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The clinical differences between early-and late-onset pulmonary hemorrhage in systemic lupus erythematosus patients.

BACKGROUND
Pulmonary hemorrhage (PH) is a rare but possible fatal complication of systemic lupus erythematous (SLE). We try to better understand the clinical symptoms and prognosis in patients with SLE and PH. Furthermore, we want to know whether there is different between early-onset and late-onset pulmonary hemorrhage in SLE patients.


METHODS
A retrospective review was carried out for all medical admissions of 3128 patients with the diagnosis of SLE at Chang Gung Medical Center from 1994 to 2003. Twenty SLE patients with PH were carefully reviewed. For all study subjects, the patient demographics, clinical, laboratory, therapeutic, and outcome data were collected and chest radiographs were reviewed. Seven of 20 patients with PH occurred earlier as one of the initial manifestations of SLE were subgrouped to early-onset group. The remaining 13 patients with PH were classified as late-onset group.


RESULTS
During the 10-year period, there were 20 patients (16 females and 4 males) who had suffered from PH. The age distribution was between 13.2 and 55 years, (median age 25.5 years). The most predominant symptoms and signs were hemoptysis, tachypnea, and dyspnea. The patients, initially with low hemoglobin concentration, were prone to death. (mortality group vs survival group was 5.6 +/- 1.4 vs 7.9 +/- 2.0 gm/dL, p value = 0.004). The late-onset group had a higher rate of presenting with cough, and younger onset-age than that in the early-onset group.


CONCLUSIONS
Low hemoglobin is a risk factor for mortality in SLE patients with pulmonary hemorrhage. Clinically, the late-onset group was younger than the early-onset group and had higher rate of presenting with cough. No statistical prognostic differences showed between late-onset and early-onset groups.