Mortality and Survival in Argentinian Lupus Patients: A Multicenter Study

Maria Constanza Bertolaccini¹, Yessika Soria Curi², Luciana Gonzalez Lucero³, Gabriela Vanesa Espasa², Ana Lucia Barbaglia², Hector Raul Sueldo², Maria Lilia Leguizamon², Susana Marcela Mazza², Mirta Santana², Liliana Maria Galindo², Rodrigo Aguila Maldonado⁴, Mercedes Garcia⁵, Dafne Capelusnik⁶, Ivana Romina Rojas Tessel⁷, Eugenia Picco⁷, Maria Elena Crespo Espindola⁷, Romina Calvo⁸, Susana Roverano⁹, Micaela Ana Cosatti⁹, Cecilia Nora Pisoni⁹, Paola Andrea Avila¹⁰, Marina Micelli¹¹, Maria Hu¹², Lucia Alascio¹³, Maria Cecilia Goizueta¹⁴ and Veronica Ines Bellomio², ¹Hospital Padilla, San Miguel de Tucumán, Argentina, ²Hospital Padilla, Tucuman, Argentina, ³Janssen Cilag Farmaceutica SA, Tucuman, Argentina, ⁴HIGA San Martin La Plata, La Plata, Argentina, ⁵Hospital Interzonal General de Agudos José de San Martín, La Plata, Argentina, ⁶Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, ⁷Hospital Señor del Milagro, Salta, Argentina, ⁸Hospital José María Cullen, Santa Fe, Argentina, ⁹CEMIC, Buenos Aires, Argentina, ¹⁰Hospital Ramos Mejía, Buenos Aires, Argentina, ¹¹Hospital General de Agudos, Ramos Mejía - CF, Buenos Aires, Argentina, ¹²Hospital José Maria Penna, Buenos Aires, Argentina, ¹³Hospital General de Agudos Dr. Enrique Tornú, Buenos Aires, Argentina, ¹⁴Sanatorio 9 de Julio, Tucuman, Argentina

Meeting: ACR Convergence 2021

Keywords: Mortality, Systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 8, 2021

Title: SLE – Diagnosis, Manifestations, & Outcomes Poster III: Outcomes (1257–1303)

Session Type: Poster Session C

Session Time: 8:30AM-10:30AM

Background/Purpose: The mortality in lupus patients is 2–3 times higher than the general population. However, survival in these patients has improved significantly and it is currently 95% at 5 years according to several studies. Since the last 20 years, there are no new reports on this issue in Argentina. Objetive: To analyze the factors associated with mortality, survival and causes of death in SLE patients.

Methods: Ten rheumatology argentinian centers participated in this longitudinal – multicenter study. Patients with SLE (ACR 1997 and / or SLICC 2012 criteria) with a minimum follow-up of 6 months between january 2008 and december 2018 were included. Demographic, clinical, laboratory, therapeutic variables (treatments received during the evolution of the disease and within 60 days prior to death or last control); mortality, causes of death and survival at 5, 10 and 20 years were evaluated. Statistical analysis: descriptive statistics, Kaplan-Meier survival curves and Cox regression model.

Results: Three hundred and eighty two patients were included; 90% women and 82% mestizos. Mean disease duration was 4.1 ± 6.7 years. Mean age was 37.2 ± 12.7 years, SLEDAI 3.2 ± 4.2 and SLICC 1.2 ± 1.9 at the last control or death. During the evolution the main manifestations were: mucocutaneous (90.6%), osteoarticular (76%), hematological (55.2%) and renal (55%) involvement. Ninety two percent of the patients received treatment with hydroxychloroquine (HCQ), for an average time of 53 ± 59 months, 43% methylprednisolone pulses, 38% cyclophosphamide and 28% mycophenolate.
Mortality rate was 12% (95% CI [8-15]) and the causes of death were: Infections (27), cardiovascular disease (6), SLE activity (3), catastrophic antiphospholipid syndrome (2) and other causes (8). According to Cox regression models, the variables that increased the risk of death significantly were: renal involvement (RR 3.3), cardiac involvement (RR 2.7), central nervous system involvement (RR 2.1), arterial thrombosis (RR 2.3), hyperlipemia (RR 2.4), number of infections (RR 1.2) and last SLEDAI (1.1). Osteoarticular involvement had a protective effect on the risk of death in all of them.
The use of hydroxychloroquine for more than 36 months decreased the risk of death in this cohort (40%, p= 0.03) and was a mortality protection factor (RR 0.4). Cyclophosphamide was a risk factor for death (RR 5.2).Prednisone was not associated with mortality (p NS).

Patients who died from infection had less disease duration (Me 2.25 years) than those who died due to cardiovascular causes (Me 10 years) or SLE activity (Me 15 years), p= 0.017. In this cohort, survival was 93% at 5 years, 88% at 10 years and 72% at 20 years.

Conclusion: Mortality in argentinian lupus patients was 12% and infection was the main cause of death. The use of HCQ decreased the risk of death.

Disclosures: M. Bertolaccini, None; Y. Soria Curi, None; L. Gonzalez Lucero, None; G. Espasa, None; A. Barbaglia, None; H. Sueldo, None; M. Leguizamon, None; S. Mazza, None; M. Santana, None; L. Galindo, None; R. Aguila Maldonado, None; M. Garcia, GSK, 6, Janssen, 6, Pfizer, 6; D. Capelusnik, None; I. Rojas Tessel, None; E. Picco, None; M. Crespo Espindola, None; R. Calvo, None; S. Roverano, None; M. Cosatti, None; C. Pisoni, None; P. Avila, None; M. Micelli, None; M. Hu, None; L. Alascio, None; M. Goizueta, None; V. Bellomio, None.

To cite this abstract in AMA style:

Bertolaccini M, Soria Curi Y, Gonzalez Lucero L, Espasa G, Barbaglia A, Sueldo H, Leguizamon M, Mazza S, Santana M, Galindo L, Aguila Maldonado R, Garcia M, Capelusnik D, Rojas Tessel I, Picco E, Crespo Espindola M, Calvo R, Roverano S, Cosatti M, Pisoni C, Avila P, Micelli M, Hu M, Alascio L, Goizueta M, Bellomio V. Mortality and Survival in Argentinian Lupus Patients: A Multicenter Study [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/mortality-and-survival-in-argentinian-lupus-patients-a-multicenter-study/. Accessed .

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