Factors associated with pericardial effusion in pediatric systemic lupus erythematosus

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Pediana Rachmawati
Indah K. Murni
Sasmito Nugroho
Noormanto Noormanto
Sumadiono Sumadiono


Background Cardiovascular involvement in systemic lupus erythematosus (SLE) has been reported to range from 4-78%. Complications can affect all structures of the heart, including the endocardium, myocardium, pericardium, and valves. Pericarditis is the most common manifestation, with an incidence of 11-54% in SLE patients. Pericardial effusion is often observed in patients with pericarditis, and can be confirmed by echocardiography.

Objective To determine factors associated with pericardial effusion in children with SLE.

Methods We conducted a restrospective cross-sectional study by reviewing medical records of children with SLE aged less than 18 years who underwent echocardiography at the Dr. Sardjito Hospital. Yogyakarta, from January 2011 to March 2018. Patients with congenital heart disease or incomplete medical records were excluded. A multivariate logistic regression analysis was done to determine factors that independetly associated with pericardial effusion.

Results Among 165 children with SLE, 73 fulfilled the inclusion criteria. The prevalence of pericardial effusion was 54.8%. Median age was 13 (range 5-17) years and the female-to-male ratio was 8:1. Hemolytic anemia (OR=4.135; 95%CI 1.039 to 16.453; P=0.044) was significantly associated with pericardial effusion.

Conclusion Hemolytic anemia is significantly associated with pericardial effusion in children with SLE.

Article Details

How to Cite
Rachmawati P, Murni I, Nugroho S, Noormanto N, Sumadiono S. Factors associated with pericardial effusion in pediatric systemic lupus erythematosus. PI [Internet]. 4Oct.2018 [cited 30Nov.2020];58(5):227-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/1891
Received 2018-07-12
Accepted 2018-09-25
Published 2018-10-04


1. Sudewi NP, Kurniati N, Suyoko D, Zakiudin M, Arwin A. Karakteristik klinis lupus eritematosus sistemik padaa nak. Sari Pediatr. 2009;11:108–12.
2. Evalina R. Gambaran klinis dan kelainan imunologis pada anak dengan lupus eritematosus sistemik di Rumah Sakit Umum Pusat Adam Malik Medan. Sari Pediatr. 2012;13:6–9.
3. Man BL, Mok CC. Serositis related to systemic lupus erythematosus: prevalence and outcome. Lupus. 2005;14:822–6.
4. Doria AÃ, Iaccarino L, Atzeni F, Turriel M, Petri M. Cardiac involvement in systemic lupus erythematosus. Lupus. 2005;14:683–6.
5. Farkhati MY, Hapsara S, Satria CD. Antibodi anti ds-DNA sebagai faktor prognosis mortalitas pada lupus eritematosus sistemik. Sari Pediatr. 2012;14:90–6.
6. Thakral A, Klein-Gitelman MS. An update on treatment and management of pediatric systemic lupus erythematosus. Rheumatol Ther. 2016;3:209–19.
7. Karuniawati, Sumadiono, Satria C. Dewi. Perbandingan diagnosis systemic lupus erythematosus menggunakan kriteria American College of Rheumatologi dan Systemic Lupus International Collaborating Clinics. Sari Pediatr. 2016;18:299–303.
8. Van Camp G. Guidelines for the diagnosis and management of pericardial diseases. Acta Cardiol. 2016;71:7–8.
9. Levy D, Kamphius S. Systemic lupus erythematosus in children and adolescents. Pediatr Rev. 2012;59:345–64.
10. Jeffries M, Hamadeh F, Aberle T, Glenn S, Kamen DL, Kelly JA, et al. Haemolytic anaemia in a multi-ethnic cohort of lupus patients: A clinical and serological perspective. Lupus. 2008;17:739–43.
11. Tucker LB. Making the diagnosis of systemic lupus erythematosus in children and adolescents. Lupus. 2007;16:546–9.
12. Hahn BH, McMahon MA, Wilkinson A, Wallace WD, Daikh DI, Fitzgerald JD, et al. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res. 2012;64:797–808.
13. Kasjmir YI, Handono K, Wijaya LK, Hamijoyo La, Albar Z, Kalim Ha, et al. Rekomendasi perhimpunan reumatologi Indonesia untuk diagnosis dan pengelolaan lupus eritematosus sistemik. Jakarta: Perhimpunan Reumatologi Indonesia; 2011. p. 8-9.
14. Gladman DD, Urowitz MB, Esdaile JM, Hahn BH, Klippel J, Lahita R, et al. Guidelines for referral and management of systemic lupus erythematosus in adults. Arthritis Rheum. 1999;42:1785–96.
15. Ryu S, Fu W, Petri MA. Associates and predictors of pleurisy or pericarditis in SLE. Lupus Sci Med. 2017;4:1–9.
16. Hashimoto H. Cardiovascular manifestations in systemic lupus erythematosus: A clinical analysis of 1,125 patients with SLE. In: cardiovascular disease 1. Tokyo, Japan: iConcept Press; 2014. p. 119–38.
17. Alsaeid K, Kamal H, Haider MZ, Al-Enezi HM, Malaviya AN. Systemic lupus erythematosus in Kuwaiti children: organ system involvement and serological findings. Lupus. 2004;13:613–7.
18 Font J, Cervera R, Espinosa G, Pallarés L, Ramos-casals M, Jiménez S, et al. Systemic lupus erythematosus (SLE) in childhood : analysis of clinical and immunological findings in 34 patients and comparison with SLE characteristics in adults. Ann Rheum Dis. 1998;57:456–9.
19. Sutcliffe N, Clarke AE, Gordon C, Farewell V, Isenberg DA. The association of socio-economic status, race, psychosocial factors and outcome in patients with systemic lupus erythematosus. Rheumatology. 1999;38:1130–7.
20. dos Santos F de M, Borges MC, Correia MI, Telles RW, Lanna CC. Assessment of nutritional status and physical activity in systemic lupus erythematosus patients. Rev Bras Reum. 2010;50:631–8.
21. Feng J-B, Ni J-D, Yao X, Pan H-F, Li X-P, Xu J-H, et al. Gender and age influence on clinical and laboratory features in Chinese patients with systemic lupus erythematosus: 1,790 cases. Rheumatol Int. 2010;30:1017–23.
22. Tang X, Huang Y, Deng W, Tang L, Weng W, Zhang X. Clinical and serologic correlations and autoantibody clusters in systemic lupus erythematosus : a retrospective review of 917 patients in South China. Medicine. 2010;89:62–7.
23. Tincani A, Rebaioli CB, Taglietti M, Shoenfeld Y. Heart involvement in systemic lupus erythematosus, anti-phospholipid syndrome and neonatal lupus. Rheumatology. 2006;45:8–13.
24. Kokori SI, Ioannidis JP, Voulgarelis M, Tzioufas A, Moutsopoulos HM. Autoimmune hemolytic anemia in patients with systemic lupus erythematosus. Am J Med. 2000;108:198–204.
25. Liang Y, Leng R-X, Pan H-F, Ye D-Q. The prevalence and risk factors for serositis in patients with systemic lupus erythematosus: a cross-sectional study. Rheumatol Int. 2016;37:305–11.