Prognosis for Hospitalized Patients with Systemic Lupus Erythematosus in China: 5-Year Update of the Jiangsu Cohort

Abstract

ObjectiveTo identify early signs associated with poor prognosis in Chinese patients with systemic lupus erythematosus (SLE) through a large population-based follow-up study.MethodsMedical records of > 2,500 SLE patients that first hospitalized between 1999–2009 were collected from 26 centers across Jiangsu province, China, and entered into a database. These patients were followed-up for 5 to 15 years, and those remained contact and had known survival status in 2015 were assessed for the association of factors presented at the initial hospitalization with mortality at two time points (≤1year and > 1year). The independency of mortality factors was evaluated using multivariate Cox regression analysis.ResultsAmong 1,372 patients we assessed, 92.3% were women and 17.2% were deceased in 2015. The main causes of death were infection (30.1%), neuropsychiatric impairment (14.8%), renal failure (14.4%) and cardiopulmonary involvement (8.5%). Hazard ratios (HR) of independent predictors for mortality (≤1year and > 1year, respectively) included hospital presentation of neuropsychiatric involvement (2.03 and 1.91), cardiopulmonary involvement (1.94 and 1.61) and increased serum creatinine (2.52 and 2.58). Patients older than 45 years and with disease durations more than 2 years at admission had unfavorable short-term outcome (HR 1.76 and 1.79), while the presence of anti-dsDNA and anti-Sm antibodies indicated diverse prognosis after 1 year (HR 1.60 and 0.45). Treatment with cyclophosphamide was beneficial for patient’s first-year outcome (HR 0.50), and anti-malarial drugs significantly reduced the risk of mortality over different time points (HR 0.48 and 0.54). SLEDAI score, proteinuria or hypocomplementemia was not independently associated with the outcome in this cohort.ConclusionSLE patients presented with vital organ damages rather than active disease at initial hospitalization are likely to have a poor outcome, especially for those with neuropsychiatric, cardiopulmonary involvements and renal insufficiency. Early and effective intervention with the use of anti-malarial drugs may decrease mortality.

Predictors of mortality in children with systemic lupus erythematosus

“…16 Feng et al in their study also reported that proteinuria and SLEDAI score were not a predictor of mortality, on the contrary it was said that seizure, as one of the manifestation of neuropsychiatry, was an independent predictor. 17 This is slightly different from our study, where the seizure are not a predictor of mortality.…”

Psychometric properties of fatigue severity scale in Chinese systemic lupus erythematosus patients

“…In China, its prevalence was 97.5 to 100/100,000 [2–5]. The peak SLE incidence occurs at age 20–29 years, followed by 30–39 years old for females, but in 70–74 years old for males [3], and the female-to-male ratio was about 10:1 in China [6–8]. The most common symptom of SLE is fatigue, with about 51%~ 90% of SLE patients experiencing fatigue problem [9].…”

Peripheral CD4CD8 Double Positive T Cells: A Potential Marker to Evaluate Kidney Damage Susceptibility During SLE

“…The outcome of patients with newly diagnosed LN was signi cantly better in recent years [2]. Especially early diagnosis and treatment of LN can greatly improve the prognosis of patients with SLE [3]. However, there is a lack of high sensitivity and coincidence markers for early diagnosis of LN.…”