Effect of different hepatitis B infection status on the prognosis of active lupus nephritis treated with immunosuppression: a retrospective analysis of 177 patients

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 .