Pediatric systemic lupus erythematosus patients in South Africa have high prevalence and severity of cardiac and vascular manifestations
| dc.contributor.author | Harrison, Michael J | |
| dc.contributor.author | Zühlke, Liesl J | |
| dc.contributor.author | Lewandowski, Laura B | |
| dc.contributor.author | Scott, Christiaan | |
| dc.date.accessioned | 2019-12-10T08:46:52Z | |
| dc.date.available | 2019-12-10T08:46:52Z | |
| dc.date.issued | 2019-11-26 | |
| dc.date.updated | 2019-12-01T04:26:29Z | |
| dc.description.abstract | Abstract Background Pediatric onset of systemic lupus erythematosus (SLE) is associated with major organ involvement, and African patients tend to develop more aggressive disease than patients of European descent. Although cardiovascular involvement is common in pediatric SLE, there are few published reports on the subject. This study describes the frequency and characteristics of cardiac and vascular manifestations of pediatric SLE in a multi-ethnic South African cohort. Methods Demographic, clinical, and echocardiographic data were collected from pediatric SLE patients at two centers in Cape Town, South Africa. At the time of investigation, this cohort consisted of 93 participants diagnosed with SLE according to international classification criteria prior to the age of 19. Individuals with cardiac and/or vascular involvement were identified by retrospective chart review. Cardiac manifestations were defined as presence of pericardial effusion, myocarditis, cardiomyopathy, cardiac failure, Libman-Sacks endocarditis, myocardial infarction, and arrhythmia. Vascular manifestations included deep vein thrombosis, pulmonary embolism, sinus thrombosis, stroke, critical limb ischemia, cerebral vasculitis and systemic vasculitis. Statistical analysis was performed using R (v3.4.1). Results Cardiac and vascular involvement was present in 47% of the cohort. Previous studies have reported prevalence of 5%—50%. Demographic features of those with cardiac/vascular involvement did not differ from the overall cohort. Echocardiographic data were available for 23 participants. The most common cardiac manifestations were pericardial effusion (n = 24) and cardiac failure (n = 8), while the most common vascular manifestations were cerebral vasculitis (n = 9), stroke (n = 7), and pulmonary embolism (n = 7). Cardiovascular manifestations were frequently severe; one third of pericardial effusion cases required intervention, including three cases of cardiac tamponade. Cardiac and vascular involvement conferred an increased risk of mortality (31.1% versus 10.4%). Conclusions Cardiac and vascular involvement were highly prevalent in this South African cohort. The mortality rate was high, and severe manifestations were frequent. Prospective research is needed to improve knowledge of pediatric SLE in Africa and to improve outcomes for this high-risk population. | |
| dc.identifier.apacitation | Harrison, M. J., Zühlke, L. J., Lewandowski, L. B., & Scott, C. (2019). Pediatric systemic lupus erythematosus patients in South Africa have high prevalence and severity of cardiac and vascular manifestations. http://hdl.handle.net/11427/30662 | en_ZA |
| dc.identifier.chicagocitation | Harrison, Michael J, Liesl J Zühlke, Laura B Lewandowski, and Christiaan Scott "Pediatric systemic lupus erythematosus patients in South Africa have high prevalence and severity of cardiac and vascular manifestations." (2019) http://hdl.handle.net/11427/30662 | en_ZA |
| dc.identifier.citation | Pediatric Rheumatology. 2019 Nov 26;17(1):76 | |
| dc.identifier.ris | TY - Journal Article AU - Harrison, Michael J AU - Zühlke, Liesl J AU - Lewandowski, Laura B AU - Scott, Christiaan AB - Abstract Background Pediatric onset of systemic lupus erythematosus (SLE) is associated with major organ involvement, and African patients tend to develop more aggressive disease than patients of European descent. Although cardiovascular involvement is common in pediatric SLE, there are few published reports on the subject. This study describes the frequency and characteristics of cardiac and vascular manifestations of pediatric SLE in a multi-ethnic South African cohort. Methods Demographic, clinical, and echocardiographic data were collected from pediatric SLE patients at two centers in Cape Town, South Africa. At the time of investigation, this cohort consisted of 93 participants diagnosed with SLE according to international classification criteria prior to the age of 19. Individuals with cardiac and/or vascular involvement were identified by retrospective chart review. Cardiac manifestations were defined as presence of pericardial effusion, myocarditis, cardiomyopathy, cardiac failure, Libman-Sacks endocarditis, myocardial infarction, and arrhythmia. Vascular manifestations included deep vein thrombosis, pulmonary embolism, sinus thrombosis, stroke, critical limb ischemia, cerebral vasculitis and systemic vasculitis. Statistical analysis was performed using R (v3.4.1). Results Cardiac and vascular involvement was present in 47% of the cohort. Previous studies have reported prevalence of 5%—50%. Demographic features of those with cardiac/vascular involvement did not differ from the overall cohort. Echocardiographic data were available for 23 participants. The most common cardiac manifestations were pericardial effusion (n = 24) and cardiac failure (n = 8), while the most common vascular manifestations were cerebral vasculitis (n = 9), stroke (n = 7), and pulmonary embolism (n = 7). Cardiovascular manifestations were frequently severe; one third of pericardial effusion cases required intervention, including three cases of cardiac tamponade. Cardiac and vascular involvement conferred an increased risk of mortality (31.1% versus 10.4%). Conclusions Cardiac and vascular involvement were highly prevalent in this South African cohort. The mortality rate was high, and severe manifestations were frequent. Prospective research is needed to improve knowledge of pediatric SLE in Africa and to improve outcomes for this high-risk population. DA - 2019-11-26 DB - OpenUCT DP - University of Cape Town KW - Lupus KW - Pediatric systemic lupus erythematosus KW - Cardiovascular disease KW - Echocardiography KW - Africa KW - Global health LK - https://open.uct.ac.za PY - 2019 T1 - Pediatric systemic lupus erythematosus patients in South Africa have high prevalence and severity of cardiac and vascular manifestations TI - Pediatric systemic lupus erythematosus patients in South Africa have high prevalence and severity of cardiac and vascular manifestations UR - http://hdl.handle.net/11427/30662 ER - | en_ZA |
| dc.identifier.uri | https://doi.org/10.1186/s12969-019-0382-x | |
| dc.identifier.uri | http://hdl.handle.net/11427/30662 | |
| dc.identifier.vancouvercitation | Harrison MJ, Zühlke LJ, Lewandowski LB, Scott C. Pediatric systemic lupus erythematosus patients in South Africa have high prevalence and severity of cardiac and vascular manifestations. 2019; http://hdl.handle.net/11427/30662. | en_ZA |
| dc.language.rfc3066 | en | |
| dc.rights.holder | The Author(s). | |
| dc.subject | Lupus | |
| dc.subject | Pediatric systemic lupus erythematosus | |
| dc.subject | Cardiovascular disease | |
| dc.subject | Echocardiography | |
| dc.subject | Africa | |
| dc.subject | Global health | |
| dc.title | Pediatric systemic lupus erythematosus patients in South Africa have high prevalence and severity of cardiac and vascular manifestations | |
| dc.type | Journal Article |