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Rheumatology International

, Volume 39, Issue 12, pp 2069–2075 | Cite as

Changing trends in mortality in systemic lupus erythematosus? An analysis of SLE inpatient mortality at University Hospital Coventry and Warwickshire NHS Trust from 2007 to 2016

  • Himashi Anver
  • Shirish DubeyEmail author
  • James Fox
Observational Research
  • 62 Downloads

Abstract

The aim of this study was to determine the causes of mortality in patients with systemic lupus erythematosus (SLE) at the University Hospital Coventry and Warwickshire (UHCW) NHS Trust over a 10 year period. This was a retrospective study of patients who had died in UHCW NHS Trust between 2007 and 2016, where SLE or lupus was mentioned on the death certificate. Ethics approval was obtained from the Research and Development. We identified 22 patients out of 1979 admissions with SLE who had died during the period between 2007 and 2016, 7 of these patients were under 50 years of age. The leading cause of death was infection with pneumococcus being associated with two deaths. Active disease was associated with younger age at death. Median age at death was 58.5 years, with median duration of disease of 14.5 years. Constitutional and mucocutaneous features were the most common items scoring on disease activity, seen in 68.2% and 45.45%, respectively. We identified three patients with biopsy proven lupus nephritis and one patient with CNS lupus. Surprisingly, none of the patients died because of vascular problems. The study suggests a changing trend in SLE mortality with none of the deaths in this cohort being due to cardiovascular or cerebrovascular disease. Infection continues to be the biggest reason for mortality in this cohort and greater emphasis is needed on vaccination for preventable infections like pneumococcus.

Keywords

Systemic lupus erythematosus Lupus Mortality 

Notes

Author contributions

All three authors have contributed to study design, data collection, data analysis, and write-up. SD and JF led the initial study design and data collection and SD and HA then led the analysis and write-up. All authors fulfil the ICMJE criteria for authorship.

Compliance with ethical standards

Conflict of interest

No conflicts of interest and no relevant disclosures.

Ethics approval

Formal ethics approval was obtained from Research and Development department within UHCW NHS Trust.

Informed consent

Written consent has not been obtained from individual patients, as this was not needed as per the ethics approval. No personal identifiable information has been collected for the study. As this is a retrospective study about patients who have died, informed consent is not possible.

References

  1. 1.
    Bernatsky S, Bolvin JF, Joseph L et al (2006) Mortality in systemic lupus erythematosus. Arthritis Rheum 54(8):2550–2557CrossRefGoogle Scholar
  2. 2.
    Uramoto KM, Michet CJ, Thumboo J, Sunko J, O’Fallon WM, Gabriel SE (1999) Trends in the incidence and mortality of systemic lupus erythematosus, 1950–1992. Arthritis Rheum 42(1):46–50CrossRefGoogle Scholar
  3. 3.
    Jorge AM, Lu N, Zhang Y, Rai SK, Choi HK (2018) Unchanging premature mortality trends in systemic lupus erythematosus: a general population-based study (1994–2014). Rheumatology 57(2):337–344CrossRefGoogle Scholar
  4. 4.
    Gordon C, Amissah-Arthur M-B, Gayed M et al (2018) The British Society of Rheumatology guidelines for the management of systemic lupus erythematosus in adults. Rheumatology 57(1):14–18CrossRefGoogle Scholar
  5. 5.
    Chambers SA, Allen E, Rahman A, Isenberg D (2009) Damage and mortality in a group of British patients with systemic lupus erythematosus followed up for over 10 years. Rheumatology 48(6):673–675CrossRefGoogle Scholar
  6. 6.
    Urowitz MB, Gladmann DD (1999) Evolving spectrum of mortality and morbidity in SLE (editorial). Lupus 8:253–255CrossRefGoogle Scholar
  7. 7.
    Yee CS, Su L, Toescu V, Hickman R, Situnayake D, Bowman S, Farewell V, Gordon C (2015) Birmingham SLE cohort: outcomes of a large inception cohort followed up for 21 years. Rheumatology 54(5):836–843CrossRefGoogle Scholar
  8. 8.
    Rees F, Doherty M, Grainge MJ, Lanyon P, Davenport G, Zhang W (2016) Mortality in systemic lupus erythematosus in the United Kingdom 1999-2012. Rheumatology 55(5):854–860CrossRefGoogle Scholar
  9. 9.
    Organ Donation and Transplantation website. https://www.odt.nhs.uk/statistics-and-reports/organ-specific-reports/. Accessed 18 Nov 2018
  10. 10.
    Kitas G, Nightingale P, Armitage J et al (2015) SAT0105 Trial of atorvastatin for the primary prevention of cardiovascular events in patients with rheumatoid arthritis (TRACE RA). Ann Rheum Dis 74:688Google Scholar
  11. 11.
    Petri M, Kim MY, Kalunian KC, Grossman J, Hahn BH, Sammaritano LR, Lockshin M, Merrill JT, Belmont HM, Askanase AD, McCune WJ, Hearth-Holmes M, Dooley MA, Von Feldt J, Friedman A, Tan M, Davis J, Cronin M, Diamond B, Mackay M, Sigler L, Fillius M, Rupel A, Licciardi F, Buyon JP (2005) Combined oral contracpetives in women with systemic lupus erythematosus. N Engl J Med 353(24):2550–2558CrossRefGoogle Scholar
  12. 12.
    Isenberg DA, Rahman A, Allen E, Farewell V, Akil M, Bruce IN, D’Cruz D, Griffiths B, Khamashta M, Maddison P, McHugh N, Snaith M, Teh LS, Yee CS, Zoma A, Gordon C, BILAG 2004 (2005) Development and initial validation of an updated version of the British Isles Lupus Assessment Group’s disease activity index for patients with systemic lupus erythematosus. Rheumatology 44(7):902–906.  https://doi.org/10.1093/rheumatology/keh624 CrossRefPubMedGoogle Scholar
  13. 13.
    Public Health England, public health outcomes framework. http://www.phoutcomes.info. Accessed on 20 Nov 2017
  14. 14.
    Gordon C (2002) Long-term complications of systemic lupus erythematosus. Rheumatology 41(10):1095–1100CrossRefGoogle Scholar
  15. 15.
    Mosca M, Tani C, Aringer M et al (2010) European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies. Ann Rheum Dis 69(7):1269–1274CrossRefGoogle Scholar
  16. 16.
    Nived O, Sturfelt G, Wollheim F (1985) Systemic lupus erythematosus and infection: a controlled and prospective study including an Epidemiological Group. Q J Med 55(218):271–287PubMedGoogle Scholar
  17. 17.
    Petri M, Genovese M (1992) Incidence of and risk factors for hospitalization in systemic lupus erythematosus: a prospective study of the Hopkins Lupus Cohort. J Rheumatol 19(10):1559–1565PubMedGoogle Scholar
  18. 18.
    Condon MB, Ashby D, Pepper RJ, Cook HT, Levy JB, Griffith M, Cairns TD, Lightstone L (2013) Prospective observational single-centre cohort study to evaluate the effectiveness of treating lupus nephritis with rituximab and mycophenolate mofetil but no oral steroids. Ann Rheum Dis 72(8):1280–1286CrossRefGoogle Scholar
  19. 19.
    Ho A, Barr SG, Magder LS et al (2001) A decrease in complement is associated with increased renal and haematological activity in patients with systemic lupus erythematosus. Arthritis Rheum 44(10):2350–2357CrossRefGoogle Scholar
  20. 20.
    Manger K, Manger B, Repp R, Geisselbrecht M, Geiger A, Pfahlberg A, Harrer T, Kalden J (2002) Definition of causes for death, end stage renal disease and thromboembolic events in a monocentric cohort of 338 patients with systemic lupus erythematosus. Ann Rheum Dis 61(12):1065–1070CrossRefGoogle Scholar
  21. 21.
    Kim WU, Min JK, Lee SH, Park SH, Cho CS, Kim HY (1999) Causes of death in Korean patients with systemic lupus erythematosus: a single centre retrospective study. Clin Exp Rheumatol 17(5):539–545PubMedGoogle Scholar
  22. 22.
    Mok CC, Lee KW, Ho CT, Lau CS, Wong RW (2000) A prospective study of survival and prognostic indicators of systemic lupus erythematosus in a southern Chinese population. Rheumatology (Oxford) 39(4):399–406CrossRefGoogle Scholar
  23. 23.
    Moss KE, Ioannou Y, Sultan SM, Haq I, Isenberg D (2002) Outcome of a cohort of 300 patients with systemic lupus erythematosus attending a dedicated clinic for over two decades. Ann Rheum Dis 61(5):409–413CrossRefGoogle Scholar
  24. 24.
    Song L, Wang Y, Zhang J et al (2018) The risks of cancer development in systemic lupus erythematosus (SLE) patients: a systematic review and meta-analysis. Arthritis Res Ther. 20:270.  https://doi.org/10.1186/s13075-018-1760-3(Published online 2018 Dec 6) CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Dey D, Kenu E, Isenberg DA (2013) Cancer complicating systemic lupus erythematosus—a dichotomy emerging from a nested case-control study. Lupus 22(9):919–927.  https://doi.org/10.1177/0961203313497118 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Bernatsky S, Bolvin JF, Joseph L (2005) An international cohort study of cancer in systemic lupus erythematosus. Arthritis Rheum 52(5):1481–1490.  https://doi.org/10.1002/art.21029 CrossRefPubMedGoogle Scholar
  27. 27.
    Office for National Statistics. Avoidable mortality in the UK 2016. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/datasets/avoidablemortalityintheuk. Accessed July 2019
  28. 28.
  29. 29.
    Cervera R, Khamashta MA, Font J et al (1993) Systemic lupus erythematosus: clinical and immunological patterns of disease expression in a cohort of 1000 patients. Medicine (Baltimore) 72(2):113–124CrossRefGoogle Scholar
  30. 30.
    Praprotnik S, Bozic B, Kveder T, Rozman B (1999) Fluctuation of anti-Ro/SS antibody levels in patients with systemic lupus erythematosus and sjogren’s syndrome: a prospective study. Clin Exp Rheumatol 17(1):63–68PubMedGoogle Scholar
  31. 31.
    Kasitanon N, Magder LS, Petri M (2006) Predictors of survival in systemic lupus erythematosus. Medicine (Baltimore) 85(3):147–156CrossRefGoogle Scholar
  32. 32.
    Bosch X, Guilabert A, Pallarés L, Cervera R et al (2006) Infections in systemic lupus erythematosus: a prospective and controlled study of 110 patients. Lupus 15:584–589CrossRefGoogle Scholar
  33. 33.
    Jaconsen S, Petersen J, Ullman S et al (1999) Mortality and causes of death of 513 Danish patients with systemic lupus erythematosus. Scand J Rheum 28:75–80CrossRefGoogle Scholar
  34. 34.
    Urowitz MB, Gladman DD (2000) How to improve mortality and morbidity in patients with systemic lupus erythematosus. Rheumatology 39(3):238–244CrossRefGoogle Scholar
  35. 35.
    Abu-Shakra M, Novack V (2012) Mortality and multiple causes of death in systemic lupus erythematosus- role of the death certificate. J Rheumatol 39(3):458–460CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Dept of RheumatologyPortsmouth Hospitals TrustPortsmouthUK
  2. 2.University Hospital Coventry and Warwickshire NHS TrustCoventryUK
  3. 3.LiverpoolUK

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