Survival analysis and prognostic indicators of systemic lupus erythematosus in Pakistani patients

Abstract

To aim of this study is to analyse the survival rate and prognostic indicators of systemic lupus erythematosus (SLE) in Pakistani population. A total of 198 patients with SLE diagnosed between 1992 and 2005 were reviewed retrospectively. Clinical features at presentation, subsequent evolving features, autoantibody profile, damage scores and mortality data were obtained. Prognostic factors for survival were studied by statistical analysis. Of 198 SLE patients studied, 174 were women and 24 were men. The women to men ratio was 7.2:1. Mean age at presentation was 31 years (range 14-76). Mean duration of symptoms before diagnosis was 2.8 years. Mean duration of follow-up was 34.21 months (+/-33.69). Mean disease duration was 15.6 years. At diagnosis, arthritis, malar rash, oral ulcers and alopecia were the commonest features. During the follow-up, the prevalence of nephritis, arthritis, neurological and hematological disease increased significantly. About 76% (n = 151) of the patients had organ damage at the time of data analysis, and renal disease was the commonest cause. Univariate analysis revealed that renal disease (P = 0.000), seizures (P = 0.048), pleural involvement (P = 0.019), alopecia (P = 0.000) and discoid lesions (P = 0.005) were predictors for damage. Multivariate model, however, revealed that only renal disease was independent risk factor for damage (P = 0.002). During the study period, 47 patients (24%) died (five due to disease-related complications and rest as a result of infections). The 3-, 5-, 10-, 15- and 20-year survival rates of our cohort were 99, 80, 77, 75 and 75%, respectively. Cox regression analysis revealed that renal involvement (P = 0.002) and infections (P = 0.004) were independent risk factors for mortality. The survival of our Pakistani SLE patients was significantly lower compared to that of the Caucasian series reported in last decade. Nephritis not only contributes to organ damage but also acts a major determinant for survival. Infection remains the commonest cause of death. Renal involvement and infections are independent risk factors for mortality. Judicious use of immunosuppressive agents is necessary to improve the short-term survival of lupus patients.

Survival Analysis of Turkish Patients With Systemic Lupus Erythematosus: Older Age at Diagnosis Affects Mortality

“…3,4,9 In the study by Kasitanon et al, 3 existence of low complement C3 or complement C4 levels during the first year after diagnosis was associated to poor survival. Dissimilar to their study, we did not identify any correlation of autoantibodies or reduced complements with mortality.…”

“…In most of them, renal failure has been highlighted as a predictor of death. [3][4][5]9,11 In addition, there are studies which indicate another finding of disease, namely, presence of autoimmune hemolytic anemia as a risk factor for mortality. 3,4 Moreover, presence of serositis and thrombocytopenia were also indicated as independent risk factors in terms of prognosis.…”

“…3,5,9 In the review by Kasitanon et al, 3 death rate ranges between 2.8 to 38.6%. We have calculated mortality rate as 8.6% and mortality incidence rate as 1.05/100 patient-years in our cohort.…”

The Effects of Fatigue and Pain on Daily Life Activities in Systemic Lupus Erythematosus

“…The results of this study are consistent with those in the literature. In a study performed by Rabbani et al (2009), it was determined that 30% had malar rash, 15% discoid lupus, 6% photosensitivity, 53% fever and 22% alopecia. In the same study, it was determined that approximately 45% of the patients had renal involvement, almost all the patients had symptomatic arthralgia and approximately 76% of the patients experienced organ damage, and that the mortality rate was 24%.…”

“…[30] In Rabbani et al 's study (2009), 20 SLE patients developed renal failure and dialysis was initiated, and 2 patients underwent renal transplantation. [27] In Şentürk et al ' study (2003), skin involvement is often the first sign of the disease in 72-85% of the patients with SLE. [31] The level of fatigue detected in the patients of this study is similar to that in the literature.…”