Work

Distinct risk factors for thrombosis in systemic lupus erythematosus and primary Sjögren's syndrome: A large Chinese cohort study with arterial-venous distinction

Year: 2026

Type: article

Abstract: Objective This study aimed to compare the overall incidence and arterial-venous distribution of thrombosis, identify independent predictors of total and subtype-specific events, develop a prediction model, and evaluate the discriminative performance of risk factors in systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS). Methods This retrospective study included 955 SLE patients and 558 pSS patients from a single center. Cox proportional hazards regression was used to determine independent risk factors for thrombosis. Discriminative ability was assessed using the time-dependent area under the curve (AUC) and Harrell’s concordance index (C-index). Results Median follow-up was 10 years (interquartile range [IQR] 8-12) for SLE and 9 years (IQR 7-12) for pSS. In multivariable analysis, independent risk factors for total thrombosis in SLE were hypertension (hazard ratio [HR] 1.523, 95% confidence interval [CI] 1.213-2.135, P =0.03), lupus nephritis (HR 1.822, 95% CI 1.225-2.883, P <0.0001), smoking history (HR 3.613, 95% CI 2.426-4.631, P <0.0001), and positive lupus anticoagulant (LA) (HR 3.213, 95% CI 2.311-4.157, P <0.0001); for pSS, they were diabetes (HR 1.913, 95% CI 1.112-3.245, P =0.023), elevated platelet count (HR 3.115, 95% CI 1.672-6.779, P =0.006), and positive LA (HR 2.611, 95% CI 1.697-3.782, P <0.0001). The SLE prediction model yielded a C-index of 0.752 (95% CI 0.71-0.79), with 3-, 5-, and 10-year time-dependent AUCs of 0.778, 0.761, and 0.755. Beyond conventional discriminative metrics, positive likelihood ratio (LR+) and negative likelihood ratio (LR−) were calculated to evaluate the clinical practicality of the prediction models. In pSS, the combined discriminative capacity was limited, with a C-index of 0.665 (95% CI 0.587-0.743) and corresponding AUCs of 0.600, 0.606, and 0.639. Conclusion The underlying risk-factor profiles differ fundamentally between SLE and pSS. The SLE prediction model demonstrates acceptable-good discriminative performance and may serve as a guide for thrombotic risk stratification. Routine LA screening, alongside standardized management of modifiable cardiovascular risk factors, should be incorporated into long-term thromboprophylaxis strategies for both diseases.

Source: Journal of Translational Autoimmunity

DOI: 10.1016/j.jtauto.2026.100409