Infection is a major cause of morbidity and mortality among patients with systemic lupus erythematosus (SLE). To describe the pattern of serious infections in patients with SLE and to identify the predictors of infection-related mortality among SLE patients with serious infections, we prospectively studied all SLE patients who were hospitalized with infections in Sarawak General Hospital during 2011-2015. Demographic data, clinical features, and outcomes were collected. Cox regression analysis was carried out to determine the independent predictors of infection-related mortality. There were a total of 125 patients with 187 episodes of serious infections. Our patients were of multiethnic origins with female predominance (89.6%). Their mean age was 33.4 ± 14.2 years. The patients had a mean disease duration of 66.8 ± 74.0 months. The most common site of infection was pulmonary (37.9%), followed by septicemia (22.5%). Gram-negative organisms (38.2%) were the predominant isolates within the cohort. There were 21 deaths (11.2%) during the study period. Independent predictors of infection-related mortality among our cohort of SLE patients were flare of SLE (HR 3.98, CI 1.30-12.21) and the presence of bacteremia (HR 2.54, CI 0.98-6.59). Hydroxychloroquine was protective of mortality from serious infections (HR 9.26, CI 3.40-25.64). Pneumonia and Gram-negative organisms were the predominant pattern of infection in our SLE cohort. The presence of flare of SLE and bacteremia were independent prognostic predictors of infection-related mortality, whereas hydroxychloroquine was protective of infection-related mortality among SLE patients with serious infections.
BackgroundLupus nephritis (LN) is a serious manifestation of systemic lupus erythematosus that can be fatal if left untreated. The causes and prognostic predictors of mortality in LN have been well studied in developed countries but evidence is lacking for developing countries. The objective of this study was to investigate the causes and predictors of mortality in a cohort of Malaysian patients with biopsy-proven LN.MethodsWe retrospectively studied all patients with biopsy-proven LN treated in Sarawak General Hospital during the period of 2000–15. Demographic data, clinical features and outcomes were collected. Cox regression analysis was carried out to determine the independent predictors of mortality.ResultsThere was a total of 250 patients with 259 renal biopsies available for our analysis. Our patients were of multi-ethnic origins with a female predominance (90%). Their mean ± standard deviation age was 37.7 ± 12.8 years. The patients had a mean disease duration of 135.6 ± 81.9 months. Nephrotic syndrome was the most common presentation (29.6%) and acute renal failure was evident at initial presentation in 16% of patients. Class IV LN was the predominant biopsy class within the cohort (66.8%). The majority of patients achieved remission (81.2%) and had normal renal function (83.9%) at the last follow-up. The 5-, 10-, 15- and 20-year survival rates for our cohort were 93%, 88%, 82% and 77%, respectively. There were 37 deaths (14.8%), of which the main causes were: infection and flare (52.7%), infection alone (25.0%) and other causes (22.3%). Independent predictors of mortality in our cohort of LN patients were: the presence of acute kidney injury at presentation [hazard ratio (HR) 3.41; confidence interval (CI) 1.50–7.76], failure to achieve remission at 1-year post-induction therapy (HR 2.99; CI 1.35–6.65) and non-compliance with treatment (HR 1.89; CI 1.22–2.96). Age, ethnicity, class of LN and type of immunosuppressant used were not predictive of mortality.ConclusionsSurvival and renal outcomes in our LN cohort were comparable to most LN studies reported worldwide. Both flare and infection remained the main causes of death. The presence of acute renal failure at presentation, failure to achieve remission at 1 year post-treatment and non-compliance with treatment were independent prognostic predictors of mortality in LN.
BackgroundAnkylosing spondylitis (AS) is a chronic spinal inflammatory disorder which leads to progressive fusion and deformity. The loss of spinal mobility is recognised as an important clinical sign. The BASMI, a composite index of spinal mobility is used internationally in clinical practice and research. However, the interpretation of BASMI has been impeded by the absence of normative values.ObjectivesWe aimed to attain the normative values for BASMI in Malaysian healthy individuals.MethodsBASMI data of 142 healthy individuals and 187 AS patients were analysed. Each BASMI component was assessed, using the 10-point scoring system, where zero is no mobility and 10 is very severe limitation. Measurements were performed by the rheumatologists and trained researchers following a designated protocol. Data were summarised and analysed according to sex and age groups.ResultsThe total BASMI scores ranged from 0.2 to 4.2 and 0.6 to 9.6 in the healthy individuals and the AS cases, respectively. There was no significant difference for the BASMI median score between healthy men and women (men=1.2, women=1.6, p>0.05). The estimated median score for healthy individuals aged 15–19 years was 1.2, increasing with age to 2.7 for healthy individuals aged ≥60 years. In AS cases, the estimated median score was 5.4 and 5.8 for men and women, respectively (p>0.05). We observed significant increase of estimated median score between AS patients aged 15–19 years (BASMI score=2.0) and AS patients aged ≥60 years (BASMI score=6.4) (p<0.05).ConclusionsOur data suggest that it is uncommon for healthy individuals to score zero on the BASMI. The magnitude of increase in BASMI score is apparent with increasing age, but not sex in the healthy individuals. Establishment of normative values may aid baseline measurement and monitor change of spinal mobility in AS patients over time, as well as help assess the impact of clinical interventions.Disclosure of InterestNone declared
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