Serum IL 18 as biomarker in predicting long term renal outcome among pediatric onset systemic lupus erythematosus patients
AbstractAn urge of biomarker identification is needed to better monitor lupus nephritis (LN) disease activity, guide clinical treatment, and predict patient's long term outcome. With the proinflammatory effect and its association with inflammasomes, the significance of interleukin 18 (IL 18) among pediatric onset systemic lupus erythematous (pSLE) patient, especially, its importance in predicting long term renal outcome was investigated.In a pSLE cohort of 96 patients with an average follow up period of 10.39 3.31 years, clinical data and laboratory workups including serum IL 18 were collected at time of disease onset and 6 months after treatment despite their initial renal status. Through Cox regression analysis, the parameters at baseline and at 6 months posttreatment were carefully analyzed.Average age of all cases was 12.74 3.01 years old and 65 of them underwent renal biopsy at the time of diagnosis. Nine subjects (9.38% progressed to end stage renal disease (ESRD) and 2 cases (2.08% died during follow up. Through multivariate analysis, serum IL 18 level 6 months posttreatment was found to be the most unfavorable factor associating poor clinical outcome despite patient's initial renal status. In addition, the presentation of serum IL 18 in its correlation with SLE global disease activity as well as the presence and severity of LN were all significant (P 0.001, P 0.03, and P 0.02, respectively) The histological classification of LN, however, was not associated with the level of IL 18 among the pSLE patients (P 0.64).The role of serum IL 18 as biomarker representing global disease activity and status of renal flares among pSLE population was shown for the first time. Additionally, we have identified IL 18 at 6 months posttreatment a novel marker for long term renal outcome prediction.
Medicine