Background/Purpose: To determine mortality and identify risk factors for mortality at 10 years in a mexican-mestizo SLE inception cohort at a tertiary care center in Mexico City.

Methods: In October 1999, an inception cohort of patients aged >16years, who were within 12 months of accrual ≥4 ACR classification criteria for SLE was assembled. At entry, patients had a standardized medical evaluation, and laboratory test. Every 3-6 months, patients were seen at the lupus clinic for medical care. Every year, information was updated, including irreversible damage index, any comorbidity and blood sample was drawn. For this purpose, we assessed disease characteristics, comorbidities, autoantibodies profile, medication, clinical and laboratory variables present at baseline and follow up (FU). Univariate and multivariate analysis were performed.

Results: Two hundred and twenty three patients were included (89.7% females, mean age 27.2±9.2 years), with a mean disease duration of 5.2 months at time of enrolment. Seventeen patients (7.62%) lost FU at our center before 10 years, so were excluded from the analysis.  During FU, 34 (16.5%) have died at 10 years and 21 (61.73%) died in the first 5 years. Main causes of death were infection (35%), diffuse pulmonary hemorrhage (8.8%) and chronic renal failure (8.8%). Twenty five deaths were considered SLE related (SLE activity or morbidity). Among patients who died during first 10 years, hypertension (56% vs 39%, p=0.001), hematologic activity (97 vs 73%, p=0.002) and peripheral neuropathy (3% vs 0, p=0.02) were more prevalent.  At baseline, lower serum albumin (2.8 ± 0.7 vs 3.1 ± 0.8, p=0.03), higher proteinuria (2.6 ± 3.5gr vs 1.6 ± 2.6gr, p=0.05), C-reactive protein (4.5 ± 4.0 vs 2.8 ± 3, p=0.02) and cumulative dose of prednisone (6.3 ± 4.3gr vs 3.7 ± 3.4gr, p=0.0003) were observed in patients who died. Antimalarial use at inclusion (53% vs 26%, p=0.005) or during FU (77% vs 47%, p < 0.001) were more frequent in survivors.  Male gender was not associated with an increased risk of death (10 vs 15%, p=0.41). SLICC damage index score ≥1 was more frequent in patients who died within first 10 years (8 vs 21%, p=0.03). In multivariate analysis, hematologic activity (HR 10.26, 95%CI 1.40-75.21, p=0.022) and cumulative prednisone dose at baseline (HR 1.14, 95%CI 1.06-1.23, p< 0.001) were associated with risk of death at 10 yrs. Antimalarial use or length of usage does not persist as independently associated with a protective effect for death however, only 50% of patients in the whole cohort were on antimalarials at baseline.

Conclusion: We identified baseline factors associated with 10 years mortality in a mexican-mestizo SLE inception cohort. Ten-year survival was 83.2% in the entire cohort. Almost two-thirds of deaths occurred during the first 5 years of FU. Hematologic activity and cumulative prednisone at baseline were the only factors associated with increased risk of dead at 10 years.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mortality-in-a-sle-inception-cohort-of-hispanic-patients/