Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.
Division of Rheumatology, Allergy and Immunology and Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Rheumatology (Oxford). 2019 May 1;58(5):840-848. doi: 10.1093/rheumatology/key335.
To examine the burden of comorbidities prior to and after the diagnosis of SLE and its impact on mortality.
We identified 1605 incident cases of SLE and 6284 matched controls from the UK primary care. The risks of comorbidities before (prevalence; odds ratios) and after SLE diagnosis (incidence; hazard ratios) and the impact of comorbidities at diagnosis on all-cause mortality were estimated.
At diagnosis, SLE was associated with adjusted odds ratios (95% CI) of 2.25 (1.97-2.56), 3.37 (2.49-4.57) and 3.54 (1.89-6.63) for a Charlson comorbidity index of 1-2, 3-4 and ≥5, respectively. Following diagnosis, SLE also associated with increased risk of developing any comorbidity with an adjusted hazard ratio (95% CI) of 1.30 (95% CI, 1.13-1.49). At diagnosis, SLE was associated with a greater risk of cancer, cardiovascular, renal, liver, rheumatological and neurological diseases as well as depression, anaemia and psoriasis. Risks of developing incident comorbidity in the categories of neoplasm, cardiovascular, genitourinary, metabolic/endocrine, gastrointestinal and hepatic diseases, chronic pulmonary diseases, musculoskeletal/connective tissue and neurological diseases were higher in SLE patients. People with SLE had higher mortality risk compared with controls, with adjusted hazard ratio of 1.91 (95% CI, 1.62-2.26); after further adjusting for comorbidities this reduced to 1.64 (1.37-1.97). Comorbidities at SLE diagnosis accounted for 27.6% of the apparent difference in mortality between SLE patients and matched controls.
People with SLE have increased risks of multiple comorbidities both prior to and after diagnosis and this contributes significantly to all-cause mortality.
研究在确诊系统性红斑狼疮（SLE）前后合并症的负担及其对死亡率的影响。
我们从英国初级保健系统中确定了 1605 例新确诊的 SLE 病例和 6284 例匹配对照。评估了合并症在 SLE 诊断前（患病率；比值比）和诊断后的（发病率；风险比）的风险，以及诊断时合并症对全因死亡率的影响。
在诊断时，SLE 与 Charlson 合并症指数为 1-2、3-4 和≥5 的患者的调整后比值比（95%CI）分别为 2.25（1.97-2.56）、3.37（2.49-4.57）和 3.54（1.89-6.63）。诊断后，SLE 也与任何合并症的发病风险增加相关，调整后的风险比（95%CI）为 1.30（95%CI，1.13-1.49）。在诊断时，SLE 与癌症、心血管疾病、肾脏疾病、肝脏疾病、风湿病和神经病以及抑郁症、贫血和银屑病的风险增加相关。SLE 患者新发合并症的风险在肿瘤、心血管、泌尿生殖、代谢/内分泌、胃肠道和肝脏疾病、慢性肺部疾病、肌肉骨骼/结缔组织和神经病等类别中更高。与对照组相比，SLE 患者的死亡率风险更高，调整后的风险比为 1.91（95%CI，1.62-2.26）；进一步调整合并症后，该风险比降至 1.64（1.37-1.97）。SLE 诊断时的合并症占 SLE 患者和匹配对照组之间死亡率差异的 27.6%。
SLE 患者在确诊前和确诊后都有发生多种合并症的风险增加，这对全因死亡率有显著影响。
