Basic & Clinical Medicine ›› 2025, Vol. 45 ›› Issue (6): 800-806.doi: 10.16352/j.issn.1001-6325.2025.06.0800

• Original Articles • Previous Articles     Next Articles

A multi-state Markov model study to estimate organ damage progression and influencing factors in systemic lupus erythematosus patients

LI Lu1, LI Liangming1, YU Bing1, LI Mengtao2*, WANG Yanhong1*   

  1. 1. Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005;
    2. Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases(NCRC-DID), State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital, CAMS & PUMC,Beijing 100730, China
  • Received:2025-02-26 Revised:2025-03-21 Online:2025-06-05 Published:2025-05-26

Abstract: Objective To establish a multi-state Markov model of systemic lupus erythematosus(SLE) for patients in China and to explore the transition rule of organ damage accumulation and possible factors affecting the transition between states. Methods A retrospective cohort study was conducted using the data from CSTAR. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index(SDI) was divided into five irreversible disease states(SDI=0, 1, 2, ≥3, and death, marked as S0, S1, S2, S3, Death). The R “mstate” package was used for statistical analysis. Results This study included 23 926 cases of SLE patients with cumulative follow-up of 12 030 visits. Among these patients, 21 070 patients had no any organ damage at baseline. At the follow-up period, the transition probabilities of organ damage of S0→S1, S1→S2, S2→S3, S3→Death were 7.01%, 12.58%, 10.64%, and 12.19%, respectively. The multi-state Markov model showed that age, gender, disease duration, SLEDAI score, corticosteroid dosage, and involvement of major organs were associated with the transition of organ damage status, each 1 year increased was associated with a 2%~3% increase in risk of damage accumulation risk(P<0.01). Also, neurological(S0→S1:HR=1.34;S1→S2:HR=1.53;S2→S3:HR=1.73), cardiopulmonary(S0→S1:HR=3.66;S1→S2:HR=1.51;S2→S3:HR=1.52), renal(S0→S1:HR=1.24)and hematological involvement(S0→S1:HR=1.24)might be the risk factors. Conclusions The probability of organ damage accumulation in SLE patients increases over time. Therefore, in the early stage of the disease, the involvement of important organs needs to be minimized and the treatment strategy should be dynamically adjusted at different stages of treatment.

Key words: systemic lupus erythematosus, multi-state Markov model, transition probability

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