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Current causes of death in systemic lupus erythematosus in Europe, 2000—2004: relation to disease activity and damage accrual

Department of Rheumatology, Institute Clinical Medicine, University of Tromsø and University Hospital, Tromsø, Norway, hans.nossent{at}unn.no

N. Cikes

Department of Rheumatology, University Hospital, Zagreb, Croatia

E. Kiss

3rd Department of Internal Medicine, Medical University of Debrecen, Debrecen, Hungary

A. Marchesoni

Rheumatology Unit, Istituto Ortopedico Gaetano Pini, Milano, Italy

V. Nassonova

Institute of Rheumatology, RAMS, Moscow, Russia

M. Mosca

Universita degli Studi di Pisa, Department of Rheumatology, Pisa, Italy

M. Olesinska

Department of Connective Tissue Diseases, Institute of Rheumatology, Warsaw, Poland

G. Pokorny

Department of Rheumatology, University of Szeged and Szeged City Hospital, Szeged, Hungary

B. Rozman

Department of Rheumatology, Dr Peter Drzaj Hospital, Ljubljana, Slovenia

M. Schneider

Department of Rheumatology, Heinrich-Heine University, Düsseldorf, Germany

P.G. Vlachoyiannopoulos

Department of Pathophysiology, School of Medicine, National University of Athens, Athens, Greece

A. Swaak

Department of Rheumatology, Ikazia Ziekenhuis, Rotterdam, The Netherlands

Current therapeutic and diagnostic resources have turned systemic lupus erythematosus (SLE) into a chronic disease by reducing mortality rates. The exact contribution of disease activity and disease related damage to mortality is not well studied. The aim of this study was to describe the current causes of death (COD) in a multinational European cohort of patients with SLE in relation to quantified measures of disease activity and damage. Prospective five-year observational study of case fatalities in SLE patients at 12 European centres was performed. Demographics, disease manifestations, interventions and quantified disease activity (by ECLAM and SLEDAI) and damage (by SLICC-DI) at the time of death were related to the various COD. Ninety-one case fatalities (89% females) occurred after median disease duration of 10.2 years (range 0.2—40) corresponding to a annual case fatality of one for each of the participating cohorts. Cumulative mortality correlated linearly with disease duration with nearly 10% of fatalities occurring in the first year and 40% after more than 10 years of disease. Death occurred during SLE remission in one third of cases. In the remaining cases a mixture of disease activity (median ECLAM 5.5, median SLEDAI 15) and accrued damage (median SLICC-DI 5.0) with opposing relationships to disease duration contributed to death. Infections and cardiovascular events were the most frequent COD in both early and late fatalities with no gender differences for type of COD, disease activity, damage or comorbidity. In Europe, case fatalities have become uncommon events in dedicated SLE cohorts. The bimodal mortality curve has flattened out and deaths now occur evenly throughout the disease course with infectious and cardiovascular complications as the main direct COD in both early and late fatalities. Accrued damage supplants disease activity over time as the main SLE specific contributor to death over time. Lupus (2007) 16, 309—317.

Key Words: cause of death • damage • disease activity • systemic lupus erythematosus • Europe

Lupus, Vol. 16, No. 5, 309-317 (2007)
DOI: 10.1177/0961203307077987


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