Clinical features and predictions of in-hospital mortality in 91 patients with systemic lupus erythematosus / 中华风湿病学杂志

ABSTRACT

Objective To explore the clinical characteristics and prognostic indicators that classify patients with systemic lupus erythematosus (SLE) at risk of in-hospital mortality.Methods Medical records of 1611 SLE patients admitted between 1999-2009 were collected from 26 centers across Jiangsu province,and patients were divided into two groups based on the outcomes.The suspected risk factors of poor outcomes were selected and then analyzed by chi-square test,independent-samples t test,Wilcoxon rank sum test and Logistic regression.Results Among the 1 611 enrolled patients,91 patients were in the death group (5.6％) and 1 520 patients in the control group (94.4％).The duration of disease [28(4,60) m vs 12(2,47) m,Z=-3.290,P＜0.05),the rate of male/female (13.2％ vs 7.1％,x2=4.606,P＜0.05),as well as the occurrence rateof seizure (8.8％ vs 1.7％,x2=17.550,P＜0.05),psychosis (41.8％ vs 23.8％,x2=14.809,P＜0.05),lupus headache (19.8％ vs 6.0％,x22=-25.898,P＜0.05),alopecia (47.3％ vs 30.3％,x2=11.541,P＜0.05),pericarditis (35.2％ vs 22.0％,x2=8.408,P＜0.05),myocarditis (4.4％ vs 1.0％,x2=5.885,P＜0.05),fever (55.0％ vs 28.5％,x2=28.632,P＜0.05),decreased hemoglobin levels (60.9％ vs 44.8％,x2=8.603,P＜0.05),urinary casts (24.2％ vs 12.2％,x2=10.884,P＜0.05),hematuria (51.7％ vs 37.8％,x2=6.988,P＜0.05),decreased estimate glomerular filtration rate (eGFR)levels (27.6％ vs 11.0％,x2=18.12,P＜0.05),and elevated glutamic-oxaloacetic transaminase (AST) levels (30.2％ vs 17.9％,x2=8.176,P＜0.05) were higher in the death group.The frequency of arthritis (34.3％ vs 18.7％,x2=9.459,P＜0.05),proteinuria (31.6％ vs 14.3％,x2=12.169,P＜0.05),elevated erythrocyte sedimentation rate (ESR) levels (80.4％ vs 71.8％,x2=4.192,P＜0.05),decreased complement levels (44.2％ vs 17.6％,x2=24.881,P＜0.05) and anti-dsDNA antibodies positivity rate (39.7％ vs 23.1％,x2=9.963,P＜0.05) were higher in the control group.Logistic regression analysis showed seizure [OR =4.035,95％ CI(1.338,12.164),P＜0.05],lupus headache [OR=3.026,95％CI (1.406,6.511),P＜0.05],decreased hemoglobin (Hb) levels [OR =2.116,95％ CI(1.139,3.934),P＜0.05],decreased eGFR levels [OR =2.159,95％ CI(1.0 11,4.610),P＜0.05] and fever [OR=2.567,95％CI (1.422,4.634),P＜0.05] were positively correlated with in-hospital mortality,with elevated ESR levels [OR=0.418,95％CI (0.218,0.802),P＜0.05] and decreased complement levels [OR=0.328,95％CI (0.120,0.894),P＜0.05] negatively correlated (P＜0.05).Conclusion The results sugest that seizure,lupus headache,decreased Hb levels,decreased eGFR levels and fever are the most important predictors of in-hospital mortality.Clinicians should pay more attention to these symptoms in admission.