Background:Systemic lupus erythematosus (SLE) is a complex autoimmune disorder with considerably high mortality.Objectives:To investigate the survival rates 5, 10, 15 and 20 years and the impact of disease related morbidity and mortality among Egyptians patients afflicted by SLE.Methods:This is a single center observational study performed in one of the leading medical school governmental hospital for teaching and training in the north African region and middle east sectors Kasr Alainy School of Medicine- Cairo University. Medical records of adult SLE patients ≥ 16 years (classified according to ACR 1997 SLE classification criteria set forth by Hochberg, 1997) who received longitudinal clinical care during the time period from 1999 to 2019 were included. Data analysis: causes of mortality, damage score and survival were determined from the time of SLE diagnosis to the last contact or date of death.Results:Records of two hundred and two SLE patients were included, 91.1% were females and 8.9% patients were males (ratio is 10:1). The mean age at diagnosis 26.71 ± 7.93 years with a mean follow up between mean: 6.6 ± 4.58 years, 34.15% had damage in at least one of the organ systems by SLICC/ACR-DI in the first 6 months. Considering an outcome label of dead or alive at the end of follow up period, results showed a total of 52 mortalities, 88.5% were females, the mean age at death onset was 30.9±8.8 years. Results identified the following death causalities in the studied SLE patients in order of frequency: Septic shock and disseminated intravascular coagulation in 11.5 %, acute respiratory distress syndrome ARDS in 11.5 %, congestive heart failure in 9.6%, thrombotic microangiopathy 5.7%, cerebritis, acute renal failure 5.7%, intracranial hemorrhage 5.7%, hypertensive encephalopathy in 5.7%. Alveolar hemorrhage, infection, intraoperative deaths each contributed to deaths in 3.8%. Hypovolemic shock, acute liver failure, brain edema, thrombotic thrombocytopenic purpura, end stage kidney disease, pulmonary renal syndrome, suicide and acute hydrocephalus contributed to fatalities in 1.9%. The cause of death was unclearly identified in 26.9%. Results of the Kaplan Meier survival curve in the studied SLE cohort showed an overall cumulative probability of survival at 5, 10, 15 and 20 years after SLE diagnosis was 82.9%, 68.8%,51.4% and 20.4%, respectively. Multivariate regression analysis revealed psychosis, chronic kidney disease and heart failure were independent predictors of survival (HR= 4.3 times, 3.58 times and 3 times respectively, p < 0.001), while the use of hydroxychloroquine and AZA showed a protective effect.Figure 1.Kaplan-Meier estimated survival function, starting at date of SLE diagnosis.Conclusion:The cumulative probability of survival at 5, 10, 15 and 20 years after SLE diagnosis was 82.9%, 68.8%,51.4% and 20.4%, respectively. The presence of renal manifestations, neuropsychiatric lupus and heart failure were independent predictors of poor survival in our cohort. The use of hydroxychloroquine and AZA were protective.Corresponding author: Reem Hamdy Abdellatif Mohammed (Reem H A Mohammed), e-mail: [email protected],. https://orcid.org/0000-0003-4994-7687, Scopus Author ID: 35280107100.References:[1]Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997 Sep;40(9):1725. doi: 10.1002/art.1780400928. PMID: 9324032.[2]Kasitanon N, Magder LS, Petri M. Predictors of survival in systemic lupus erythematosus. Medicine (Baltimore) 2006;85:147–56.[3]Gladman D, Ginzler E, Goldsmith C, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum 1996;39:363–9.Disclosure of Interests:None declared
Myopericarditis and Pericardial Effusion as the Initial Presentation of Systemic Lupus Erythematosus
