Background and aims To identify early signs associated with poor prognosis in Chinese patients with systemic lupus erythematosus (SLE) through a large population-based follow-up study.

Methods Medical records of >2500 SLE patients that first hospitalised between 1999 −2009 were collected from 26 centres across Jiangsu province, China, and entered into a database. These patients were followed-up for 5 to 15 years, and those remained contact and had known survival status in 2015 were assessed for the association of factors presented at the initial hospitalisation with mortality. The independency of mortality factors was evaluated using multivariate Cox regression analysis.

Results Among 1372 patients we assessed, 92.3% were women and 17.2% were deceased in 2015. The main causes of death were infection, neuropsychiatric impairment, renal failure and cardiopulmonary involvement. Hazard ratios (HR) of independent predictors for mortality (≤1 year and >1 year, respectively) included hospital presentation of neuropsychiatric involvement (2.03 and 1.91), cardiopulmonary involvement (1.94 and 1.61) and increased serum creatinine (2.52 and 2.58). The presence of anti-dsDNA and anti-Sm antibodies indicated diverse prognosis after 1 year (HR 1.60 and 0.45). Treatment with cyclophosphamide was beneficial for patient’s first-year outcome (HR 0.50), and anti-malarial drugs significantly reduced the risk of mortality over different time points (HR 0.48 and 0.54). SLEDAI score, proteinuria or hypocomplementemia was not independently associated with the outcome.

Conclusions SLE patients presented with vital organ damages rather than active disease at initial hospitalisation are likely to have a poor outcome. Early and effective intervention with the use of anti-malarial drugs may decrease mortality.