Elevated D-Dimer and Non-Glucocorticoid Therapies Risk Factors for Thromboembolic Events in Dermatomyositis: Study
A recent study found that the prevalence of thromboembolic events is increased in individuals with Dermatomyositis with elevated D-dimer levels and the lack of glucocorticoid therapy as per the results that were published in the Journal of Inflammation Research.
Dermatomyositis (DM) is an autoimmune disorder and is a common clinical subtype of Idiopathic inflammatory myopathies. Clinically it presents with skin manifestations, which can affect the lungs, joints, esophagus, and heart. DM is characterized by a hypercoagulable state associated with endothelial dysfunction, leading to Thromboembolic events (TEs). There is uncertainty about the risk factors that cause TEs in DM. Hence Chinese researchers conducted a retrospective analysis to investigate the prevalence of TEs in DM in Southeast China and identify the independent predictors.
A 10-year retrospective analysis included patients aged ≥18 with at least one ICD code for DM. The European League Against Rheumatism/American College of Rheumatology 2017 classification criteria were used to identify a well-defined, relatively homogenous population of individuals with DM. Individuals with a score ≥7.5 without a muscle biopsy or ≥8.7 with a muscle biopsy, along with at least one of the three skin criteria, were considered eligible for the study. TEs were determined by ultrasonography, computed tomography, magnetic resonance imaging, or angiogram.
About 543 patients hospitalized for DM within the past 10 years were analyzed retrospectively and compared with patients with DM with and without TEs for demographic, clinical, and laboratory characteristics. The independent predictors were analyzed using multivariate logistic regression analysis. The diagnostic performance was calculated by a receiver operating curve (ROC).
Findings:
- Twenty-two (4.1%) patients with DM had TEs, including 12 (54.5%) with venous thromboembolism and 10 (45.5%) with arterial thromboembolism.
- Multivariate logistic regression analysis revealed that glucocorticoid therapy was a protective factor for patients with DM developing TEs, whereas increased D-Dimer was a risk factor.
- The combined ROC analysis of glucocorticoid therapy and D-Dimer indicated high diagnostic values in distinguishing patients with both DM and TEs from patients without TEs, with 86.4% sensitivity, 98.9% specificity, and 0.983 area under the ROC curve (95% CI 0.962– 1.000, P< 0.001).
Thus, the study concluded that the prevalence of TE was less in DM. However, the lack of glucocorticoid therapy and increased levels of D-dimer were risk factors for the development of TEs in DM patients. Hence, the researchers suggested early screening of thromboembolic events in all dermatomyositis individuals by evaluating the risk factors. Physicians should also consider adding anticoagulants in DM patients to prevent TEs.
Further reading: Prevalence and Risk Factors of Thromboembolic Events in Dermatomyositis in China: A 10-Year Retrospective Analysis. Doi: https://doi.org/10.2147/JIR.S482055
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