RESUMO
INTRODUCTION: Thrombotic events constitute a frequent complication in patients with systemic lupus erythematosus (SLE) and are associated with increased morbidity and mortality of these patients. OBJECTIVE: To identify clinical and laboratorial factors associated with the development of arterial or venous thrombosis in patients with SLE and lupus nephritis (LN). MATERIAL AND METHODS: We reviewed 200 files of patients with SLE and LN to determine if any patients had presented a symptomatic episode of thrombosis confirmed by an image study. We collected demographic, clinical and laboratory data. Logistic regression was used to determine clinical and laboratorial factors associated with thrombotic complications. RESULTS: There were 25 thrombotic events in 23 patients, of which 68% (n = 17) occurred in the venous bed. The overall incidence rate of thrombotic events was 29.1 per 1,000 patient-years. The class IV was the most frequent class of LN with 40.8% of cases. There were no differences in the distribution of the different classes of NL, eGFR, magnitude of proteinuria and markers of lupus activity among patients with and without thrombotic complications. In multivariate analysis, previous diagnosis of antiphospholipid-antibody syndrome (APS) (OR = 126; IC95% 11.3-1419; p < 0.001), serositis (OR = 5; IC95% 0.95-26.9; p = 0.05) and history of arterial thrombosis (OR = 24; IC95% 1.8-314; p = 0.01) were associated with thrombotic complications and the use of ACE inhibitors showed a protective effect (RM = 0.19; IC95% 0.03-0, 98; p = 0.04). CONCLUSIONS: Thrombotic complications were frequent in our population. Risk factors related with thrombotic complications were a personal history of arterial thrombosis, serositis and previous diagnosis of APS. Interestingly, the use of ACE inhibitors was associated with reduced risk. We found no greater or lesser risk of thrombosis with renal factors such as proteinuria, histological type of LN and eGFR.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Trombofilia/etiologia , Trombose/epidemiologia , Adulto , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Síndrome Antifosfolipídica/epidemiologia , Comorbidade , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Imunossupressores/uso terapêutico , Incidência , Testes de Função Renal , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Nefrite Lúpica/complicações , Nefrite Lúpica/tratamento farmacológico , Masculino , Recidiva , Estudos Retrospectivos , Fatores de Risco , Serosite/epidemiologia , Trombose/etiologia , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Adulto JovemRESUMO
Two hundred sixty Haemophilus spp isolates that had been obtained from the respiratory tract and other sites of swine were acquired from diagnostic laboratories, primarily in the United States and Canada. The majority of isolates (243/260) were biochemically characterized as H parasuis; however, a few isolates of taxa distinct from H parasuis (taxa "minor group," D, E, and F) were identified. Fourteen H parasuis serovars were identified, and of those previously described, the most prevalent were 5 (24.3% of isolates), 4 (16.1%), 2 (8.2%), and 7 (3.7%). Three new serovars that were also prevalent included ND4 (11.1%), ND3 (8.6%), and ND5 (6.6%). Serovars 1, 3, 6, C, D, and new serovars ND1 and ND2 were infrequently identified, and 15.2% of isolates were nontypeable. It was not uncommon to isolate multiple serovars from swine of the same herd or related herds. Distribution of serovars among isolates from the United States and Canada was generally similar; however, a higher prevalence of serovar 5 and a lower prevalence of serovars 2, ND3, and ND5 were evident in isolates from Canada. Comparison of isolates obtained from the respiratory tract of swine without polyserositis with those obtained from swine with polyserositis revealed an increased frequency of serovars 4 and 5, and a decreased frequency of serovar 2, among isolates from swine with polyserositis. However, all prevalent serovars were isolated from swine with polyserositis, and data were not indicative of an association between serovar, site of isolation, or pathogenic potential.