Background/Purpose

To evaluate the factors associated with accrual of organ damage in a longitudinal cohort of Chinese patients with SLE

Methods

A longitudinal cohort of 747 southern Chinese patients who fulfill >=4 of the 1997 ACR criteria for SLE from 1995 to 2014 was studied.  Organ damage in 12 systems was assessed by the ACR SLICC damage scores (SDI).  The cumulative rate of survival was studied by Kaplan-Meier’s plot.  In those who died or were lost for follow-up, data were censored at the time of death and the last clinic visits, respectively.  Early damage accrual was defined as occurrence of organ damage (SDI³1) within the first year of SLE onset.  Factors associated with damage accrual and mortality over time were studied by multivariate regression models. 

Results

747 SLE patients were studied.  There were 691 women (93%) and 56 men (7%).  The mean age at SLE onset was 33.0±13.5 years and the mean duration of follow-up was 111±89.1 months.  Seventy-six patients (10%) died and 28(4%) patients were lost to follow-up.  Early damage occurred in 191 (26%) patients.  The frequency of organ damage in these patients, in decreasing order, was neuropsychiatric (29%), musculoskeletal (19%), renal (17%), dermatological (16%), pulmonary (9.4%), ocular (8.9%), cardiovascular (8.4%) and peripheral vascular (5.8%).  Compared with those patients without early damage, patients with early organ damage were older at onset of SLE (37.4±15.2 vs 31.4±12.5 years; p<0.001) and were more likely to be men (13% vs 6%; p=0.009).  Patients with early damage had accrued a significantly higher cumulative SDI score than those without (1.59±1.6 vs 0.84±1.5; p<0.001).  Logistic regression revealed that the male sex (RR 2.20 [1.22-3.95]; p=0.008) and the age of SLE onset (RR 1.04[1.02-1.05]; p<0.001) were independently associated with early damage after adjustment for the use of corticosteroids, antimalarials and immunosuppressive agents that included cyclophosphamide, azathioprine and mycophenolate mofetil.  In the entire cohort, 344 patients (46%) eventually developed organ damage (SDI³1) and the median time to damage was 28 months.  The cumulative survival of the patients studied was 98% at 12 months, 96% at 36 months, 94% at 60 months and 89% at 120 months.  The SDI score was associated with mortality (age and sex adjusted HR for each point of increase in SDI 1.31[1.18-1.44]; p<0.001).  Cox regression analysis showed that early damage (HR 6.49[3.84-11.0]; p<0.001) was independently associated with mortality after adjustment for age of SLE onset, sex and the use of medications that included prednisolone, cyclophosphamide, azathioprine, mycophenolate mofetil and hydroxychloroquine.

Conclusion

In this large longitudinal cohort of Chinese patients with SLE, the male sex and older age of onset were associated with early organ damage, which occurred most frequently in the neuropsychiatric, musculoskeletal and renal systems.  The presence of early organ damage increased SLE mortality by more than 6-fold.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-damage-accrual-and-survival-in-chinese-patients-with-systemic-lupus-erythematosus-sle-a-prospective-cohort-analysis-of-747-patients/