Cause of death in patients with Systemic Lupus Erythematosus

Abstract

BACKGROUNDAlthough the survival of patients with systemic lupus erythematosus (SLE) has increased, mortality rates from SLE remain high when compared to the general population. The objective of this work was to describe the cause of death and related sociodemographic, clinical and laboratory aspects of patients with SLE at from a tertiary hospital. METHODSRetrospective and observational study of patients with SLE who died between January 2005 and October 2019 was performed. Thirty-nine medical records were analyzed, of which 28 were validated after the exclusion criteria. DataSUS data were also collected on SLE mortality in the same period for comparison. Student's t-test was used in the sociodemographic comparison between group. Values were considered statistically significant when p < 0.05. RESULTSA total of 651 patients with SLE were hospitalized in the period and 28 died (4.3%). Twenty-six (92.8%) were female and 2 (7.1%) were male. The mean age at death was 35 ± 15.69 years, with the most affected age group being between 20 and 29 years. DataSUS data revealed 78 deaths from SLE in same region and period, and there was no statistical difference for sex, age and ethnicity. The mean age at diagnosis was 28.2 ± 13.37 years, ranging from 8 to 69 years, and the mean time from diagnosis to death was 93.11 ± 107 months, ranging from 3 days to 288 months. Twelve patients (43%) died within the first year of disease, 7 patients (25%) died between 1 and 10 years, and 9 patients (32%) died after 10 years of disease. At death, the main manifestations of the disease were hematological and renal. The main cause of death was infection, in 26 (92.8%) patients, 17 of whom underwent procedures that predispose to infection. In only 9 patients, cultures were performed, whose agents were Klebsiella pneumoniae, Pseudomonas, Enterococcus faecalis, Mycobacterium tuberculosis, Staphylococcus aureus, Escherichia coli and Candida sp. The other causes of death included 1 acute myocardial infarction and 1 due to disease activity. CONCLUSIONMortality from SLE in the study was 4.3%, close to the mortality rate found in the literature, which was 5%. The main cause of death was infection, associated with hematological and renal activity. Infection remains an important cause of death. Measures are needed to reduce the risk of infection and improve the survival of patients with SLE, such as the judicious use of immunosuppressants and corticosteroids, encouraging vaccination and less exposure to risk situations such as invasive procedures.