Work

Risk Factors and Subtype-Specific Prediction Models for Arterial versus Venous Thrombotic Events in Chinese Patients with Lupus Nephritis: A Retrospective Cohort Study

Year: 2026

Type: article

Abstract: Objective: Autoimmune diseases heighten thrombosis risk, yet large-scale studies that systematically profile risk factors while simultaneously distinguishing arterial from venous events in lupus nephritis (LN) remain lacking. This study aimed to determine the incidence and arterial-venous distribution of thrombosis in LN, identify independent risk factors for overall, arterial, and venous thrombosis, and construct separate prediction models for each subtype. Methods: This single-center retrospective study included 348 patients with biopsy-confirmed LN from 2017 to 2023. Over a median follow-up period of 4 years (with a maximum of 8 years), all thrombotic events were verified through imaging. Cox regression analysis was employed to identify independent risk factors, while time-dependent area under the curve (AUC) and Harrell’s C-index were utilized to assess model discrimination. Results: The overall incidence of thrombosis was 14.1% (49/348), with arterial events being more prevalent (55.1% arterial and 40.8% venous). Independent risk factors for overall thrombosis included age at diagnosis (HR=1.036, P < 0.0001), hypertension (HR=2.097, P =0.011), smoking (HR=3.155, P < 0.0001), and the positive lupus anticoagulant (LA) (HR=3.266, P < 0.0001). Arterial thrombosis was independently associated with age, hypertension, smoking, and the Systemic Lupus Erythematosus Disease Activity Index (SLE-DAI), while venous thrombosis was associated with age and positive LA. The arterial model exhibited excellent discrimination (3-year AUC=0.909, C-index=0.884), whereas the venous model demonstrated moderate discrimination (3-year AUC=0.766, C-index=0.752). Conclusion: This study provides the first systematic characterization of thrombosis in Chinese LN patients with a specific focus on arterial-venous heterogeneity, and constructs separate risk prediction models. The arterial prediction model demonstrates excellent discriminative performance and may serve as a guide for thrombotic risk stratification. Venous prediction model demonstrated moderate discrimination. Both models rely on routinely available clinical variables. Routine LA screening, alongside standardized management of modifiable cardiovascular risk factors, should be incorporated into long-term thromboprophylaxis strategies for LN. Keywords: thrombosis, LN, risk factors, risk model

Source: Journal of Inflammation Research

DOI: 10.2147/jir.s647326