Chen
PY - 2026
DA - 2026/10/20
JO - Journal of translational autoimmunity
DO - 10.1016/j.jtauto.2026.100409
UR - https://europepmc.org/article/MED/42997061
AB - This study aimed to compare the overall incidence and arterial-venous distribution of thrombosis, identify independent predictors of total and subtype-specific events, develop a prediction model, and evaluate the discriminative performance of risk factors in systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS). This retrospective study included 955 SLE patients and 558 pSS patients from a single center. Cox proportional hazards regression was used to determine independent risk factors for thrombosis. Discriminative ability was assessed using the time-dependent area under the curve (AUC) and Harrell's concordance index (C-index). Median follow-up was 10 years (interquartile range [IQR] 8-12) for SLE and 9 years (IQR 7-12) for pSS. In multivariable analysis, independent risk factors for total thrombosis in SLE were hypertension (hazard ratio [HR] 1.523, 95% confidence interval [CI] 1.213-2.135, P = 0.03), lupus nephritis (HR 1.822, 95% CI 1.225-2.883, P < 0.0001), smoking history (HR 3.613, 95% CI 2.426-4.631, P < 0.0001), and positive lupus anticoagulant (LA) (HR 3.213, 95% CI 2.311-4.157, P < 0.0001); for pSS, they were diabetes (HR 1.913, 95% CI 1.112-3.245, P = 0.023), elevated platelet count (HR 3.115, 95% CI 1.672-6.779, P = 0.006), and positive LA (HR 2.611, 95% CI 1.697-3.782, P < 0.0001). The SLE prediction model yielded a C-index of 0.752 (95% CI 0.71-0.79), with 3-, 5-, and 10-year time-dependent AUCs of 0.778, 0.761, and 0.755. Beyond conventional discriminative metrics, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were calculated to evaluate the clinical practicality of the prediction models. In pSS, the combined discriminative capacity was limited, with a C-index of 0.665 (95% CI 0.587-0.743) and corresponding AUCs of 0.600, 0.606, and 0.639. The underlying risk-factor profiles differ fundamentally between SLE and pSS. The SLE prediction model demonstrates acceptable-good discriminative performance and may serve as a guide for thrombotic risk stratification. Routine LA screening, alongside standardized management of modifiable cardiovascular risk factors, should be incorporated into long-term thromboprophylaxis strategies for both diseases.
SN - 2589-9090
ER -