Skip to main content

Advertisement

SpringerLink
Log in

Causes and predictors of death in Brazilian lupus patients

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

The objective of this study is to determine the causes and predictors of death in systemic lupus erythematosus (SLE) patients. Causes of death were defined based on death certificates, medical records, and information collected from doctors and relatives. Possible variables predicting mortality were assessed by Kaplan–Meier and Cox regression methods. The multivariate model was validated using the bootstrap method, and the hazard ratios were adjusted according to the shrinkage coefficient. One hundred eighty-one patients were included, and two patients were lost to follow-up. The median (IR) age at T 0 and disease duration of the 179 patients were 26.7 (21.8–34.6) and 8.2 (4.3–12.4) years, respectively. After a median (IR) follow-up of 3.3 (3.1–3.5) years, 13 (7.3 %) patients died due to end-organ failure (5), infection (5), disease activity (1), and atherosclerotic cardiovascular disease (CVD) (1). The cause of mesenteric ischemia in one patient could not be determined. Predictors of mortality collected at T 0 were the following: nephritis, chronic kidney disease, antiphospholipid syndrome (APS), higher modified SLEDAI-2k, higher damage index score, intravenous cyclophosphamide use, higher daily dose of prednisone, and higher systolic blood pressure. Independent predictors of mortality were higher damage index score (HR: 1.40; 95 % CI: 1.08–1.82), cyclophosphamide use (HR: 3.80; 95 % CI: 1.13–12.77), and APS diagnosis (HR: 3.82; 95 % CI: 1.07–13.59). This paper presents a high frequency of late mortality in lupus patients due to the SLE itself and infection. This result is not in agreement with the initial proposed bimodal pattern of lupus mortality, nor is it in agreement with the high frequency of CVD as a cause of death in developed countries. The most important predictors of death were related to the lupus itself.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Borchers AT, Keen CL, Shoenfeld Y et al (2004) Surviving the butterfly and the wolf: mortality trends in systemic lupus erythematosus. Autoimmun Rev 3:423–453

    Article  PubMed  Google Scholar 

  2. Cervera R (2006) Systemic lupus erythematosus in Europe at the change of the millennium: lessons from “Euro-Lupus Project”. Autoimmun Rev 5:180–186

    Article  PubMed  Google Scholar 

  3. Doria A, Iaccarino L, Ghirardello A et al (2006) Long-term prognosis and causes of death in systemic lupus erythematosus. Am J Med 119:700–706

    Article  PubMed  Google Scholar 

  4. Funauchi M, Shimadzu H, Tamaki C et al (2007) Survival study by organ disorders in 306 Japanese patients with systemic lupus erythematosus: results from a single center. Rheumatol Int 27:243–249

    Article  PubMed  CAS  Google Scholar 

  5. Jacobsen S, Petersen J, Ullman S et al (1999) Mortality and causes of death of 513 Danish patients with systemic lupus erythematosus. Scand J Rheumatol 28:75–80

    Article  PubMed  CAS  Google Scholar 

  6. Cervera R, Khamashta M, Font J et al (1999) Morbidity and mortality in systemic lupus erythematosus during a 5-year period. A multicenter prospective study of 1,000 patients. European Working Party on Systemic Lupus Erythematosus. Medicine (Baltimore) 78:167–175

    Article  CAS  Google Scholar 

  7. Rabbani MA, Habib HB, Islam M et al (2009) Survival analysis and prognostic indicators of systemic lupus erythematosus in Pakistani patients. Lupus 18:848–855

    Article  PubMed  Google Scholar 

  8. Tikly M, Navarra SV (2008) Lupus in developing world - is it any different? Best Pract Res Clin Rheumatol 22:643–655

    Article  PubMed  Google Scholar 

  9. Bernatsky R, Boivin JF, Joseph L et al (2006) Mortality in systemic lupus erythematosus. Arthritis Rheum 54:2250–2257

    Article  Google Scholar 

  10. Vasoo S, Hughes GRV (2004) Perspectives on the changing face of lupus mortality (edit). Autoimmun Rev 3:415–417

    Article  PubMed  CAS  Google Scholar 

  11. Urowitz MB, Bookman AAM, Koehler BE et al (1976) The bimodal mortality pattern of systemic lupus erythematosus. Am J Med 60:221–225

    Article  PubMed  CAS  Google Scholar 

  12. Rubin L, Urowitz MB, Gladman DD (1985) Mortality in systemic lupus erythematosus: the bimodal pattern revisited. Q J Med 55:87–98

    PubMed  CAS  Google Scholar 

  13. Moss KE, Ioannou Y, Sultan SM et al (2002) Outcome of a cohort of 300 patients with systemic lupus erythematosus attending a dedicated clinic for over two decades. Ann Rheum Dis 61:409–413

    Article  PubMed  CAS  Google Scholar 

  14. Nossent J, Cikes N, Kiss E et al (2007) Current causes of death in systemic lupus erythematosus in Europe, 2000–2004: relation to disease activity and damage accrual. Lupus 16:309–317

    Article  PubMed  CAS  Google Scholar 

  15. Shinjo SK, Bonfa E, Wojdyla D et al (2010) Antimalarial treatment may have a time-dependent effect on Lupus Survival. Arthritis Rheum 62:855–862

    Article  PubMed  CAS  Google Scholar 

  16. Wadee S, Tikly M, Hopley M (2007) Causes and predictors of death in South Africans with systemic lupus erythematosus. Rheumatology 46:1487–1491

    Article  PubMed  CAS  Google Scholar 

  17. Telles RW, Lanna CCD, Ferreira GA et al (2007) Frequência de doença cardiovascular aterosclerótica e de seus fatores de risco em pacientes com lúpus eritematoso sistêmico. Rev Bras Reum 47:165–172

    Google Scholar 

  18. Telles RW, Lanna CCD, Ferreira GA et al (2008) Carotid atherosclerotic alterations in systemic lupus erythematosus treated at a Brazilian university setting. Lupus 17:105–113

    Article  PubMed  CAS  Google Scholar 

  19. Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of the systemic lupus erythematosus (letter). Arthritis Rheum 40:1725

    Article  PubMed  CAS  Google Scholar 

  20. Tan EM, Cohen AS, Fries JF (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271

    Article  PubMed  CAS  Google Scholar 

  21. Gladman DD, Ibañez D, Urowitz MB (2002) Systemic lupus erythemtosus disease activity index 2000. J Rheumatol 29:288–291

    PubMed  Google Scholar 

  22. Petri M, Susan G, Barr AZ et al (1999) Patterns of disease activity in systemic lupus erythematosus. Arthritis Rheum 42:2682–2688

    Article  PubMed  Google Scholar 

  23. Gladman DD, Ginzler EM, Goldsmith C et al (1996) The development and initial validation of the systemic lupus international collaborating clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum 39:363–369

    Article  PubMed  CAS  Google Scholar 

  24. Wilson WA, Gharavi AE, Koike T et al (1999) International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome—report of an international workshop. Arthritis Rheum 42:1309–1311

    Article  PubMed  CAS  Google Scholar 

  25. Cockcroft D, Gault MK (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Article  PubMed  CAS  Google Scholar 

  26. Harrel FE, Lee KL, Mark DB (1996) Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387

    Article  Google Scholar 

  27. Cardoso CRL, Signorelli FV, Papi JAS et al (2008) Initial and accrued damage as predictors of mortality in Brazilian patients with systemic lupus erythematosus: a cohort study. Lupus 17:1042–1048

    Article  PubMed  CAS  Google Scholar 

  28. Appenzeller S, Costallat LTL (2004) Análise de sobrevida global e fatores de risco para óbito em 509 pacientes com lúpus eritematoso sistêmico (LES). Rev Bras Reumatol 44:198–205

    Google Scholar 

  29. Alamanos Y, Voulgari PV, Papassava M et al (2003) Survival and mortality rates of systemic lupus erythematosus patients in northwest Greece. Study of a 21-year incidence cohort (letter). Rheumatol 42:1122–1123

    Article  CAS  Google Scholar 

  30. Trager J, Ward MM (2001) Mortality and causes of death in systemic lupus erythematosus. Curr Opin Rheumatol 13:345–351

    Article  PubMed  CAS  Google Scholar 

  31. Alarcón GS, McGwin-Jr G, Bastian HM et al (2001) Systemic lupus erythematosus in three ethnic groups. VII. Predictors of early mortality in the LUMINA cohort. Arthritis Rheum 45:1991–2202

    Article  Google Scholar 

  32. Pons-Estel B, Catoggio LJ, Cardiel MH et al (2004) The GLADEL multinational Latin American prospective inception cohort of 1,214 patients with systemic lupus erythematosus: ethnic nad disease heterogeneity among “hispanics”. Medicine (Baltimore) 83:1–17

    Article  Google Scholar 

  33. Iriya SM, Capelozzi VL, Calich I et al (2001) Causes of death in patients with systemic lupus erythematosus in Sao Paulo, Brazil: a study of 113 autopsies. Arch Intern Med 161:1557

    Article  PubMed  CAS  Google Scholar 

  34. Doria A, Canova M, Tonon M et al (2008) Infections as triggers and complications of systemic lupus erythematosus. Autoimmun Rev 8:24–28

    Article  PubMed  CAS  Google Scholar 

  35. Esdaile JM, Abrahamwicz M, Grodzicky T (1998) Myocardial infarction and stroke in SLE: markedly increased incidence after controlling for risk factors. Arthritis Rheum 41:S139

    Article  Google Scholar 

  36. Manzi S, Meilahn EN, Rairie JE et al (1997) Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham study. Am J Epidemiol 145:408–415

    Article  PubMed  CAS  Google Scholar 

  37. Alarcón GS, Roseman JM, McGwin-Jr G et al (2004) Systemic lupus erythematosus in three ethnic groups. XX. Damage as a predictor of further damage. Rheumatol 43:202–205

    Article  Google Scholar 

  38. Chambers SA, Allen E, Rahman A et al (2009) Damage and mortality in a group of British patients with systemic lupus erythematosus followed up for 10 years. Rheumatol 48:673–675

    Article  Google Scholar 

  39. Rahman P, Gladman DD, Urowitz MB et al (2001) Early damage as measured by the SLICC/ACR damage index is a predictor of mortality in systemic lupus erythematosus. Lupus 10:93–96

    Article  PubMed  CAS  Google Scholar 

  40. Ruiz-Irastorza G, Egurgibe MV, Ugalde J et al (2004) High impact of antiphospholipid syndrome on irreversible organ damage and survival of patients with systemic lupus erythematosus. Arch Intern Med 164:77–82

    Article  PubMed  Google Scholar 

  41. Vaarala O (1998) Antiphospholipids antibodies and myocardial infarction. Lupus 7:S132–S134

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Hospital das Clínicas, Belo Horizonte, Minas Gerais, Brazil

    Rosa Weiss Telles, Cristina Costa Duarte Lanna, Fabiana Lemos Souza, Luciana Andrade Rodrigues, Rodrigo Citton Padilha Reis & Antonio Luiz Ribeiro

Authors
  1. Rosa Weiss Telles
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Costa Duarte Lanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabiana Lemos Souza
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luciana Andrade Rodrigues
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rodrigo Citton Padilha Reis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Luiz Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rosa Weiss Telles.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Telles, R.W., Lanna, C.C.D., Souza, F.L. et al. Causes and predictors of death in Brazilian lupus patients. Rheumatol Int 33, 467–473 (2013). https://doi.org/10.1007/s00296-012-2372-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-012-2372-x

Keywords

Search

Navigation