Causes of death in hospitalized patients with systemic lupus erythematosus: a 10-year multicenter nationwide Chinese cohort

Abstract

To estimate the mortality and describe the causes of death in a large multicenter cohort of hospitalized patients with SLE in China. This was a retrospective study of a nationwide SLE cohort (10 centers, 29,510 hospitalized patients) from 2005 to 2014 in China. Standardized mortality ratios (SMRs) were calculated for all death and were stratified by sex and age. Chi-square test was used to determine whether the major causes of death vary in age, sex, duration of SLE, disease activity, or medications. Comparison between dead patients and survival controls was used to identify the risk factors for mortality. Logistic regression analysis was used to evaluate the risk factors for mortality. A total of 360 patients died during the study period, accounting for 1.22%. The overall SMR was 2.13 (95% CI 1.96, 2.30), with a particularly high SMR seen in subgroups characterized by younger age. Infection (65.8%) was the most common cause of death, followed by lupus nephritis (48.6%), hematological abnormality (18.1%), neuropsychiatric lupus/NPSLE (15.8%), and interstitial pneumonia (13.1%). Cardiovascular disease and malignancy contributed little to the causes of death. Infection, in particular severe pulmonary infection, emerged as the foremost risk factor for mortality, followed by lupus encephalopathy. However, lupus nephritis and hematological abnormalities occurred more frequently in survival patients. SLE patients at a younger age of diagnosis have a poorer prognosis. Infection dominated the causes of death in recent China. Ethnicity and medications might account for the differences in causes of death compared with western populations.

The Truth Behind Hematuria

“…Lupus nephritis (LN) is a common manifestation of SLE. In the early stage of SLE, LN may show slight abnormalities in urine(microhematuria and /or albuminuria and /or leukuria) [2][3][4][5] , or nephrotic syndrome, hypertension, or renal failure [6][7] . In this case, the child was diagnosed with nephrotic syndrome and renal biopsy revealed lupus nephritis.…”

Systemic lupus erythematosus and immunodeficiency

“…Wu et al also examined the causes of death in a large nationwide database in China involving 10 centers and 29,510 patients with SLE who were hospitalized between 2005 and 2014. They found that infection (65.8%), particularly severe pulmonary infection, was the most common cause of death, followed by lupus nephritis (48.6%), hematological abnormality (18.1%), neuropsychiatric SLE (15.8%), and interstitial pneumonia (13.1%) [56].…”

Ab1238 patients’ Perceptions of Support Programs for the Treatment of Chronic Inflammatory Diseases

“…So Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with heterogeneous, multisystem involvements which can sometimes be severe and life threatening. Different causes of mortality have been described over different decades in SLE patients (1) . All these patients were on a median dose of prednisolone 10 (2.5-20) mg daily with median of 10 (4-24) years of steroids.…”