Risk Factors and Subtype-Specific Prediction Models for Arterial versus Venous Thrombotic Events in Chinese Patients with Lupus Nephritis: A Retrospective Cohort Study
4 affiliations
- 1Department of Clinical Laboratory Medicine, The Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People’s Republic of China
- 2Department of Clinical Laboratory Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, People’s Republic of China
- 3Department of Clinical Laboratory Medicine, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, People’s Republic of China
- 4Department of Laboratory Medicine, Nanjing Jiangning Hospital of Traditional Chinese Medicine Affiliated to China Pharmaceutical University, Nanjing, Jiangsu, 211100, People’s Republic of China
Abstract
Objective: Autoimmune diseases heighten thrombosis risk, yet large-scale studies that systematically profile risk factors while simultaneously distinguishing arterial from venous events in lupus nephritis (LN) remain lacking. This study aimed to determine the incidence and arterial-venous distribution of thrombosis in LN, identify independent risk factors for overall, arterial, and venous thrombosis, and construct separate prediction models for each subtype.
Methods: This single-center retrospective study included 348 patients with biopsy-confirmed LN from 2017 to 2023. Over a median follow-up period of 4 years (with a maximum of 8 years), all thrombotic events were verified through imaging. Cox regression analysis was employed to identify independent risk factors, while time-dependent area under the curve (AUC) and Harrell’s C-index were utilized to assess model discrimination.
Results: The overall incidence of thrombosis was 14.1% (49/348), with arterial events being more prevalent (55.1% arterial and 40.8% venous). Independent risk factors for overall thrombosis included age at diagnosis (HR=1.036, P<0.0001), hypertension (HR=2.097, P=0.011), smoking (HR=3.155, P<0.0001), and the positive lupus anticoagulant (LA) (HR=3.266, P<0.0001). Arterial thrombosis was independently associated with age, hypertension, smoking, and the Systemic Lupus Erythematosus Disease Activity Index (SLE-DAI), while venous thrombosis was associated with age and positive LA. The arterial model exhibited excellent discrimination (3-year AUC=0.909, C-index=0.884), whereas the venous model demonstrated moderate discrimination (3-year AUC=0.766, C-index=0.752).
Conclusion: This study provides the first systematic characterization of thrombosis in Chinese LN patients with a specific focus on arterial-venous heterogeneity, and constructs separate risk prediction models. The arterial prediction model demonstrates excellent discriminative performance and may serve as a guide for thrombotic risk stratification. Venous prediction model demonstrated moderate discrimination. Both models rely on routinely available clinical variables. Routine LA screening, alongside standardized management of modifiable cardiovascular risk factors, should be incorporated into long-term thromboprophylaxis strategies for LN.
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BibTeX
@article{xia2026risk,
title = {{Risk Factors and Subtype-Specific Prediction Models for Arterial versus Venous Thrombotic Events in Chinese Patients with Lupus Nephritis: A Retrospective Cohort Study}},
author = {Mao Xia and Guanghao Song and Xiaojie Chu and Guiting Zhang and Daibao Peng and Bo Shi and Nan Zhang and Fei Chen},
journal = {Journal of Inflammation Research},
year = {2026},
month = oct,
doi = {10.2147/jir.s647326},
url = {https://doi.org/10.2147/jir.s647326},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Risk Factors and Subtype-Specific Prediction Models for Arterial versus Venous Thrombotic Events in Chinese Patients with Lupus Nephritis: A Retrospective Cohort Study
AU - Mao Xia
AU - Guanghao Song
AU - Xiaojie Chu
AU - Guiting Zhang
AU - Daibao Peng
AU - Bo Shi
AU - Nan Zhang
AU - Fei Chen
PY - 2026
DA - 2026/10/30
JO - Journal of Inflammation Research
DO - 10.2147/jir.s647326
UR - https://doi.org/10.2147/jir.s647326
AB - Objective: Autoimmune diseases heighten thrombosis risk, yet large-scale studies that systematically profile risk factors while simultaneously distinguishing arterial from venous events in lupus nephritis (LN) remain lacking. This study aimed to determine the incidence and arterial-venous distribution of thrombosis in LN, identify independent risk factors for overall, arterial, and venous thrombosis, and construct separate prediction models for each subtype. Methods: This single-center retrospective study included 348 patients with biopsy-confirmed LN from 2017 to 2023. Over a median follow-up period of 4 years (with a maximum of 8 years), all thrombotic events were verified through imaging. Cox regression analysis was employed to identify independent risk factors, while time-dependent area under the curve (AUC) and Harrell’s C-index were utilized to assess model discrimination. Results: The overall incidence of thrombosis was 14.1% (49/348), with arterial events being more prevalent (55.1% arterial and 40.8% venous). Independent risk factors for overall thrombosis included age at diagnosis (HR=1.036, P<0.0001), hypertension (HR=2.097, P=0.011), smoking (HR=3.155, P<0.0001), and the positive lupus anticoagulant (LA) (HR=3.266, P<0.0001). Arterial thrombosis was independently associated with age, hypertension, smoking, and the Systemic Lupus Erythematosus Disease Activity Index (SLE-DAI), while venous thrombosis was associated with age and positive LA. The arterial model exhibited excellent discrimination (3-year AUC=0.909, C-index=0.884), whereas the venous model demonstrated moderate discrimination (3-year AUC=0.766, C-index=0.752). Conclusion: This study provides the first systematic characterization of thrombosis in Chinese LN patients with a specific focus on arterial-venous heterogeneity, and constructs separate risk prediction models. The arterial prediction model demonstrates excellent discriminative performance and may serve as a guide for thrombotic risk stratification. Venous prediction model demonstrated moderate discrimination. Both models rely on routinely available clinical variables. Routine LA screening, alongside standardized management of modifiable cardiovascular risk factors, should be incorporated into long-term thromboprophylaxis strategies for LN.
SN - 1178-7031
ER -