Division of Rheumatology, Department of Internal Medicine, Medical College, Chungbuk National University, Cheongju, South Korea.
Lupus. 2011 Aug;20(9):989-97. doi: 10.1177/0961203311402245. Epub 2011 Jun 23.
We investigated the causes of death and analyzed the prognostic factors in Korean systemic lupus erythematosus (SLE) patients. We evaluated 1010 patients with SLE who visited Seoul Saint Mary's Hospital from 1997-2007. Changing patterns in the causes of death were analyzed. Survival rate was calculated by the Kaplan-Meier method and the log-rank test. The risk factors for death were analyzed by multivariate logistic regression analysis. The 5-year survival rate was 97.8%. Over the period of the study, 59 deaths were observed. Among 44 patients who died in our hospital, the most common cause of death was infection (37.3%), with SLE-related death as the next most frequent cause (22.0%). In comparison with earlier data, the proportion of SLE-related deaths has fallen and the proportion of infections has risen. SLE-related death was the most frequent cause of early death, while infection was the most common cause of death in the overall population. In univariate analysis, damage related to SLE, cumulative glucocorticoid dose, mean glucocorticoid dose for 1 month before death, intravenous methylprednisolone therapy and cyclophosphamide treatment were associated with death (p < 0.001 each). The late onset of SLE and renal involvement were predictive factors of poor outcome (p = 0.03 and p < 0.001). In multivariate analysis, the risk factors for death were irreversible damage related to SLE, cyclophosphamide therapy and mean glucocorticoid dose for 1 month before death. The most common cause of death in Korean SLE patients was infection. The judicious use of immunosuppressive agents may be important to decrease infection and to improve survival in SLE patients.
我们研究了韩国系统性红斑狼疮（SLE）患者的死亡原因，并分析了其预后因素。我们评估了 1997 年至 2007 年期间在首尔圣玛丽医院就诊的 1010 例 SLE 患者。分析了死亡原因的变化模式。通过 Kaplan-Meier 方法和对数秩检验计算生存率。通过多变量 logistic 回归分析分析死亡的危险因素。5 年生存率为 97.8%。在研究期间，观察到 59 例死亡。在我院死亡的 44 例患者中，最常见的死亡原因为感染（37.3%），其次为与 SLE 相关的死亡（22.0%）。与早期数据相比，SLE 相关死亡的比例下降，感染的比例上升。SLE 相关死亡是早期死亡的最常见原因，而感染是总体人群死亡的最常见原因。单因素分析显示，SLE 相关损害、累积糖皮质激素剂量、死亡前 1 个月的平均糖皮质激素剂量、静脉甲基强的松龙治疗和环磷酰胺治疗与死亡相关（p<0.001）。SLE 发病晚和肾累及是预后不良的预测因素（p=0.03 和 p<0.001）。多因素分析显示，死亡的危险因素为 SLE 的不可逆损害、环磷酰胺治疗和死亡前 1 个月的平均糖皮质激素剂量。韩国 SLE 患者最常见的死亡原因为感染。合理使用免疫抑制剂可能有助于减少感染并改善 SLE 患者的生存。
