Systemic Lupus Erythematosus Presenting With Ascites

Background/Objective: Ascites is a rare but potentially severe manifestation of systemic lupus erythematosus (SLE). We investigated the clinical characteristics and treatment outcomes, including recurrence of ascites, in patients with SLE. Methods: We conducted a historical cohort study of patients with SLE who presented with ascites via computed tomography and diagnostic paracentesis. Patients were categorized into 3 etiologic groups: SLE-related ascites, liver cirrhosis (LC)-related ascites, and ascites due to other causes. Clinical features and treatment responses were compared between the SLE-related and LC-related groups. Results: Among the 72 patients with SLE and ascites, 44 (61.1%) had SLE-related ascites, and 16 (22.2%) had LC-related ascites. The median age in the SLE-related group was 39.0 years (interquartile range, 26.5 to 52.5), and 74.4% were female. Compared with the LC-related group, SLE-related ascites was associated with lower serum albumin (1.0 vs. 2.4 g/dL; p =0.04) and lower white blood cell counts in ascitic fluid (125 vs. 530 cells/μL; p =0.03). Glucocorticoids were administered to 97.7% of patients in the SLE-related group, with a higher short-term treatment response rate (88.6% vs. 25.0%; p <0.01). During a median follow-up of 5.7 years, recurrence occurred in 54.5% of patients with SLE-related ascites. Low baseline serum albumin ( p =0.047) and elevated baseline C-reactive protein (CRP) ( p =0.001) were identified as significant predictors of ascites recurrence. Conclusions: SLE-related ascites is characterized by marked hypoalbuminemia. Low serum albumin and elevated CRP levels are predictors of recurrence, highlighting the need for close monitoring and tailored management in high-risk patients.