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Survival of Mexican patients with paediatric-onset systemic lupus erythematosus and abnormal electroencephalogram
L Blancas-Galicia1, M Guevara-Cruz, R Berrón-Pérez
1Unidad de investigación en inmunodeficiencias, Instituto Nacional de Pediatría, Mexico City, Mexico.
Insights
Survival rates for pediatric systemic lupus erythematosus (SLE) patients are lower than in wealthier nations. Proteinuria and abnormal electroencephalograms are key predictors of mortality in these children, with infection and high disease activity being common causes of death.
Area of Science:
- Pediatric Rheumatology
- Autoimmune Diseases
- Clinical Outcomes
Background:
- Paediatric-onset systemic lupus erythematosus (SLE) generally has poorer outcomes than adult-onset SLE.
- Historically, higher mortality and disease damage are observed in children with SLE.
- Understanding prognostic factors is crucial for improving survival in pediatric SLE.
Purpose of the Study:
- To determine the impact of clinical, laboratory, and electroencephalographic findings on survival in pediatric-onset SLE patients.
- Identify independent predictors of mortality in this population.
- Compare survival rates with those reported internationally.
Main Methods:
- Retrospective analysis of Mexican pediatric SLE patients diagnosed between 1970 and 2001.
- Univariate and multivariate analyses to assess associations between features and death.
- Kaplan-Meier survival curve estimation.
Main Results:
- 159 patients included; 105 female, median age 12.7 years.
- Poor prognostic factors identified: haematuria, leukocyturia, proteinuria, urine casts, low GFR, haemolytic anaemia, abnormal EEG.
- Multivariate analysis revealed proteinuria and abnormal EEG as independent predictors of death.
- Overall 5-year survival was 82.9%, 10-year survival was 77.4%.
Conclusions:
- Pediatric SLE survival in this cohort was lower than in wealthier countries.
- Proteinuria and abnormal electroencephalograms were significant determinants of mortality.
- Infection and high disease activity were the primary causes of death.
Background:
Over the past three decades, there has been a remarkable improvement in the outcome of children diagnosed with systemic lupus erythematosus (SLE). In general, paediatric-onset SLE has been associated with higher mortality rates and more disease damage than adults with SLE. The objective was to determinate the impact of clinical, laboratory, and electroencephalographic findings on survival amongst patients with paediatric-onset SLE.
Methods:
Charts of Mexican patients with paediatric-onset SLE diagnosed between 1970 and 2001 were analysed retrospectively; univariate and multivariate analyses were used for analysing associations between clinical and laboratory features and death; Kaplan-Meier tests were used to estimate survival curves.
Results:
159 patients were included, 105 were female, with a median age of 12.7 years at diagnosis and a median duration of symptoms prior to diagnosis of 8.4 months. Univariate analysis showed that haematuria, leukocyturia, proteinuria, presence of urine cast, <60% glomerular filtration rate, haemolytic anaemia, and abnormal electroencephalogram, were all poor prognostic factors (p<0.05). Multivariate analysis showed that the presence of proteinuria and abnormal electroencephalograms (p<0.05) were independent factors associated with death. The overall survival rate was 82.9% at five years and 77.4% at ten years upon follow-up. Infection and high disease activity were the most common causes of death.
Conclusions:
Survival of paediatric-onset SLE patients was lower compared to that reported for patients in wealthier countries. Amongst the patients who died, the presence of proteinuria and abnormal electroencephalograms were found to be determinant for survival. Infection and activity were the most common causes of death.
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