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Damage Accrual in Patients with Systemic Lupus Erythematosus Predicts Mortality and Is Associated Primarily with

Yael Pri-Paz Basson1,2, Hadar Haim-Pinhas2,3, Daniel Erez2,4

  • 1Rheumatology Unit, Meir Medical Center, Kfar Saba 4428164, Israel.

Journal of Clinical Medicine
|May 27, 2026
PubMed

Insights

Systemic lupus erythematosus (SLE) patients frequently experience organ damage, with antiphospholipid syndrome (APS) and hypertension significantly increasing this risk and mortality. Managing these comorbidities is key for better SLE outcomes.

Area of Science:

  • Rheumatology
  • Internal Medicine
  • Clinical Epidemiology

Background:

  • Long-term outcomes in systemic lupus erythematosus (SLE) are influenced by irreversible organ damage.
  • The role of comorbidities in SLE damage accrual and mortality requires further characterization.

Purpose of the Study:

  • To characterize organ damage progression in SLE patients.
  • To identify comorbidities associated with increased damage severity and mortality in SLE.

Main Methods:

  • Retrospective study of 182 adult SLE patients from 2014-2023.
  • Utilized the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) to assess damage.
  • Employed multivariable logistic regression and Cox proportional hazards models.

Main Results:

  • 59.5% of patients accrued damage, with 30.8% experiencing severe damage (SDI ≥3).
  • Antiphospholipid syndrome (APS) and hypertension were dominant independent predictors of damage.
  • Mortality significantly increased with damage severity (p < 0.0001).

Conclusions:

  • Organ damage is common in SLE and a strong predictor of mortality.
  • APS and hypertension are key modifiable drivers of damage and mortality in SLE.
  • Integrated cardiovascular and thrombotic risk management is crucial for SLE patients.

Keywords:
antiphospholipid syndromedamage accrualhypertensionmortalitysystemic lupus erythematosus

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