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The bm12 Inducible Model of Systemic Lupus Erythematosus (SLE) in C57BL/6 Mice
Published on: November 1, 2015
Causes of death in Korean patients with systemic lupus erythematosus: a single center retrospective study
1Center for Rheumatic Diseases, Kang-Nam St. Mary's Hospital, Seoul, Korea.
Insights
In Korean patients with systemic lupus erythematosus (SLE), infection, primarily gram-negative bacterial sepsis, was the leading cause of death. SLE-related factors, mostly non-renal, were the second most common cause, with pulmonary hypertension also being a significant mortality factor.
Area of Science:
- Rheumatology
- Internal Medicine
- Immunology
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with significant morbidity and mortality.
- Understanding the specific causes of death in different patient populations is crucial for improving clinical management and outcomes.
Purpose of the Study:
- To investigate and identify the primary causes of mortality among Korean patients diagnosed with SLE.
- To analyze demographic and disease-specific factors associated with death in this cohort.
Main Methods:
- Retrospective analysis of Korean SLE patients who died between 1993 and 1997.
- Comparison of demographic data and disease activity indices between deceased patients and survivors.
- Categorization and frequency analysis of causes of death, including infection, SLE-related factors, and other conditions.
Main Results:
- Infection, predominantly gram-negative bacterial sepsis, was the leading cause of death (32.5%) in 43 out of 544 SLE patients.
- SLE-related factors (25.0%) and pulmonary hypertension (15.0%) were the second and third most common causes of mortality.
- Patients who died from infection exhibited higher disease activity at presentation (lower C3, higher anti-dsDNA antibody) and received higher steroid doses prior to death.
Conclusions:
- Infection is the primary cause of death in Korean SLE patients, often presenting as gram-negative sepsis.
- Non-renal SLE-related complications and pulmonary hypertension are significant contributors to mortality.
- Higher disease activity and increased steroid use are associated with fatal infections in SLE patients.
Objective:
To determine the causes of death in Korean patients with systemic lupus erythematosus (SLE).
Methods:
We evaluated retrospectively Korean SLE patients who were monitored in the Center for Rheumatic Disease in Kang-Nam St. Mary's Hospital from 1993 to 1997 and who died.
Results:
Forty-three (7.9%) of 544 patients died. Comparison of demographics and disease activity indices between the deceased and the survivors showed that the age was older and C3 at presentation was lower in the deceased (n = 40) than the survivors (n = 453) (age: 33.8 +/- 13.6 versus 28.3 +/- 10.6 years, p = 0.02, C3: 36.8 +/- 21.4 versus 49.7 +/- 20.8 mg/dl, p = 0.03). Among 40 patients who died, the frequency and causes of death were as follows: 13 from infection (32.5%), 10 SLE-related factors (25.0%), 6 pulmonary hypertension (15.0%), 4 cerebrovascular accidents (10.0%), and 3 thrombotic thrombocytopenic purpura (7.5%). The majority of the SLE-related deaths were non-renal in origin, including 3 cerebral nervous system disease, 2 TTP, 2 acute pulmonary hemorrhage syndrome, 1 acute myocarditis, and 1 multi-system illness. SLE-related renal causes were responsible for only death. The major organisms of infection were gram negative bacilli (69.2%), primarily manifesting as sepsis or bacteremia (76.9%). The patients (n = 13) who died from infection had lower levels of complement and higher levels of anti-ds DNA antibody at presentation than those (n = 27) who died from the other causes (C3: 24.7 +/- 17.8 versus 41.7 +/- 21.5 mg/dl, p = 0.02, anti-dsDNA antibody: 68.0 +/- 73.5 versus 27.0 +/- 35.3 IU, p = 0.04). The mean steroid dose being administered one month before death was also higher in the patients who died of infection (30.5 +/- 15.2 versus 15.2 +/- 7.7 mg/day, p = 0.03). Patients who died of pulmonary hypertension, the third most common cause of mortality, showed extremely high pulmonary pressures at the initial diagnosis, with a short interval to death, and had less major organ involvement at death. There were no deaths due to coronary heart disease or neoplasm in this cohort.
Conclusion:
The most common cause of death in 544 Korean lupus patients was infection, mainly manifesting as gram negative bacterial sepsis. SLE-related factors (mostly non-renal) were the next most frequent cause. Death from infection was associated with higher disease activity at presentation and a higher dose of steroid used previously. Death due to pulmonary hypertension was common, whereas death due to coronary heart disease was absent.
