Disease activity and damage in hospitalized lupus patients: a Sabah perspective

Abstract

Objective Systemic lupus erythematosus (SLE) is a complex multi-systemic autoimmune disease with variable levels of activity that may wax and wane within the same patient over the years. In view of the scarcity of data about lupus in the East Malaysian population, we aimed to study the disease activity and damage index in patients with SLE hospitalized in a tertiary center in Sabah, East Malaysia. Methods We retrospectively studied all patients with SLE admitted from 1 January 2013 to 31 December 2015. Demographic data, clinical features, treatment received, SLEDAI and SLICC/ACR (Systemic Lupus International Collaborating Clinics/American College of Rheumatology) criteria and outcomes were collected. Results There were 108 patients studied whereby 88.9% were females. They had a mean age of 31.4 ± 11.02 years at admission and were multiethnic in origin. The mean number of ACR criteria for SLE was 5.03 ± 1.5 at the time of diagnosis. There were 158 hospitalizations during the 3 years. The main causes of hospitalization were flare of SLE (66.5%), infection (57.6%), renal biopsy (15.5%) and others (11.4%). Active nephritis (65%), cutaneous (44.4%) and hematological involvement (40.2%) were the three commonest manifestations. There was concurrent flare of SLE and infection in 41.1% of the admissions. The mean SLEDAI score at admission was 10.8 ± 7.20, with a mean SLEDAI of 9.3 ± 6.9 in those without damage and 11.9 ± 7.21 in those with damage ( p-value = 0.026). The median SLICC score was 1 with a mean of 0.93 ± 1.07. There were nine deaths (5.6%) during the study period and all patients were females. Compared with those who survived, they had a significantly higher SLEDAI score of 15.80 ± 8.2 ( p-value = 0.0207) and a SLICC score of 2.70 ± 1.6 ( p-value <0.001). Conclusion SLE is more common among the indigenous population of Sabah, the Kadazan-Dusun, which has not been shown before this study. Disease characteristics were, however, similar to reports from the Asia-Pacific region. Acute flare of SLE and infection remained the main causes of admission and readmissions and was present in 44.4% of the mortalities in our cohort.

Trend of Survival of a Cohort of Chinese Patients With Systemic Lupus Erythematosus Over 25 Years

“…This is a survival study of an inception cohort of SLE patients diagnosed since 1995. Our results showed that the overall 10-year survival of our SLE patients was 92.9%, which is similar to those reported in Asian studies after the 2000s ( 9 – 11 , 16 , 18 , 21 , 24 ). However, direct comparison is not feasible because the cumulative survival rate computed by the Kaplan–Meier method was not reported in most of these studies.…”

“…Although there have been a number of survival studies of SLE in the past decade, not too many were performed in the Asian populations (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Analysis of the survival of hospitalized patients (9,22), those admitted to the intensive care unit (12,19) or referred to tertiary centers (23), subsets of patients with nephritis (14), neuropsychiatric manifestations (17), or pulmonary hypertension (15) in some studies would create bias in the mortality rate. Moreover, the follow-up of most of these Asian studies was not long enough to look at the trend of survival over time.…”

Trends in Hospital Admissions and Death Causes in Patients with Systemic Lupus Erythematosus: Spanish National Registry

“…However, mortality rates and specific causes of death have varied throughout the last decades [4,[13][14][15][16]. Other groups have previously analyzed the causes of admission in SLE patients worldwide, with different results limited in many cases by sample size, monocentric design, and short follow-up periods [17][18][19][20][21][22][23][24][25]. Our study analyzes data from 99.859 admissions of SLE patients between 1997 and 2015, thus offering quite a wide view of the whole picture in Spain.…”

“…According to our analysis, hospital admissions and deaths due to active SLE decreased dramatically from the late 1990's to the 2010-2015 period. Several studies have identified SLE itself as the main cause of hospital admission, with a wide range between 8.1 and 86.3% [17][18][19][20][21][22][23][24][25][26]. On the other hand, other studies have shown a significant downward trend in SLE-related admissions [19,[27][28][29].…”

“…Previous studies have identified infections as an important cause of admission [19,23,25,30] and death [4,15,16,[31][32][33][34]. Selvananda et al reported that infections were concurrent with SLE flares in 41.1% of admissions, reflecting that both situations tend to coincide, and emphasizing the importance of the rational use of immunosuppressants [24]. Similarly to our findings, a recent study in the US showed that hospitalization rates due to infection significantly increased in the period 2015-2016 compared to 1998-2000, with sepsis overtaking pneumonia as the most common infection [35].…”