A Retrospective Study Of Long-term Survival Of Inpatients With Systemic Lupus Erythematosus

Objective: To study the survival rate and prognostic indicators of inpatients with systemic lupus erythematosus (SLE) in Zhejiang Province and to provide some guidelines for the choice of treatment to improve their prognosis.Methods: A total of 580 cases of SLE at our hospital between January 1 1993 and December 31 2004 were enrolled in this study. All patients were followed up. Their clinical characteristics, laboratory data, therapy, disease activity, and serial damage scores were retrospectively analyzed. According to the disease onset age, patients were classified into three groups: the child group (< 16 years old), adult group (16- 50 years old), and elder group (>50 years old). We established a sound database with Access. All data were analyzed using statistical software package 13.0. Bothunivariate and multivariate models were applied for survival analysis. Survival over time was studied by the Life-table method, and predictive factors of mortality was evaluated by the Cox proportional hazard model.Results: All the 580 SLE inpatients (92% women) lived in Zhejiang Province, among whom, 21 (3.5%) patients were lost to follow up, one hundred and nine patients died (2 from the child group, 88 from the adult group, and 19 from the elder group). The overall 1 -, 3-, 5-, and 10-year survival rates were 97%, 85%, 79% and 65%, respectively. Survival was significantly worse in the elder patients with 5- and 10-year survival rates of 66% and 47%( P < 0.05), respectively. Cox regression revealed that low levels of C3, and C4, increased level of serum creatinine (Cr) ,the number of ACR criteria at diagnosis (^ 7 items), relapse (^ 3 times), medication noncompliance, and living in rural area were independent predictors.In this study, the overall 1-, 3-, 5-, and 10-year mortality rates were 3%, 15%, 21% and 35%, respectively. One hundred and nine patients separately died from infection (50, 45.87%), SLE-related diseases (45, 41.28%), and malignant tumor (4,3.67%). Pneumonia had the highest incidence rate of 29.36% (32/109). The major organisms of infection were opportunistic infection (74.36%). Compared to community acquired infection, the incidence of hospital acquired infection was markedly higher (78.00% vs. 22.00%). SLE-related disease was the second cause of death, including lupus pneumonitis(10), multi-organ function failure(9), cerebral nervous system diseases(9), and heart failure(8). The renal failure (6.42) was the commonest form of organ damage in our cohort. This could attribute to the use of new immunosuppressive drugs and other therapies. In addition, two cases of SLE accompanied with severe pulmonary hypertensionrelieved by endodermis progenitor cell transplantation.Conclusions:1. The overall 1 -, 3-, 5-, and 10-year survival rates were 97%, 85%, 79% and 65%, respectively. The elder SLEpatients have the worst prognosis (P