Survival analysis of mortality and development of lupus nephritis in patients with systemic lupus erythematosus up to 40 years of follow-up

Abstract

Objectives Patients with systemic lupus erythematosus (SLE) have increased mortality compared with age and sex-matched controls. Lupus nephritis (LN) is a severe manifestation of SLE and an important cause of death. We carried out a retrospective survival analysis to investigate factors that could influence risk of mortality and LN in a large multi-ethnic cohort of patients with SLE. Methods By careful review of medical records, we identified 496 patients with SLE for whom we had complete information regarding period of observation and occurrence of death and nephritis. Patients were stratified into groups according to sex, ethnicity, age at start of follow-up and time-period of diagnosis. Kaplan-Meier analysis was used to investigate differences between the groups. Results Of 496 patients in the study, 91(18.3%) died, 165(33.3%) developed LN and 33(6.7%) developed end-stage renal failure. There was no difference between men and women in either mortality or development of LN. Caucasian patients were significantly less likely to develop LN than other ethnic groups (p< 0.0001) but not less likely to die. Patients diagnosed before the median age of 28 years were significantly more likely to develop LN (p< 0.0001) but significantly less likely to die (p= 0.0039) during the period of observation. There has been a significant improvement in survival between patients diagnosed between 1978–1989 and those diagnosed between 2006–11 (p= 0.019). Conclusion In our cohort, non-Caucasian ethnicity and younger age at diagnosis are associated with risk of developing LN. There is evidence of improvement in survival of patients with SLE over time.

Lupus nephritis: clinical characteristics, serological associations, pattern of pro- and anti-inflammatory markers

“…Patients with renal involvement were younger than patients with non-renal SLE in our cohort. In agreement with previous reports [15], we also found younger age of SLE onset in LN patients than in those without kidney involvement. In opposition to most previous studies [16], there was no significant difference between men in women in LN and non-renal SLE groups.…”

“…Besides, a higher proportion of LN patients had necrotizing vasculitis (9.2% vs 2.0%) and a history of arterial/venous thrombosis (9.7% vs 2.5%) compared to patients without kidney involvement. In addition, the SLEDAI score of LN patients was significantly higher (14 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) points vs 8 (4-14) points, p<0.001) than in non-renal SLE patients. The frequency of anemia, leukopenia, and thrombocytopenia did not differ significantly between the groups.…”

VEGF Gene Polymorphism And Study On Genetic Susceptibility Of Neuropsychiatric Lupus

“…In a prospective study on the long-term survival of newly diagnosed SLE patients in China [42], it was found that in the early univariate analysis, age growth was a predictor of mortality, but in the late multivariate model, it was found that age was replaced, and organ damage in the early stage of the disease was more important, which meant that the increase in mortality in patients with delayed SLE was more related to early organ damage than age itself [43]. Biogenetic analysis found that lupus nephritis in Asian patients had higher levels of autoantibodies, higher frequency of lupus nephritis and higher prevalence of active glomerulonephritis compared with white patients [44]. At the same time, it was found that the incidence of lupus nephritis in Asian patients was younger (the most common damage in children with SLE was kidney, neuropsychiatric system, optic nerve system and skeletal muscle [45]), system involvement was faster, organ damage was earlier, and neuropsychiatric damage score was more serious at 5 years.…”

Diagnostik und Therapie der Lupusnephritis – 2023

“…Trotz erheblicher Verbesserungen in der Therapie, die zu einer besseren Kontrolle der Krankheit geführt haben, sind Patient*innen mit LN nach wie vor einem hohen Mortalitätsrisiko ausgesetzt, das insbesondere durch kardiovaskuläre und infektiöse Komplikationen sowie durch Malignome bedingt ist [ 60 – 62 ]. Die Prävention von Organschäden und eine angemessene Behandlung von Komorbiditäten sind unerlässlich, um die durch die Krankheit und immunsuppressive Therapie bedingte Mortalität in dieser Patientengruppe zu minimieren.…”