Background/Purpose: Background: Few studies of systemic lupus erythematosus (SLE) have a follow-up duration long enough to evaluate the time trend of survival, particularly in Asian countries.

Objectives: To revisit the trend of survival of SLE in a cohort of southern Chinese patients over 25 years.

Methods: Patients who fulfilled the 1997 ACR criteria for SLE and were followed in our hospital since 1995 were included.  Patients were stratified into 2 groups according to the year of diagnosis: (1) 1995-2004; and (2) 2005-2018.  Survival of patients was studied by Kaplan Miere’s analysis. For those who died or lost to follow-up, data were censored at their last clinic / hospital visits.  Organ damage was assessed by the Systemic Lupus International Collaborating Clinics (SLICC) damage index (SDI) and causes of death in the first 10 years of SLE onset were compared between the two groups.  Cox regression was used to study factors associated with survival. 

Results:  A total of 1098 SLE patients were registered in our database.  After excluding 157 patients diagnosed outside the time period of 1995-2018, 941 patients were studied (92% women).  All were ethnic Chinese.  The mean age of SLE onset was 35.1±14.4 years and the mean follow-up duration by the same groups of physicians was 13.1±6.6 years.  Seventy-seven patients were lost to follow up.  Groups 1 and 2 consisted of 364 and 577 patients, respectively.    The mean SDI score at 10 years of disease onset was significantly higher in group 1 than group 2 patients (1.01±1.43 vs 0.57±0.94; p< 0.01), particularly in the neuropsychiatric, musculoskeletal and gonadal domains.  The proportion of patients with organ damage in these 3 systems was also significantly higher in this group of patients.  Within 10 years of SLE onset, 32 (8.8%) patients in group 1 and 25 (4.3%) patients in group 2 died (p=0.005).  The 5- and 10-year cumulative survival rates were 93.6% and 91.0% in group 1; and 96.5% and 94.2% in group 2 patients, respectively (log rank test p=0.048).  Infection accounted for more than half of the deaths in both groups.  More group 1 than group 2 patients died of vascular events but the difference was not statistically significant. Univariate Cox regression analysis showed that age of onset, male sex and SDI score at 10 years were associated with survival. Group 2 patients showed a better survival than group 1 but statistical significance was borderline (HR 0.61[0.38-1.001]; p=0.05).  Multivariate analysis revealed only the age of onset (1.06 [1.04-1.08] per year; p< 0.001) and SDI at 10 years (1.65 [1.47-1.85] per point; p< 0.001) were significantly associated with survival.  The period in which SLE was diagnosed was not a significant factor determining survival (HR 0.68[0.41-1.14]; p=0.14).

Conclusion: The survival of our Chinese SLE patients has improved significantly from 1995-2004 to 2005-2018, which is contributed by lower organ damage accrual.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/trend-of-survival-of-a-cohort-of-patients-with-systemic-lupus-erythematosus-over-25-years/