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

Chien-Chih Lai; Yi-Syuan Sun; Wei-Sheng Chen; Hsien-Tzung Liao; Ming-Han Chen; Chang-Youh Tsai; De-Feng Huang; Chung-Tei Chou; Deh-Ming Chang

doi:10.1097/JCMA.0000000000000783

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

J Chin Med Assoc. 2022 Nov 1;85(11):1044-1050. doi: 10.1097/JCMA.0000000000000783. Epub 2022 Nov 2.

Authors

Chien-Chih Lai^{1

2

3}, Yi-Syuan Sun^{1

2

3}, Wei-Sheng Chen^{1

2

3}, Hsien-Tzung Liao^{1

3}, Ming-Han Chen^{1

3}, Chang-Youh Tsai^{1

3}, De-Feng Huang¹, Chung-Tei Chou¹, Deh-Ming Chang^{1

2

4

5}

Affiliations

¹ Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
² Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
³ Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
⁴ Division of Immunology and Rheumatology, Fu Jen Catholic University Hospital, New Taipei City, Taiwan, ROC.
⁵ Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC.

PMID: 36343272
DOI: 10.1097/JCMA.0000000000000783

Abstract

Background: Overall survival of systemic lupus erythematosus (SLE) patients significantly increased in recent decades, however, the relative risk of mortality is still high. Long-term survival outcome of pediatric SLE remains unclear. This study aims to explore the long-term survival rate and its predictors in patients with systemic lupus erythematosus (SLE).

Methods: A retrospective, hospital-based cohort study was performed between 2004 and 2018 in a tertiary referral medical center in Taiwan. Data on comorbidities, medications, and causes of admission were collected for risk factor analysis using time-dependent multivariate Cox proportional hazards models.

Results: A total of 2392 adults and 115 pediatric SLE patients were enrolled (female, n = 2157 and 95, respectively). The 10-year survival rates were 93.2%, 90.2%, 98.9%, and 100% in adult women, adult men, girls, and boys with SLE, respectively. The overall mortality rate was 2.09 case/100 patient-years (PY) for male SLE and 1.39 case/100 PY for female SLE patients. Male SLE patients did not have a statistically significantly higher mortality rate than female SLE patients in each age stratification. Infectious disease (n = 119), heart failure (n = 21), and cerebrovascular accident (n = 14) were the leading causes of death in adult SLE patients. Advanced age (hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.03-1.05), treatment with mean dosage of systemic glucocorticoid equivalent to >10 mg/d of prednisolone (HR: 1.71, 95% CI: 1.14-2.57), comorbidities with malignancy (HR: 1.94, 95% CI: 1.22-3.09), chronic kidney disease (HR: 1.86, 95% CI: 1.25-2.77), hypertension (HR: 1.42, 95% CI: 1.01-1.98), and admission due to bacterial pneumonia (HR: 1.92, 95% CI: 1.12-3.31) and sepsis (HR: 2.78, 95% CI: 1.51-5.13) were independent risk factors for mortality in SLE patients.

Conclusion: SLE patients with advanced age, malignancy, chronic kidney disease, hypertension, treated with a higher average dosage of glucocorticoids, and admission due to bacterial pneumonia and sepsis have an increased risk of mortality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Child
Cohort Studies
Female
Glucocorticoids / therapeutic use
Humans
Hypertension*
Lupus Erythematosus, Systemic* / complications
Lupus Erythematosus, Systemic* / drug therapy
Male
Multivariate Analysis
Proportional Hazards Models
Renal Insufficiency, Chronic*
Retrospective Studies
Risk Factors
Sepsis*
Taiwan / epidemiology

Substances

Glucocorticoids