Elevated Circulating Thrombomodulin Levels in Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis

Objectives: Thrombomodulin (TM) is closely related to the pathogenesis of autoimmune diseases, in-cluding systemic lupus erythematosus (SLE). However, current evidence on circulating TM levels in SLE pa-tients is contradictory. We conducted this meta-analysis to more accurately assess circulating TM levels in pa-tients with SLE and lupus nephritis (LN) and to analyze related influencing factors. Methods: Systematic search of relevant documents was conducted in PubMed, Embase, and The Cochrane Li-brary databases (up to 28 February 2021). Studies on the comparison of circulating TM between SLE patients and controls were screened and evaluated for inclusion. Random-effects model analysis was applied to calcu-late the combined standardized mean difference (SMD) with a 95% confidence interval (CI). Heterogeneity was estimated by Q statistics and I-2. Results: A total of 353 articles were identified, 14 provided adequate information for this study finally. The re-sults illustrated that SLE patients had higher TM levels than healthy controls (SMD=0.38, 95% CI: 0.02 to 0.74, p=0.04). Circulating TM levels were increased in patients with active SLE compared to inactive SLE pa-tients (SMD=1.12, 95% CI: 0.03 to 2.20, p=0.04). In addition, circulating TM levels of SLE patients with LN were higher than those without LN (SMD=4.55, 95% CI: 1.97 to 7.12, p=0.001). Conclusion: The circulating TM levels in SLE patients are enhanced. In addition, circulating TM levels may be practical in reflecting the disease activity and nephritis involvement of SLE patients.

Automated summary

This study conducted a meta-analysis to evaluate circulating thrombomodulin levels in patients with systemic lupus erythematosus (SLE) and lupus nephritis (LN). The results showed that SLE patients had higher TM levels than healthy controls. Additionally, circulating TM levels were found to be associated with disease activity and the presence of LN in SLE patients.