To identify frequency, causes and outcomes of hospitalisations among adult patients with systemic lupus erythematosus (SLE). Methods: A record-based retrospective study was conducted at Aseer Central Hospital for a period of four and half years from January 2012 to June 2016. The study includes adult SLE patients who were diagnosed according to the 1997 SLE criteria. Results: A total of 155 patients (8 males and 147 females) with 251 hospital admissions were included. The average admission rate for all cases was about 2.0 ± 1.0 times. The most commonly recorded causes of admissions were SLE nephritis flare (33.9%), and infections (16.3%). Mortality rate for SLE patients is almost 7.7% and the recorded main causes of death were pulmonary hemorrhage (33.3%), sepsis (25%), bilateral massive pulmonary oedema and pneumonia (8.3% for each). Conclusion: Almost half of adult SLE patients are frequently hospitalized. Female patients and those with associated chronic co-morbidity have more frequent admissions. Consequences of SLE remain the most frequently recorded causes for hospital admission. Pulmonary complications are the main cause for death. Therefore, prompt and aggressive management of pulmonary consequences could markedly reduce disease mortality. Adopting preventive measures such as using prophylactic antibiotics and pneumococcal vaccination, early in the disease course, should be accentuated.