Rubrics for mortality: a real-world observational long-term lupus nephritis cohort

Abstract

<jats:p> In this study, we aimed to evaluate long-term patient survival according to demographic data, clinical manifestations of systemic lupus erythematosus (SLE) and previous and current treatments, collected retrospectively. Patient selection required a minimum of four American College of Rheumatology revised criteria for SLE, biopsy-proven lupus nephritis (LN) available for reclassification according to the modified National Institutes of Health proposal for activity and chronicity indices and a minimum follow-up of at least three years since the last renal biopsy. Selection criteria were fulfilled in 25 patients followed for a median of 21 years. Based on the last renal biopsy, an equal number of patients were thus classified as class I/II and IV ( n=8) and class III and V ( n = 4). The mortality rate for LN was 14%. Having ever been diagnosed with glomerulonephritis (GN) type III or type IV but not class IV alone ( p = 0.046), a higher histological chronicity index at the last renal biopsy ( p = 0.022), not attaining renal remission one year after induction therapy ( p = 0.004), end-stage renal disease on dialysis ( p = 0.033) and the extra-renal Systemic Lupus International Collaborating Clinics Damage Index score ( p = 0.017) were all significantly associated with mortality. Our results may provide important clues for strict observation protocols in particular categories of LN patients with long-standing disease. </jats:p>

Renal function deterioration is an independent mortality determinant in Koreans diagnosed with lupus nephritis

“…As shown in Figure 2(a), the mortality depended on the final renal function, which was the independent predictor for mortality identified in multivariate Cox proportional hazards analysis, and differed significantly between the groups. However, contrary to previous studies, 12,39 the mortalities depended on the histologic type, CYC usage, and HCQ usage were not differed significantly between the groups. This result was consistent with the conclusion of our study that if each patient received appropriate treatment according to the guidelines, response to treatment and prevention of renal function decline are more important than specific histological findings and treatment methods.…”

“…9 Other studies reported that baseline C3 and C4 levels were significantly lower in patients who died. 23 Pathology parameters such as proliferative type pathology 12 and a higher index of activity 10,12 were known to predict mortality. Failure to reach CR is a known risk factor for mortality in 12 months 9,10,12 or 24 months.…”

“…23 Pathology parameters such as proliferative type pathology 12 and a higher index of activity 10,12 were known to predict mortality. Failure to reach CR is a known risk factor for mortality in 12 months 9,10,12 or 24 months. 24 In our study, Hb less than 10 mg/dl and eGFR at baseline, treatment resistance at 6 and 12 months, time to remission, final renal response, and final renal function were identified as risk factors for mortality using univariate Cox hazards proportional analysis.…”

“…11 Several predictors of mortality in patients with LN have been reported, including the presence of acute kidney injury at presentation, higher activity index and proliferative type of pathology, and the absence of renal remission 1 year after induction therapy and ESRD. 9,10,12 Although evidence suggests that deterioration of renal function is related to adverse outcomes, including loss of kidney function, CVD, and premature death, 13 limited attention has been paid to the impact of renal function on mortality or cause of death in LN patients. Hence, we conducted a retrospective study to identify the mortality rate and the risk factors for mortality and to identify the causes of death depending on renal function.…”

“…11 Several predictors of mortality in patients with LN have been reported, including the presence of acute kidney injury at presentation, higher activity index and proliferative type of pathology, and the absence of renal remission 1 year after induction therapy and ESRD. 9,10,12…”