Background Systemic lupus erythematosus (SLE) patients have shorter survival when compared with general population.1 Previous studies have reported that disease activity, complications associated with treatment and cardiovascular events are primarily responsible for mortality in these patients.2
Objectives The present study aims at analyzing the 5-year survival rate of SLE patients and at identifying potential factors associated with mortality.
Methods This cohort study consisted of 151 SLE patients attending the Rheumatology Clinic of Hospital de Clínicas de Porto Alegre. Patients who started follow-up between 2004 and 2008 were selected. Data were obtained from medical chart review, standardized forms fulfilled in every visit and telephone contact with patients with no visits in the previous 6 months.
Results The study population was composed predominantly by females (92.7%) and caucasians (66.9%). The mean (±SD) age at diagnosis was 34.3±15.4 years. The total number of deaths was 14 (9.27%). The 5-year survival rate was 95.2%. For subjects that died the median (IQR) survival was 5.0 years (4.0-7.5) after starting follow-up. The main causes of death were infection (57.1%) and disease activity (35.7%). Bacterial infections were the most common type (35.6%). The most common site of infection was the respiratory tract (28.5%). The leading causes of death by SLE activity were hematologic (21.0%) and neurological (14.3%). No statistically significant difference was found between deaths and non-deaths in relation to age at diagnosis, disease classification criteria, presence of autoantibodies, Sjögren's syndrome, antiphospholipid syndrome or other autoimmune disease. The disease activity index measured by SLEDAI was similar between groups. The chronicity index measured by SLICC was higher in the group of deaths (2 vs. zero) (p<0.001). Cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity and smoking) were not associated with mortality. Similarly, the use of immunosuppressive doses of steroids, hydroxychloroquine, cyclophosphamide, mycophenolate mofetil, azathioprine and rituximab did not have association with mortality.
Conclusions Five-year survival rate was over 90% as demonstrated by other authors. As infection was the main cause of death, preventive measures such as vaccination should be considered. SLICC was higher in patients who died, but other features, including cardiovascular factors were not different, probably due to the small number of events.
Arthritis & Rheumatism. 2006;54(8): 2550–2557.
Arthritis Care Res (Hoboken). 2013 Sep 19. doi: 10.1002/acr.22173.
Disclosure of Interest None declared