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Abstract
Background and aims To investigate the long-term outcomes, both mortality and damage, and predict factors of patients with systemic lupus erythematosus (SLE) in the CSTAR (Chinese SLE Treatment and Research group) registry cohort.
Methods Patients were enrolled from April 2009 to February 2010. They were followed up at clinic and were telephone interviewed at the endpoint. Demographic data, clinical manifestations, activity, damage scores, and medications were collected. Survival rates were studied by Kaplan-Meier method, and COX proportional hazard model was adopted to perform the analysis of predicting factors for mortality.
Results A total of 2104 patients were recruited at baseline, and 1494 patients were successfully followed up. The cumulative 1, 3 and 5 year survival rates from diagnosis were 99.0%, 98.1% and 97.1%. 78 patients died during follow-up, and the main death causes were infection (34.6%), active disease (26.9%), cardiovascular and cerebrovascular events (6.41%) and malignancy (5.13%). At entry, 247 patients presented with irreversible organ damage, 398 patients at the endpoint. The major accumulated organ damages were renal (25.9%), musculoskeletal (20.2%), neuropsychiatric (12.4%), and pulmonary (10.8%) damage. Cox regression showed that male, late onset (≥50y), onset to diagnosis time ≥1 year, previous organ damage, renal involvement, pulmonary arterial hypertension, neuropsychiatric involvement, serositis and the number of involved organ systems ≥3predict for higher mortality.
Independent predictors of morality obtained by univariate analysis
Independent predictors of morality obtained by multivariate analysis
Conclusions Long-term survival rates of SLE patients have been improved in China. Early diagnosis, preventing from the emerging systemic organ involvements and organ damage could be the treating target for the management of SLE patients.