Characteristics and risk factors of retinal vasculopathy in antiphospholipid syndrome

• Published in: Lupus Vol. 31; no. 2; pp. 178 - 186
• Main Authors: Xie, Zhijuan, Li, Hui, Qi, Wanting, Li, Jing, Wu, Chanyuan, Hu, Chaojun, Jiang, Nan, Wang, Qian, Tian, Xinping, Li, Mengtao, Zhao, Jiuliang, Sui, Ruifang, Zeng, Xiaofeng
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.02.2022; Sage Publications Ltd
• Subjects: Adult; Antiphospholipid syndrome; Antiphospholipid Syndrome - complications; Autoimmune diseases; Cluster analysis; Coronary artery disease; Female; Heart diseases; Heart Valve Diseases; Humans; Kidney Diseases; Lupus Erythematosus, Systemic; Male; Nephropathy; Occlusion; Patients; Prospective Studies; Retina; Retinal Vein Occlusion - epidemiology; Retinal Vein Occlusion - etiology; Rheumatic heart disease; Risk Factors; Statistical analysis; Thrombocytopenia; Thrombotic microangiopathy; Vascular diseases; retinal vasculopathy; thrombotic microangiopathy; risk factor; Antiphospholipid syndrome
• ISSN: 0961-2033; 1477-0962; 1477-0962
• DOI: 10.1177/09612033211069762

Background Retinal vasculopathy including retinal artery occlusion (RAO) or retinal vein occlusion (RVO) was recently found to occur more frequently in antiphospholipid syndrome (APS) patients than non-APS patients. This study aims to investigate the clinical manifestation and risk factors of retinal vasculopathy among APS patients. Methods In this single-center prospective cohort study, we evaluated APS patients with or without retinal vasculopathy during 2018–2020 at Peking Union Medical College Hospital. Clinical variables were compared, and a logistical regression model was built to explore risk factors. Hierarchical cluster analysis using Euclidean distances was applied to identify clusters of variables. Results A total of 310 APS patients (67.4% female, mean age 38.1 years) were included, of whom 18 (5.8%) were diagnosed with retinal vasculopathy (9 with RVO and 9 with RAO). No significant differences were found among most demographic characteristics, clinical manifestations, or antibody profiles. APS-related heart valve disease (odds ratio OR 13.66, 95% confidence interval CI 4.55–40.98), APS nephropathy (OR 12.77, 95% CI 4.04–40.35), and thrombocytopenia (OR 2.63, 95% CI 1.01–6.89) were predictive of retinal vasculopathy. APS-related heart valve disease and nephropathy were also found to be statistically significant predictors in multivariate logistical regression analysis. Non-criteria manifestations were aggregated with retinal vasculopathy from a cluster analysis of variables. Conclusion Patients with APS-related heart valve disease and nephropathy suffered a higher risk of retinal vasculopathy. The underlying mechanisms of aPL-associated retinal vasculopathy may involve thrombotic microangiopathy, leading to poor prognosis and therapeutic changes.