Comprehensive risk assessment for pulmonary manifestations in systemic lupus erythematosus: a large-scale Korean population-based longitudinal study.

Summary

In a nationwide Korean cohort, SLE patients had a 3.3-fold higher risk of pulmonary manifestations than matched controls over 9.3 years, with the greatest excess risks for pulmonary hypertension and interstitial lung disease. ARDS and pulmonary hemorrhage risk was also elevated (aHR 1.85).

Key Findings

• SLE cohort had an adjusted hazard ratio of 3.26 for overall pulmonary manifestations versus controls.
• Highest risks observed: pulmonary hypertension (aHR 14.66) and interstitial lung disease (aHR 9.58).
• Risk of ARDS and pulmonary hemorrhage increased (aHR 1.85), along with PE, pleural disorders, TB, and lung cancer.

Clinical Implications

Implement proactive screening for pulmonary hypertension and ILD in SLE and maintain heightened vigilance for ARDS/hemorrhage during hospitalizations. Risk stratification can guide timely referral and management.

Limitations

• Claims-based definitions may introduce misclassification; limited clinical granularity (e.g., imaging, biomarkers).
• Residual confounding (e.g., medications, disease activity) cannot be excluded.

Future Directions

Integrate clinical and imaging data to refine risk prediction; evaluate preventive strategies and screening intervals for high-risk SLE subgroups.