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Survival analysis and prognostic indicators of systemic lupus erythematosus in Pakistani patients

Department of Nephrology, The Kidney Center, Post Graduate Training Institute Karachi, Pakistananasrabbani{at}yahoo.com

HB Habib

Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan

M Islam

Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan

B Ahmad

Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan

S Majid

Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan

W Saeed

Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan

SMA Shah

Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan

A Ahmad

Department of Nephrology, The Kidney Center, Post Graduate Training Institute Karachi, Pakistan

To aim of this study is to analyse the survival rate and prognostic indicators of systemic lupus erythematosus (SLE) in Pakistani population. A total of 198 patients with SLE diagnosed between 1992 and 2005 were reviewed retrospectively. Clinical features at presentation, subsequent evolving features, autoantibody profile, damage scores and mortality data were obtained. Prognostic factors for survival were studied by statistical analysis. Of 198 SLE patients studied, 174 were women and 24 were men. The women to men ratio was 7.2:1. Mean age at presentation was 31 years (range 14–76). Mean duration of symptoms before diagnosis was 2.8 years. Mean duration of follow-up was 34.21 months (±33.69). Mean disease duration was 15.6 years. At diagnosis, arthritis, malar rash, oral ulcers and alopecia were the commonest features. During the follow-up, the prevalence of nephritis, arthritis, neurological and hematological disease increased significantly. About 76% (n = 151) of the patients had organ damage at the time of data analysis, and renal disease was the commonest cause. Univariate analysis revealed that renal disease (P = 0.000), seizures (P = 0.048), pleural involvement (P = 0.019), alopecia (P = 0.000) and discoid lesions (P = 0.005) were predictors for damage. Multivariate model, however, revealed that only renal disease was independent risk factor for damage (P = 0.002). During the study period, 47 patients (24%) died (five due to disease-related complications and rest as a result of infections). The 3-, 5-, 10-, 15- and 20-year survival rates of our cohort were 99, 80, 77, 75 and 75%, respectively. Cox regression analysis revealed that renal involvement (P = 0.002) and infections (P = 0.004) were independent risk factors for mortality. The survival of our Pakistani SLE patients was significantly lower compared to that of the Caucasian series reported in last decade. Nephritis not only contributes to organ damage but also acts a major determinant for survival. Infection remains the commonest cause of death. Renal involvement and infections are independent risk factors for mortality. Judicious use of immunosuppressive agents is necessary to improve the short-term survival of lupus patients.

Key Words: lupus • prognosis • prognostic indicators • survival

Lupus, Vol. 18, No. 9, 848-855 (2009)
DOI: 10.1177/0961203309103410


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