Alarcón G S, McGwin G, Bastian H M, Roseman J, Lisse J, Fessler B J, Friedman A W, Reveille J D
Department of Medicine, Schools of Medicine and Public Health, The University of Alabama at Birmingham 35294, USA.
Arthritis Rheum. 2001 Apr;45(2):191-202. doi: 10.1002/1529-0131(200104)45:2<191::AID-ANR173>3.0.CO;2-2.
To determine the features associated with mortality in a multiethnic US cohort of patients with systemic lupus erythematosus (SLE) within 5 years of study onset.
Socioeconomic and demographic features (age, gender, ethnicity, marital status, education, occupation, poverty, and health-related behaviors [drinking, smoking, exercising]), clinical and immunologic features (disease duration, disease onset type, disease activity according to the Systemic Lupus Activity Measure [SLAM], disease damage according to the Systemic Lupus International Collaborating Clinics [SLICC] Damage Index [SDI], number of American College of Rheumatology criteria at diagnosis, organ system manifestations, fatigue and pain ratings, and medication usage and autoantibodies), immunogenetic features (HLA class II genotypes), and behavioral and psychosocial features (social support, illness-related behaviors, and helplessness), as obtained at enrollment into the study, were compared between survivors and deceased patients. Logistic regression analysis was used to determine significant independent risk factors for mortality.
Within 5 years of study onset, 34 of 288 patients have died. Fourteen deaths could be directly attributed to SLE and 11 to infections. In 1 patient the cause of death could not be determined. In the remaining 8 patients the cause of death was neither infectious nor disease-related. There were 10 deaths among Hispanics, 18 among African Americans, and 6 among Caucasians (P < 0.05). Variables associated with mortality in the univariable analyses included poverty, less than full-time employment, difficulty in accessing health care, shorter disease duration, cardiovascular and renal involvement, higher serum creatinine levels and lower hematocrit values, higher SLAM and SDI scores, lower use of antimalarial drugs, and higher use of (some) immunosuppressants. Specific autoantibodies and class II HLA genotypes were not associated with mortality. Poverty and higher baseline SLAM and SDI scores were independently associated with mortality in the multivariable analyses.
Disease activity, disease damage, and poverty appear to be the most important determinants of mortality in this multiethnic US cohort of SLE patients. These results have applicability to the management of patients with SLE, a disease that more severely affects disadvantaged minority population groups.
确定美国一个多民族系统性红斑狼疮（SLE）患者队列在研究开始后5年内与死亡率相关的特征。
比较幸存者和死亡患者在入组研究时获得的社会经济和人口统计学特征（年龄、性别、种族、婚姻状况、教育程度、职业、贫困状况以及与健康相关的行为[饮酒、吸烟、锻炼]）、临床和免疫学特征（疾病持续时间、疾病发作类型、根据系统性狼疮活动度量表[SLAM]得出的疾病活动度、根据系统性狼疮国际协作临床组[SLICC]损伤指数[SDI]得出的疾病损伤、诊断时美国风湿病学会标准的数量、器官系统表现、疲劳和疼痛评分以及药物使用和自身抗体）、免疫遗传学特征（HLA II类基因型）以及行为和社会心理特征（社会支持、与疾病相关的行为和无助感）。采用逻辑回归分析确定死亡率的显著独立危险因素。
在研究开始后的5年内，288例患者中有34例死亡。14例死亡可直接归因于SLE，11例归因于感染。1例患者的死亡原因无法确定。其余8例患者的死亡原因既非感染也与疾病无关。西班牙裔中有10例死亡，非裔美国人中有18例，白种人中有6例（P<0.05）。单变量分析中与死亡率相关的变量包括贫困、非全职工作、获得医疗保健困难、疾病持续时间较短、心血管和肾脏受累、血清肌酐水平较高和血细胞比容值较低、SLAM和SDI评分较高、抗疟药物使用较少以及（某些）免疫抑制剂使用较多。特定的自身抗体和II类HLA基因型与死亡率无关。在多变量分析中，贫困以及较高的基线SLAM和SDI评分与死亡率独立相关。
疾病活动度、疾病损伤和贫困似乎是这个美国多民族SLE患者队列中死亡率的最重要决定因素。这些结果适用于SLE患者的管理，SLE是一种对弱势少数群体影响更为严重的疾病。
