Faco M M M, Leone C, Campos L M A, Febrônio M V, Marques H H S, Silva C A
Unidades de Reumatologia e Infectologia Pediátricas, Instituto da Criança, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Braz J Med Biol Res. 2007 Jul;40(7):993-1002. doi: 10.1590/s0100-879x2006005000110.
We assessed the risk factors associated with death in patients hospitalized for juvenile systemic lupus erythematosus (JSLE) and evaluated the autopsy reports. A total of 57,159 hospitalizations occurred in our institution from 1994 to 2003, 169 of them involving 71 patients with JSLE. The most recent hospitalization of these patients was evaluated. Patients were divided into two groups based on mortality during hospitalization: those who survived (N = 53) and those who died (N = 18). The main causes of hospitalization were JSLE activity associated with infection in 52% and isolated JSLE activity in 44%. Univariate analysis showed that a greater risk of death was due to severe sepsis (OR = 17.8, CI = 4.5-70.9), systemic lupus erythematosus disease activity index (SLEDAI) >or=8 (OR = 7.6, CI = 1.1-53.8), general infections (OR = 6.1, CI = 1.5-25), fungal infections (OR = 5.4, CI = 3.2-9), acute renal failure (OR = 5.1, CI = 2.5-10.4), acute thrombocytopenia (OR = 3.9, CI = 1.9-8.4), and bacterial infections (OR = 2.3, CI = 1.2-7.5). Stratified analysis showed that severe sepsis and SLEDAI >or=8 were not confounder variables. In the multivariate analysis, logistic regression showed that the only independent variable in death prediction was severe sepsis (OR = 98, CI = 16.3-586.2). Discordance between clinical diagnosis and autopsy was observed in 6/10 cases. Mortality of hospitalized JSLE patients was associated with severe sepsis. Autopsy was important to determine events not detected or doubtful in dead patients and should always be requested.
我们评估了青少年系统性红斑狼疮（JSLE）住院患者的死亡相关危险因素，并对尸检报告进行了评估。1994年至2003年期间，我们机构共发生了57159次住院治疗，其中169次涉及71例JSLE患者。对这些患者最近一次住院情况进行了评估。根据住院期间的死亡率将患者分为两组：存活患者（N = 53）和死亡患者（N = 18）。住院的主要原因是52%与感染相关的JSLE活动以及44%的孤立性JSLE活动。单因素分析显示，死亡风险较高的原因包括严重脓毒症（OR = 17.8，CI = 4.5 - 70.9）、系统性红斑狼疮疾病活动指数（SLEDAI）≥8（OR = 7.6，CI = 1.1 - 53.8）、一般感染（OR = 6.1，CI = 1.5 - 25）、真菌感染（OR = 5.4，CI = 3.2 - 9）、急性肾衰竭（OR = 5.1，CI = 2.5 - 10.4）、急性血小板减少症（OR = 3.9，CI = 1.9 - 8.4）和细菌感染（OR = 2.3，CI = 1.2 - 7.5）。分层分析显示，严重脓毒症和SLEDAI≥8不是混杂变量。在多因素分析中，逻辑回归显示死亡预测中唯一的独立变量是严重脓毒症（OR = 98，CI = 16.3 - 586.2）。10例中有6例观察到临床诊断与尸检结果不一致。JSLE住院患者的死亡率与严重脓毒症相关。尸检对于确定死亡患者未检测到或存在疑问的事件很重要，应始终要求进行。
