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Effect of different hepatitis B infection status on the prognosis of active lupus nephritis treated with immunosuppression: a retrospective analysis of 177 patients
Author(s) -
Fang Jing,
Li Wenge,
Tan Min,
Peng Xiangxin,
Tan Zhao,
Wang Wenbo
Publication year - 2018
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.13313
Subject(s) - medicine , hbsag , hepatitis b virus , lupus nephritis , gastroenterology , immunosuppression , hepatitis b , immunology , prednisone , virus , disease
Aim To analyze whether different hepatitis B virus ( HBV ) infection status influenced the prognosis of patients with lupus nephritis ( LN ) under immunosuppressive therapy. Methods A retrospective study enrolled 177 adults with active LN (Classes III , IV , V or mixed), and divided them into three groups: (i) HBV ‐free group ( n = 93), antibodies to hepatitis B surface antigen positive only or all items negative; (ii) occult HBV infection group ( n = 68), hepatitis B surface antigen ( HB sAg) negative and antibody to hepatitis B core antigen positive with undetectable HBV DNA ; and (iii) HBV infection group ( n = 16), HB sAg‐positive. The composite renal outcome was defined as a composite of progression to end‐stage renal disease, 50% estimated glomerular filtration rate decrease, or death. Results The HBV infection rate was 9.04% in active LN . In the HBV infection group, a greater proportion of patients delayed immunosuppressive therapy, reduced prednisone dose, used mycophenolate mofetil in the first induction phase, received immunoglobulin pulse therapy, as well as avoided methylprednisolone pulse treatment ( P < 0.05). The composite renal outcome was significantly different among the three groups: 4/93 (4.30%) of the HBV ‐free group, 7/68 (10.29%) of the occult HBV infection group, and 4/16 (25.00%) of HBV infection group ( P = 0.018). Univariate and multivariate analyses identified three independent risk factors of composite renal outcome: active HBV carrier (odds ratio [ OR ] 10.342, 95% CI 2.151–66.053, P = 0.017), cycle of immunosuppression > 1 ( OR 3.345, 95% CI 1.201–9.983, P = 0.025), and delayed immunosuppressive therapy ( OR 3.118, 95% CI 1.207–10.662, P = 0.031). Conclusions All these results suggested that HBV infection status might confer a worse prognosis for patients with active LN .