Early Organ Damage Raises Mortality Risk in SLE Patients, Study Suggests

Systemic lupus erythematosus (SLE) patients with signs of organ damage when first hospitalized, even if they don’t have active disease, are likely to have poorer outcomes, researchers in China reported.

Mortality risk was particularly high in SLE patients with neuropsychiatric and cardiopulmonary complications or with evidence of kidney failure. But treatment, especially with anti-malarial drugs, was helpful.

The study was published in the journal PLoS One, and titled “Prognosis For Hospitalized Patients With Systemic Lupus Erythematosus In China: 5-Year Update Of The Jiangsu Cohort.”

Previous studies have shown that SLE patients in Western countries frequently die of tumors and cardiovascular complications, while those in Asia are more prone to succumb to infections and active SLE disease.

To understand survival patterns among SLE patients in China, researchers analyzed the medical records of 1,372 patients who had been hospitalized between 1999–2009 and then followed for five to 15 years at 26 centers across the Jiangsu province.

Their status was assessed in 2015, in an attempt to relate risk factors to mortality at two time points.

Researchers collected information on several parameters, including gender, age, disease duration, time to diagnosis, disease activity and damage, organ involvement, and cause of death, if relevant.

Disease activity was calculated according to the SLE Disease Activity Index (SLEDAI) score, and organ damage was determined by the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI).

Organ involvement was defined as mucocutaneous (conditions affecting the skin), musculoskeletal, neuropsychiatric (patients with symptoms of brain involvement), cardiopulmonary (including cases of interstitial lung disease, pulmonary arterial hypertension, heart failure and arrhythmia), renal (symptoms of kidney failure, including lupus nephritis), gastrointestinal, or hematological (symptoms including anemia; leukopenia, or low white blood cell count; thrombocytopenia, or low number of blood platelets).

Laboratory tests included blood analyses of levels of hemoglobin, white blood cells and creatinine protein (a marker for kidney function).

Of the 1,372 SLE patients whose medical data was analyzed, most (92.3 percent) were women and 17.2 percent had died by 2015, mainly due to infection (30.1 percent), neuropsychiatric impairment (14.8 percent), kidney failure (14.4 percent), and cardiopulmonary complications (8.5 percent).

Indeed, patients who died within one year after a first hospitalization had an older age (more than 45 years) at admission, disease duration for more than two years, neuropsychiatric involvement, cardiopulmonary complications, anemia, increased blood urea nitrogen, and increased blood levels of creatinine protein.

Mortality over one year after hospitalization was mainly associated with neuropsychiatric involvement, cardiopulmonary complications, and increased serum creatinine

The analysis also showed that treatment with an immunosuppressive drug improved patients’ outcome during the first year, and anti-malarial drugs — such as hydroxychloroquine, known to have positive effects on organ damage — significantly reduced the risk of mortality over time.

“[T]his study shows that SLE patients had high risk of death within 1 year after the first hospitalization, especially for those with neuropsychiatric, cardiopulmonary involvements and [kidney] insufficiency”, the researchers concluded. “Early and effective intervention with the use of anti-malarial drugs may be helpful to improve the prognosis of these patients.”