Objectives To describe the causes of death in a Chinese lupus cohort with SLE.
Methods We examined mortality in a cohort of 427 Chinese patients with SLE seen between 1985–1997. During a mean ± SD of 5.0 ± 3.8 years of follow-up, 56 patients died. The causes of death were determined.
Results The mean ± SD disease duration from diagnosis to last visit or death for the 427 patients was 6.7 ± 5.4 years, with a duration of follow-up of 5.0 ± 3.8 years. 53 females and 3 males died. The age at death was 35.3 ± 11.3 years. Among those who died, the duration of disease was 5.2 ± 4.8 years with a follow-up of 3.5 ± 3.3 years. In comparison, patients last seen alive had a longer disease duration of 6.9 ± 5.4 years and a longer follow-up of 5.3 ± 3.9 years. Infection and active SLE were the two leading causes of death, occurring in 17 patients (31%) in both instances. The clinical manifestations amongst the 17 patients with active SLE were as follows: seizure in 2, cerebritis in 1, cardiac tamponade in 2, pneumonitis in 2, pulmonary haemorrhage in 2, pulmonary hypertension in 2, nephritis in 2, vasculitis in 2, pancreatitis in 2. In 12 patients, SLE was a contributing factor of death. Thus, active SLE was present in over half of the cases (28 patients) at the time of deaths. The most common type of infection was pneumonia (41%) followed by bacteremias (35.3%). The most prevalent infections were bacterial infections (23.5%), followed by mixed infections (17.6%), fungal (17.6%) and mycobacterium infections (17.6%). Out of the 17 patients in whom the primary cause of death was due to infection, 9 had active SLE at the time of death.
Conclusion The majority of patients at the time of death had active SLE. Although the percentage of patients dying from infections and active SLE were the same, active SLE was present in half of those with infections suggesting that active disease remains the most important factor in mortality in SLE.
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