Korean J Intern Med.  2015 Nov;30(6):906-912. 10.3904/kjim.2015.30.6.906.

Factors related to outcomes in lupus-related protein-losing enteropathy

• Lim DH
• Kim YG
• Bae SH
• Ahn S
• Hong S
• Lee CK
• Yoo B

• KMID: 2381596
• DOI: http://doi.org/10.3904/kjim.2015.30.6.906

Abstract

BACKGROUND/AIMS
Protein-losing enteropathy (PLE), characterized by severe hypoalbuminemia and peripheral edema, is a rare manifestation of systemic lupus erythematosus. This present study aimed to identify the distinctive features of lupus-related PLE and evaluate the factors related to the treatment response.
METHODS
From March 1998 to March 2014, the clinical data of 14 patients with lupus PLE and seven patients with idiopathic PLE from a tertiary center were reviewed. PLE was defined as a demonstration of protein leakage from the gastrointestinal tract by either technetium 99m-labelled human albumin scanning or fecal alpha1-antitrypsin clearance. A positive steroid response was defined as a return of serum albumin to > or = 3.0 g/dL within 4 weeks after initial steroid monotherapy, and remission as maintenance of serum albumin > or = 3.0 g/dL for at least 3 months. A high serum total cholesterol level was defined as a level of > or = 240 mg/dL.
RESULTS
The mean age of the lupus-related PLE patients was 37.0 years, and the mean follow-up duration was 55.8 months. Significantly higher erythrocyte sedimentation rate and serum total cholesterol levels were found for lupus PLE than for idiopathic PLE. Among the 14 patients with lupus PLE, eight experienced a positive steroid response, and the serum total cholesterol level was significantly higher in the positive steroid response group. A positive steroid response was associated with an initial high serum total cholesterol level and achievement of remission within 6 months.
CONCLUSIONS
In lupus-related PLE, a high serum total cholesterol level could be a predictive factor for the initial steroid response, indicating a good response to steroid therapy alone.

Keyword

Protein-losing enteropathies; Lupus erythematosus, systemic; Hypercholesterolemia

MeSH Terms

Adult
Aged
Biomarkers/blood
Cholesterol/blood
Drug Therapy, Combination
Edema/diagnosis/drug therapy/*etiology
Female
Glucocorticoids/therapeutic use
Humans
Hypoalbuminemia/diagnosis/drug therapy/*etiology
Immunosuppressive Agents/therapeutic use
Lupus Erythematosus, Systemic/*complications/diagnosis/drug therapy
Male
Middle Aged
Protein-Losing Enteropathies/diagnosis/drug therapy/*etiology
Remission Induction
Risk Factors
Serum Albumin/metabolism
Tertiary Care Centers
Time Factors
Treatment Outcome
ALB protein, human
Biomarkers
Cholesterol
Glucocorticoids
Immunosuppressive Agents
Serum Albumin