A multicenter study of outcome in systemic lupus erythematosus. ii.

Abstract

Causes of death were examined for 1,103 systemic lupus erythematosus patients who were followed from 1965 to 1978 at 9 centers that participated in the Lupus Survival Study Group. A total of 222 patients (20%) died. Lupus-related organ system involvement (mainly active nephritis) and infection were the most frequent primary causes of death. Causes of death were similar throughout the followup period. Hemodialysis had little impact on the length of survival for patients with nephritis. Active central nervous system disease and myocardial infarction were infrequent causes of death. There were no deaths from malignancy.Despite a linear improvement in survival rates since the turn of the century (l), mortality in systemic lupus erythematosus (SLE) is still appreciable. In 1964, Kellum and Haserick (2) EUGENE V. BARNETT(3) noted 54 (36%) deaths in 150 patients who were followed prospectively for an 8-year period. Dubois et a1 (4) in 1974 reported 249 (51%) deaths among 491 patients who were followed for 13 years. Renal disease was the most common cause of death in the latter two series. Mortality rates and causes of death reflect in part the nature of each center's patient population. In order to more accurately describe the causes of death among SLE patients treated at university-affiliated centers in the United States, we have studied the causes of death in more than 4,000 patient-years of followup of 1,103 patients with SLE who were seen by members of the Lupus Survival Study Group (5).

Causes of death in systemic lupus erythematosus, long‐term followup of an inception cohort

“…In the 3 largest reported series, for example, death was attributed to SLE in 20%, 33%, and 52% of cases, to infection in 21%, 33%, and 17%, and to cardiovascular disease in 20%, 3%, and 6%, respectively (7,25,27).…”

“…In the cohort examined by the Lupus Survival Study Group, which had a mean followup of 3.6 years among patients with an average SLE duration of 3.0 years at entry, only 6% of 222 deaths were due to cardiovascular disease, cerebrovascular disease, or cancer (8,25). In contrast, 21% of 142 deaths were attributed to these causes in a study with a mean followup period of 6 years (27), and 37% of 128 deaths were due to these causes in a study with a mean followup period of 10 years (7).…”

“…Several studies have suggested that this improvement in survival has been accompanied by a shift in the predominant causes of death, with fewer deaths due to SLE and a greater proportion of deaths due to infections and the complications of atherosclerosis (3,7,(15)(16)(17)(18)20,24). Other investigators, however, report that SLE remains the most common cause of death (4,5,10-I 2, 14,19,[25][26][27][28][29]. Still others maintain that the predominant cause of death varies with the duration of disease, with SLE itself being the most common cause of death during the early years, and causes other than SLE responsible for most deaths later in the illness (3, 25,30).…”

“…Other investigators, however, report that SLE remains the most common cause of death (4,5,10-I 2, 14,19,[25][26][27][28][29]. Still others maintain that the predominant cause of death varies with the duration of disease, with SLE itself being the most common cause of death during the early years, and causes other than SLE responsible for most deaths later in the illness (3, 25,30).…”

Analysis of Lupus Activity in End-Stage Renal Disease Treated by Hemodialysis.

“…Lupus nephritis occurs in 50% to 80% of SLE patients (1) and has a strong impact on the prognosis; the high morbidity and mortality of patients with SLE are associated with the severity of lupus nephritis (2)(3)(4). About 20%of patients progressing to ESRDrequire maintenance dialysis or renal transplantation within ten years (2,5). The activity of SLE after the development of ESRDhas been reported by several groups (3)(4)(5)(6)(7)(8)(9).…”