Pulmonary Hypertension in Systemic Lupus Erythematosus Among Black and Hispanic Patients: An Observational Cohort...

To determine clinical factors associated with pulmonary hypertension (PH) and assess its impact on clinical outcomes in a predominantly Black and Hispanic systemic lupus erythematosus (SLE) cohort from an underserved US urban setting.

We conducted an observational cohort study of 140 adults with SLE treated at a large academic center in the Bronx, New York, from 2017 to 2021. PH was diagnosed by clinicians, supported by a right ventricular or pulmonary artery systolic pressure >35 mm Hg by echocardiography. The primary outcome was time to clinician-adjudicated lupus flare-related hospitalization. Secondary outcomes included hospitalization due to lupus flare with cardiac involvement and all-cause mortality. Cox proportional hazards models with PH as a time-varying covariate were used to assess associations.

At baseline, the following comorbidities were all significantly more common in patients with PH compared with those without interstitial lung disease (ILD) (22.9% vs. 8.7%; p=0.03), Raynaud phenomenon (66.7% vs. 39.1%; p<0.01), atrial fibrillation (12.5% vs. 0%; p<0.01), and sepsis (20.8% vs. 7.6%; p=0.03). Over a median follow-up of 84 months, 57 patients (41%) experienced a flare-related hospitalization. In multivariable analysis, PH was an independent predictor of earlier lupus flare-related hospitalization (HR: 1.90; 95% CI: 1.07-3.38; p=0.03), as were younger age (HR: 0.97; 95% CI: 0.96-0.99; p<0.01) and higher SLEDAI scores (HR: 1.11; 95% CI: 1.05-1.18; p<0.01). PH was not significantly associated with cardiac-related hospitalization or all-cause mortality, though trends suggested higher event rates in the PH group.

In this predominantly Black and Hispanic cohort with SLE, PH emerged as a clear, independent predictor of lupus flare-related hospitalizations. Vigilant PH screening and timely intervention may help reduce morbidity in high-risk, underserved SLE populations.