Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, many organs and tissues may be affected, and little is known about its pathophysiology. There are few objective tools for assessment of disease activity and predicting outcomes of SLE patients and further aiding in directing clinical therapeutic programs.A complex interaction of impaired apoptotic clearance, upregulation of innate and adaptive immune systems, complement activation, immune complexes, and tissue inflammation culminates in a self-sustained autoimmune process.  Dyslipidemia refers to the abnormality of lipid metabolism. The aberrant lipid profiles are usually characterized by elevated plasma levels of low-density lipoprotein cholesterol (LDL-c), total cholesterol (TC), triglycerides (TG), apoprotein B (ApoB), and decreased level of high-density lipoprotein cholesterol (HDL-c), has been shown to be associated with SLE. It has been demonstrated that lipid-abnormality can cause B-lymphocytes to secrete auto-antibodies and result in diseases via certain cytokines.This study aimed to determine whether dyslipidemia reflects disease severity and predicts SLE patient outcomes. 

We included 736 patients with SLE, and 579 healthy patients were used as control group. Data included demographics; levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and complement C3 on admission. The predictive ability of dyslipidemia for outcomes was determined using receiver operating characteristic (ROC) curve analysis.

The levels of TC (4.09±0.02vs3.93±0.05), TG(1.78±0.04vs1.08±0.02), and LDL-c (2.18±0.02vs2.06±0.03) were increased in the group of SLE (p<0.05); and the level of HDL-c (0.98±0.01 vs1.34±0.01) was decreased in the group of SLE patients (p<0.05); serum TC (r=0.100), HDL-c (r=0.214), and LDL-c (r=0.080) showed a positive correlation with disease activity (p<0.05), TG (r=-0.147) showed a negative correlation with disease activity (p<0.05); the area under ROC curve for HDL-c to determine disease activity was 0.403, the cut off value was 0.165, the sensitivity was 75.6%, and the specificity was 68.5%; the area under ROC curve for TG to determine disease activity was 0.592, the cut off value was 2.145, the sensitivity was 62.1%, and the specificity was 84.8%. 

Dyslipidemia is a promising objective tool for SLE disease activity and outcome prediction. A high content total cholesterol, triglyceride and low-density lipoprotein cholesterol and low levels of high-density lipoprotein cholesterol were associated with worse disease severity and predicted poor outcomes.