Department of Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam.
Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht.
Rheumatology (Oxford). 2021 Jan 5;60(1):207-216. doi: 10.1093/rheumatology/keaa267.
We wanted to estimate the magnitude of the risk from all-cause, cause-specific and sex-specific mortality in patients with SLE and relative risks compared with matched controls and to evaluate the influence of exposure to medication on risk of mortality in SLE.
We conducted a population-based cohort study using the Clinical Practice Research Datalink, Hospital Episode Statistics and national death certificates (from 1987 to 2012). Each SLE patient (n = 4343) was matched with up to six controls (n = 21 780) by age and sex. Cox proportional hazards models were used to estimate overall and cause-specific mortality rate ratios.
Patients with SLE had a 1.8-fold increased mortality rate for all-cause mortality compared with age- and sex-matched subjects [adjusted hazard ratio (HR) = 1.80, 95% CI: 1.57, 2.08]. The HR was highest in patients aged 18-39 years (adjusted HR = 4.87, 95% CI: 1.93, 12.3). Mortality rates were not significantly different between male and female patients. Cumulative glucocorticoid use raised the mortality rate, whereas the HR was reduced by 45% with cumulative low-dose HCQ use. Patients with SLE had increased cause-specific mortality rates for cardiovascular disease, infections, non-infectious respiratory disease and for death attributable to accidents or suicide, whereas the mortality rate for cancer was reduced in comparison to controls.
British patients with SLE had a 1.8-fold increased mortality rate compared with the general population. Glucocorticoid use and being diagnosed at a younger age were associated with an increased risk of mortality. HCQ use significantly reduced the mortality rate, but this association was found only in the lowest cumulative dosage exposure group.
我们旨在评估系统性红斑狼疮（SLE）患者全因、病因特异性和性别特异性死亡率的幅度，并与匹配对照相比评估相对风险，以及评估暴露于药物对 SLE 患者死亡率的影响。
我们使用临床实践研究数据链接、医院病例统计数据和国家死亡证明（1987 年至 2012 年）开展了一项基于人群的队列研究。每例 SLE 患者（n=4343）通过年龄和性别与多达 6 名对照（n=21780）相匹配。采用 Cox 比例风险模型估计全因和病因特异性死亡率率比。
与年龄和性别匹配的受试者相比，SLE 患者的全因死亡率增加了 1.8 倍（校正后的危险比 [HR] = 1.80，95%CI：1.57，2.08）。18-39 岁患者的 HR 最高（校正 HR = 4.87，95%CI：1.93，12.3）。男性和女性患者的死亡率没有显著差异。累积使用糖皮质激素会增加死亡率，而累积使用低剂量 HCQ 则使 HR 降低 45%。SLE 患者的心血管疾病、感染、非传染性呼吸道疾病以及归因于意外或自杀的死亡率均高于对照，而癌症死亡率则低于对照。
与普通人群相比，英国 SLE 患者的死亡率增加了 1.8 倍。糖皮质激素的使用和较年轻的诊断年龄与死亡率增加相关。HCQ 的使用显著降低了死亡率，但仅在最低累积剂量暴露组中发现了这种关联。
