Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Mortality Causes and Associated Factors in a Systemic Lupus Erythematosus Monocentric Cohort: Is the Systolic Pulmonary Artery Pressure a Risk Factor for Death?
Rua-Figueroa, I., Erausquin, C., Fiuza, MD, Francisco-Hernandez, F., Ojeda, S., Naranjo, A., Quevedo, JC
Despite improved prognosis, patients with SLE remain at increased risk for early death. Limited data are available in our country regarding the mortality of patients with SLE.
To examine the mortality and associated factors in a monocentric Spanish
We studied 254 SLE (ACR 1997 criteria) patients under protocolized follow up in a rheumatology service. Acumulated clinical characteristic and damage accrual (ponderated SLICC/ACR/DI) (SDIp) and severity (Severity Katz Index) (SI) were recorded. The standardized mortality ratio (SMR), ROC analysis, with Hanley and McNeil contrast' for area under curve (AUC) comparisons and a multivariable analysis (logistic regression) were carried out.
Mean age: 44.2±13.6; 92.1% female. The mean time (±S.D.) since the lupus diagnosis was 13.3 years (± 8.5); 19 patients (7.5%) died, 12 by SLE (63.2%). The most common cause of death was of respiratory origin (31.6%), followed by infection (26.3%), cancer (21%) cardiovascular (10.5%) and others (10.5%). SMR: 1.84 (1.48 females).The ROC curve cutoff for SDIp was >4 (sensitivity 66.6%; specificity 73.8% and + likelihood ratio (LR) 2.54 and for SI was >3 (S: 94.4%; E: 59.3%; +LR 2.31). There were no differences in AUC between SDIp (0.756; IC95% 0.6980.808) and SI (0.820; IC95% 0.7670.866) (p=0.632).The variables associated with mortality in the bi-variable analysis were: hospitalization by SLE, any time (66% vs 100% in deaths, OR 1,1; 95%CI:1.061.18; p=0.003), tobacco use (24.3 vs 47.4% OR 3.4; 95%CI:1.39.3; p=0.011), vasculitis (13.6 vs 42.1% OR 4.5; 95%CI: 1.712.1; p=0.001), severe thrombocytopenia (10.6% vs 26.3%; OR: 3.1; 95%CI: 1.049.6; p=0.033), hematocrit <30% (24.7% vs 73.7%; OR: 10.1; 95%CI: 3.232; p<0.0001), elevated systolic pulmonary artery pressure (SPAP) ( 2.6% vs 31.6%; OR:18.8; 95%CI: 5.267; p=0.0001), ischemic event ( 10.6% vs 26,3%; OR: 4,5; 95%CI: 1.414.2; p=0.005), cutaneus ulcers (4.3 vs 21.1 OR: 6.3; 95%CI: 1.722.7; p=0.002), major organ (52.8 vs. 84.2 OR: 6.9; 95%CI: 1.530.7; p=0.004), severe infection (29.8 vs. 78.9;OR: 8.7; 95%CI: 2.727.2; p=0.0001), antimalarials use (16.7% vs. 4.7%;OR: 0.2; 95%CI: 0.090.6; p=0.002), SI >3(OR: 24.6; 95%CI: 3.228.3; p<0.0001) and SDIp >0 (OR: 6.4; 95%CI: 1,428,3; p=0.006). Only hematocrit <30% (OR 10.3; 95%CI: 1.8657.67, p=0.008) and elevated SPAP (OR 23.1; 95% CI: 3.24165, p=0.002) were proven as independent factors in multivariate analysis.
Consistent with previous data, a strong association was found between anemia and mortality in SLE. However, the association with elevated SPAP, whatever cause, has not been previously recorded. We could not demonstrate a protective effect of antimalarials in the final model, perhaps by the very definition of the variable and/or the high percentage of patients treated with these drugs in our cohort. However, the protection against mortality was independent of severity, minimizing bias due to confounding by indication. This point needs to be explored further. Finally, our analysis doesn't reveal any differences between SDIp and SI as predictors of mortality.
To cite this abstract, please use the following information:
Rua-Figueroa, I., Erausquin, C., Fiuza, MD, Francisco-Hernandez, F., Ojeda, S., Naranjo, A., et al; Mortality Causes and Associated Factors in a Systemic Lupus Erythematosus Monocentric Cohort: Is the Systolic Pulmonary Artery Pressure a Risk Factor for Death? [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2268