Mortality in SLE patients compared with population controls in Finland in years 2000–2015

Abstract

Objective To estimate the risk of mortality in the Finnish incident SLE cohort in a 16-year period compared with the general population. Methods Adults with new-onset SLE between 1 January 2000 and 31 December 2014 identified from the national drug reimbursement register and their individually matched controls from the Population Register Centre were followed up until death or 31 December 2015. Data on deaths were retrieved from the national causes of death register. Comorbidities and education were obtained by linkage to the other national registries. Results A total of 1006 patients with incident SLE and 3005 population controls were found (mean follow-up 8.6 years). Of these, 98 SLE patients subsequently died. Their 5 -, 10-, and 15-year survival rates were 95.0% (95% CI: 93.3, 96.2), 88.8% (86.2, 91.0), and 82.1% (77.6, 85.8), respectively. Crude hazard ratio (HR) was 1.61 (95% CI: 1.26, 2.06), adjusted for education level was almost the same 1.61 (95% CI: 1.26, 2.05). After adjustment for comorbidities and education at baseline, the difference in mortality disappeared: HR 1.14 (95% CI: 0.88, 1.48). The leading causes of death were cardiovascular diseases (CVDs) (33%), malignancies (27%) and neurological diseases (10%). Subhazard ratio for CVD deaths was 1.28 (95% CI: 0.85, 1.93), adjusted for comorbidities and education 0.88 (95% CI: 0.56, 1.39). Conclusions These results suggest that the increased mortality in SLE patients is highly associated with comorbidities present at diagnosis. This underlines the importance to screen and treat comorbidities and disease actively without delays.

Risk factors for mortality in systemic lupus erythematosus patients: Analysis of adult and pediatric cohorts in Taiwan

“…27,28 Malignancy remains the major cause of death reported in many SLE studies. 1,4,14 All of the abovementioned cancers were found in our adult SLE cohort. Breast cancer, lung cancer, colonorectoanal cancer, and non-Hodgkin's lymphoma were the most common cancer types in female SLE; hepatobiliary cancer, non-Hodgkin's lymphoma, lung cancer, and colonorectoanal cancers were the leading cancer types in male SLE patients.…”

“…1,3,6 The 10-year survival rate in the present study falls within the range of recent investigations (68.8%-94.9%). 4,5,[19][20][21][22] Due to the development of novel pharmaceutical agents, the trend in mortality rates decreased in recent years as compared to that few decades ago. 1,3,23,24 Ethnic, geographic, and secular changes and social-economic differences contribute to the heterogeneity of survival rates in SLE patients.…”

“…Infectious diseases, cardiovascular diseases, and malignancy were major causes of death in our adult SLE patients, and the findings are consistent with many previous studies. 1,2,4,12,14,19,20,32 Judicious use of systemic glucocorticoids and early diagnosis and precise treatment of infections could improve the survival status in SLE patients. However, no universal protocols for infection surveillance were developed and validated till date.…”

“…[1][2][3] Although the treatment of SLE has progressed in recent decades, its relative risk of mortality is high. [3][4][5][6] The attempt to improve survival in SLE patients cannot neglect the management of risk factors of mortality.…”

Postoperative Major Adverse Cardiac Events in Patients With Systemic Lupus Erythematosus

“…Systemic lupus erythematosus (SLE) is a risk factor for cardiovascular disease (CVD), which has emerged as a leading cause of death in this population ( 1 , 2 , 3 , 4 , 5 , 6 ). CVD can lead to major adverse cardiac events (MACE) after surgery.…”