Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: A large multicenter multinational inception cohort was established initially to study risk factors for atherosclerosis (AS) in SLE. The aim of this study was to determine all cause and cause-specific mortality and their risk factors during the first 10 years of observation.
Methods: Patients enter the cohort within 15 months of SLE diagnosis (≥4 ACR criteria). Clinical and laboratory features of SLE and comorbidities are gathered in a standardized protocol at yearly intervals. Deaths are recorded as they occur and the cause of death was coded according to ICD9. Overall and Cause-Specific Survival curves were obtained using a Cumulative Incidence Competing Risk Analysis. Prediction models for overall survival and cause-specific for the three major causes were done using time-dependent covariate analysis for competing risks using date of birth as time zero. Variables included were geography of origin, ethnicity, sex, disease duration, disease activity, damage and medication use. The selection of variable retained was done using the stepwise approach.
Results: 1677 patients had follow-up beyond enrolment. At the time of data cut 78 patients had died. Cause of death included: atherosclerosis 11, active SLE 17, infection 27 and all other causes 23 (cancer in 5, other in 8, and unknown in 10). At enrolment 89.0% were female with a mean age at diagnosis of 34.9 ± 13.4 yrs and a disease duration of 0.5 ± 0.4 yrs. Mean SLEDAI-2K was 5.4 ± 5.4, SDI 0.12 ± 0.50 (SDI > 0: 131 (7.9%)). Patients on steroids 1167 (69.8%), on antimalarials 1124 (67.3%) and on immunosuppressives 671 (40.2%). 825 (49.2%) were Caucasian, 275 (16.4%) Black, 260 (15.5%) Hispanic, 255 (15.2%) Asian and 61 (3.6%) other. Geography of origin included USA 460 (27.4%), Canada 398 (23.7%), Europe 450 (26.8%), Mexico 160 (9.5%), and Asia 209 (12.5%). The Competing –Risk survival Analysis is presented in the Table.
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Hazard Ratio
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95% Confidence Interval
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P value
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ALL CAUSES
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|||
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Mexico
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4.02
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2.30, 7.02
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<0.0001 |
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Disease Duration
|
0.90
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0.82, 0.98
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0.02
|
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SDI
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1.47
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1.29, 1.66
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<0.0001 |
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On Steroids at Visit
|
3.97
|
2.01, 7.82
|
<0.0001 |
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On Antimalarials at Visit
|
0.56
|
0.35, 0.89
|
0.01
|
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ATHEROSCLEROSIS
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|||
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SDI excluding cardiac damage
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1.56
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1.17, 2.06
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0.002
|
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ACTIVE LUPUS
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|||
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Mexico
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9.73
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3.31, 28.59
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<0.0001 |
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Sex Male
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4.40
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1.51, 12.82
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0.007
|
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Disease Duration
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0.70
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0.55, 0.91
|
0.006
|
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SDI
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1.58
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1.17, 2.13
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0.003
|
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INFECTION
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|||
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Hispanic
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4.50
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1.70, 11.92
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0.002
|
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SDI
|
1.59
|
1.32, 1.93
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<0.0001 |
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On Steroids at Visit
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25.27
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3.35, 190.66
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0.002
|
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On Antimalarials at Visit
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0.39
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0.17, 0.92
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0.03
|
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On Immunosuppressives at Visit
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0.27
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0.12, 0.61
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0.002
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Damage was an important risk factor for all cause and cause-specific mortality. Demographic factors, disease activity and treatment contribute differently to mortality both all cause and cause specific. Anti-malarials are protective for all-cause mortality and mortality due to infection.
Conclusion: Risk factors differ for all cause mortality and mortality related to active lupus, atherosclerosis and infection and all must be considered in pursuing preventive strategies.
Disclosure:
M. B. Urowitz,
None;
D. D. Gladman,
None;
N. Anderson,
None;
D. Ibanez,
None;
S. L. I. C. C. (SLICC),
None.
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