Background Survival of systemic lupus erythematosus (SLE) patients has improved significantly over time because of recognition of mild disease and better approaches to therapy. The identification of predictor variables for mortality is necessary to identify subgroups at greater risks to die and who need more aggressive therapy.

Objectives To analyse survival and mortality risks of various clinical variables in a cohort of SLE patients, followed prospectively in a single centre.

Methods The survival of a cohort of 509 SLE patients, SLE followed over a 20-year period according to a standard protocol was studied using the Kaplan Meier lifetable analysis methods. Univariate associations between clinical and laboratory informations and drugs used were calculated. The Cox proportional hazard regression model was used to estimate risk ratio of death and to examine the simultaneous effects of multiple prognostic factors.

Results Over the duration of follow-up of 20 years, 58 (11.4%) died. The survival rate was 97% at 1 year, 90% at 5 years, 81% at 10 years and 75% at 20 years. Age <16 years at diagnosis, hypertension, weight loss, nephritis, ocular involvement, the presence of anti DNA antibodies, the absence of artralgia/arthritis and frequent infections were significantly associated with reduced survival in univariate analysis. Using multivariate analysis, hypertension (OR 2.2, 95% CI 1.1–4.5), age <16 years at diagnosis (OR 2.6, 95% CI 1.4–5.0), ocular involvement (OR 4.9, 95% CI 1.9–12.8), treatment without antimalarial drugs (OR 2.8, 95% CI 0.15–0.53)and frequent infections (OR 2.3, 95% CI 1.3–4.1) were independent risk factors associated with increased mortality.

Conclusion Hypertension, age <16 years at diagnosis , ocular involvement, treatment without antimalarial drugs and frequent infections were independent risk factors associated with increased mortality.

References

1. Uramoto, Kristine M, Michet CJJ, et al. Trends in the incidence of mortality of SLE. Arthritis Rheum 1999;42(1)

2. Petri M. Hopkins Lupus Cohort. Rheum Dis Clin N Am. 2000;26(2)