Session Information
Date: Tuesday, November 10, 2015
Session Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: To investigate risk of
mortality among SLE patients cohort in the NDB.
Methods: Systemic lupus erythematous
(SLE) and non-inflammatory rheumatic disease (NIRD) patients were studied from
1998 through 2011 in the National Data Bank for Rheumatic Diseases (NDB), a longitudinal
observational study following patients from all regions of the US through biannual
questionnaires. Patients were required to have at least 2 observations or 1
observation and died before 2012. Mortality was confirmed through National
Death Index-matched death records. We calculated standardized mortality ratios
(SRRs) of SLE vs. NIRD based on age-, race- and sex-stratified US population
data (CDC.gov). Cox regression models with time varying covariates were used to
investigate the risk of mortality among diagnoses. A second Cox regression
model was done at last observation using SLE specific variables.
Results: 2,374 SLE and 5,603 NIRD
patients were studied. The mean (median) time in the study for SLE patients was:
2.52 (1.71) years with a total of 5,981 patient-years of follow-up, and for
NIRD, 3.77 (2.12) years with a total of 21,090 patient-years of follow-up. At a
random observation, SLE patients were described as: mostly male (93.3%), with
an average of 50.4 (SD 13.5) years, white (73.0%), married (59%), mostly
high-graduated (93.9%), with worse disease activity measures compared to NIRD
(P<0.001 for the majority). At last observation, the BILD score was 3.36 (SD
2.08), PHQ8 scale 5.67 (SD 5-04) and GAD2 0.93 (SD 1.36).
The overall SRM were: 2.88 (95% CI 2.42-3.44) and 1.46 (95%
CI 1.37-1.55) for SLE and NIRD patients, respectively. After multivariate
adjustment (including demographic and disease severity outcomes), the hazard
ratio comparing diagnoses was 0.96 (95%CI 0.74 -1.24). Among SLE patients, univariate preditors of
mortality (age, age-squared and sex
adjusted) were presented in Table. Almost all disease severity variables were
associated with an increased risk of mortality among the SLE cohort.
Conclusion: Predictors of mortality were studied among SLE
patients. Worse disease severity, more comorbidities and smoking habits were
all important factors to an increased risk of mortality, among others. When comparing
diagnoses, the risk of mortality did not seem to differ. The use of treatment
will be further investigated in future works.
Table – Age, age-squared and sex adjusted predictors of
mortality among SLE patients.
|
Cox regression
|
HR
|
95% CI
|
|
|
Age |
0.90 |
0.84 |
0.97 |
|
Age- squared |
1.00 |
1.00 |
1.00 |
|
Sex |
2.37 |
1.47 |
3.83 |
|
White |
0.61 |
0.40 |
0.94 |
|
Married |
0.70 |
0.50 |
0.99 |
|
Widowed |
1.96 |
1.14 |
3.37 |
|
Employed |
0.38 |
0.23 |
0.63 |
|
Educational level (yrs)
|
0.90 |
0.84 |
0.96 |
|
Past smoker |
1.49 |
1.03 |
2.16 |
|
Current smoker |
1.86 |
1.10 |
3.15 |
|
BMI (Kg/m2) |
1.02 |
1.00 |
1.05 |
|
HAQ disability (0-3) |
2.30 |
1.82 |
2.90 |
|
VAS pain scale (0-10) |
1.18 |
1.11 |
1.25 |
|
VAS Global (0-10) |
1.19 |
1.11 |
1.27 |
|
VAS Fatigue scale (0-10) |
1.14 |
1.08 |
1.21 |
|
PAS (0-10) |
1.29 |
1.19 |
1.39 |
|
SF-36 PCS (0-100) |
0.94 |
0.92 |
0.96 |
|
SF-36 MCS (0-100) |
0.98 |
0.96 |
0.99 |
|
Comorbidity index (0-9) |
1.26 |
1.15 |
1.37 |
|
VAS function scale (0-10) |
1.17 |
1.12 |
1.22 |
|
Symptom intensity scale (0-10) |
1.09 |
1.06 |
1.12 |
|
SLAQ score* |
1.09 |
0.99 |
1.19 |
|
SLAQ flares* |
|||
|
Yes, mild flare |
2.68 |
0.41 |
17.40 |
|
Yes, moderate flare |
2.53 |
0.19 |
34.25 |
|
Yes, severe flare |
14.11 |
1.59 |
124.92 |
|
* Model performed at last observation, not using time-varying covariates. |
|||
To cite this abstract in AMA style:
Michaud K, Pedro S, Katz PP. Mortality Among SLE Patients in the National Data Bank for Rheumatic Diseases [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/mortality-among-sle-patients-in-the-national-data-bank-for-rheumatic-diseases/. Accessed October 26, 2020.« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/mortality-among-sle-patients-in-the-national-data-bank-for-rheumatic-diseases/