SAT0291 Non-reporting of systemic lupus erythematosus in death certificates of lupus patients: its extent and predictors

Abstract

BackgroundSystemic lupus erythematosus (SLE) is frequently not reported in death certificates of lupus patients, despite its known role as an underlying and/or immediate cause of death. Possible reasons may be insufficient access to patients' medical records at time of death (including details on their medical history) and/or physicians' unawareness of the contribution of SLE to death.ObjectivesWe aimed to analyze the extent and predictors of non-reporting of SLE in death certificates of 90 deceased SLE patients regularly followed-up in a routine academic setting at our Department.MethodsWe retrospectively observed 90 SLE patients (68 females) deceased within the 2002–2011 period. All patients were ≥18 years of age and Croatian residents at the time of death, fulfilling ≥4 classification criteria of the American College of Rheumatology (ACR). We identified patients with SLE listed as a cause of death in the death certificate. An extensive set of variables was compared between patients with and without SLE reported in the certificate: demographics, ACR criteria at time of death and damage according to the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC)/ACR index and its components at the time of death. We also compared the proportion of in-hospital deaths and autopsies performed. Frequencies were compared using the χ2 and Fisher's exact test, and continuous variables using the t-test and Mann-Whitney U test. Variables associated with reporting of SLE in the death certificate in the univariate analysis were included in a multivariate logistic regression model.ResultsSLE was reported in death certificates of 41/90 (46%) patients. Patients with SLE not reported in their death certificates were older at death (62±14 vs. 53±15 years) and diagnosis (53±14 vs 42±18 years) and had a longer time from their last visit at our Department to death (0.80±1.00 vs. 0.34±0.66 years), compared to patients with SLE listed in the death certificate (p<0.05). They also had a lower proportion of renal disorder (20/49 vs. 29/41), cardiovascular and pulmonary damage (18/49 vs. 28/41 and 7/49 vs. 13/41, respectively), and died less frequently in hospital (28/49 vs. 35/41) and due to infections (4/49 vs. 26/41) (p<0.05). Conversely, these patients had a higher frequency of malignancy as a feature of damage (17/49 vs. 6/41) and a cause of death (14/49 vs. 1/41) (p<0.05). Only patients without SLE listed in their death certificate accrued gastrointestinal damage (7/49 vs. 0/41, p=0.015), hence this type of damage could not be included in the multivariate logistic model. In the multivariate model, the presence of infection as a cause of death was the single variable related to (non-)reporting of SLE (OR 0.053; 95% CI 0.012–0.237) (Table 1).Table 1.Predictors of non-reporting of SLE in death certificates (OR: odds ratio; CI: confidence interval)ConclusionsNon-reporting of SLE in death certificates of lupus patients may be an obstacle towards assessing the true extent of SLE-related mortality, calling into question the re...