{
  "abstract": "Objectives To assess hemostatic parameters in SLE patients in relation to disease activity, kidney involvement and presence of extraglomerular vascular changes in kidney biopsies.Methods This cross-sectional study included 72 SLE patients enrolled between 2002 and 2024 at Rheumatology clinic, Karolinska University Hospital, Stockholm, Sweden. Exclusion criteria were coagulopathies and ongoing anticoagulant therapy. Plasma samples collected at study inclusion were analyzed using global hemostatic assay assessing overall hemostasis potential (OHP), overall coagulation potential (OCP), overall fibrinolysis potential (OFP), fibrin clot density (Cmax) and clot lysis time (CLT). Extraglomerular vascular changes explored in kidney biopsies were defined as intimal thickening and/or hypertonic vessels. Disease activity was assessed using SLEDAI-2K: active > 4; inactive < 2.Results 27 (37.5%) patients had kidney biopsy-proven lupus nephritis (LN) and active disease at inclusion. In the non-LN subgroup, 26 (36.1%) patients had active and 19 (26.4%) inactive disease. Antiphospholipid antibodies were equally distributed between LN and non-LN subgroups (p > 0.05). ( Table 1).SLE-LN cases had significantly elevated levels of OCP, OHP and Cmax; OFP was diminished and CLT prolonged compared to non-LN cohort (table 1). Differences remained significant regardless of the disease activity in non-LN group (p<0.01, respectively). In LN patients, albumin/creatinine urine ratio correlated inversely with OFP (r = -0.49, p<0.05) and positively with CLT (r = 0.45, p < 0.05). Ongoing therapeutic modalities had no impact on explored parameters in LN subgroup.17 (63%) LN patients had vascular changes in the kidney tissue, and increased OHP and Cmax levels, decreased OFP and prolonged CLT (p<0.05, respectively) compared to both the active or inactive non-LN cohort.ROC analysis confirmed that all explored hemostatic parameters could discriminate patients with kidney involvement (AUC range 0.67-0.77, all p<0.01) from the non-renal group. Moreover, OHP, OFP, Cmax and CLT discriminated patients with LN-vascular changes and active disease from active non-LN patients (figure 1).Abstract PO:09:226 Table 1Patient baseline characteristics and hemostatic parameters in the groups with and without lupus nephritisAbstract PO:09:226 Figure 1ROC curve analysis for discriminating patients with active systemic lupus erythematosus (SLE) with lupus nephritis (LN) and renal vascular changes vs. patients with active SLE without LN, based on the clot lysis time (CLT), maximum absorbance ( Cmax), overall coagulation potential (OCP), overall fibrinolysis potential (OFP) and overall hemostasis potential (OHP).Conclusions Active SLE patients with LN, particularly with additional extraglomerular renal vascular involvement, exhibit pronounced coagulation and impaired fibrinolysis. Global hemostatic parameters may be reliable biomarkers of renal vascular changes in LN patients.",
  "authors": [
    {
      "affiliations": [
        "Institute of Rheumatology, Belgrade, Serbia"
      ],
      "name": "Nina Tomonjic"
    },
    {
      "affiliations": [
        "Karolinska Institutet, Department of Medicine, Division of Rheumatology, Solna, Stockholm, Sweden",
        "Institute of Rheumatology, Belgrade, Serbia, School of Medicine University of Belgrade, Belgrade, Serbia, Belgrade, Serbia"
      ],
      "name": "Jelena Colic"
    },
    {
      "affiliations": [
        "Karolinska Institutet, Department of Medicine, Division of Rheumatology, Solna, Stockholm, Sweden"
      ],
      "name": "Linnea Karlsson"
    },
    {
      "affiliations": [
        "Karolinska Institutet, Department of Medicine, Division of Rheumatology, Solna, Stockholm, Sweden"
      ],
      "name": "Aliisa Häyry"
    },
    {
      "affiliations": [
        "Institute of Rheumatology, Belgrade, Serbia, School of Medicine University of Belgrade, Belgrade, Serbia, Belgrade, Serbia"
      ],
      "name": "Mirjana Sefik-Bukilica"
    },
    {
      "affiliations": [
        "Karolinska Institutet, Department of Medicine, Division of Rheumatology, Solna, Stockholm, Sweden",
        "Karolinska University Hospital, Rheumatology, Stockholm, Sweden"
      ],
      "name": "Agneta Zickert"
    },
    {
      "affiliations": [
        "Karolinska Institutet, Department of Medicine, Division of Rheumatology, Solna, Stockholm, Sweden",
        "Karolinska University Hospital, Rheumatology, Stockholm, Sweden"
      ],
      "name": "Elisabet Svenungsson"
    },
    {
      "affiliations": [
        "Karolinska Institutet, Department of Medicine, Division of Rheumatology, Solna, Stockholm, Sweden",
        "Karolinska University Hospital, Rheumatology, Stockholm, Sweden"
      ],
      "name": "Aleksandra Antovic"
    },
    {
      "affiliations": [
        "Karolinska Institutet, Department of Medicine, Division of Rheumatology, Solna, Stockholm, Sweden",
        "Karolinska University Hospital, Rheumatology, Stockholm, Sweden"
      ],
      "name": "Iva Gunnarsson"
    }
  ],
  "title": "PO:09:226 Hemostatic alterations in systemic lupus erythematosus: associations with extraglomerular renal vascular changes",
  "uid": "365b32a9-ba99-5fe1-a15c-e885bd05d9d8"
}