Arrucha-Cozaya Michelle, Zamora-Zúñiga Nuria Cecilia, Miranda-Hernández Dafhne, Bustamante-González Reyna, Martínez-Díaz Gabriela, Tovar-Rodríguez Drusila, López-Zamora Berenice, Del Pilar Cruz-Domínguez María, Gracia-Ramos Abraham Edgar, Saavedra Miguel Angel
Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.
Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Rheumatol Int. 2023 Dec;43(12):2221-2231. doi: 10.1007/s00296-023-05469-1. Epub 2023 Sep 30.
Systemic lupus erythematosus (SLE) is a disease that affects the immune system, and it can lead to increased morbidity and mortality. The primary causes of mortality for individuals with SLE are disease activity, infections, drug toxicity, and other health conditions. The aim of this study is to estimate the mortality rate of patients with SLE who are hospitalized, describe the causes of death, and identify factors associated with mortality. The study was conducted at a referral hospital from 2009 to 2021, utilizing a nested case-control design. The records of patients with SLE who were hospitalized in the Department of Rheumatology were reviewed. Cases were identified as individuals who died during their hospitalization, while controls were those who were discharged alive during the same period. Elective hospitalizations were not included in the study. The primary causes of death were recorded, and demographic, clinical, laboratory, and immunological variables were analyzed as potential risk factors associated with in-hospital mortality. The study included 105 patients who died while hospitalized and 336 who were discharged alive. The estimated mortality rate was 10.93 deaths per 1000 hospital admissions per year. The leading causes of death were SLE activity (20%), infections (34.2%), or a combination of both (24.8%). Risk factors associated with in-hospital mortality were any infection (OR 2.5, CI 95% 1.2-5.2), nosocomial infections (OR 5.0, CI 95% 1.8-13.7), SLEDAI-2K > 2 (OR 2.0, CI 95% 1.02-3.8), lymphopenia (OR 2.1, CI 95% 1.01-4.6), anemia (OR 2.9, CI 95% 1.4-5.7), and thrombocytopenia (OR 3.3, CI 95% 1.7-6.4). Disease activity and infections, particularly nosocomial infections, are significant causes of mortality in hospitalized patients with SLE. Furthermore, hematological manifestations play a significant role in in-hospital mortality for these patients.
系统性红斑狼疮（SLE）是一种影响免疫系统的疾病，它会导致发病率和死亡率上升。SLE患者的主要死亡原因是疾病活动、感染、药物毒性和其他健康状况。本研究的目的是估计住院SLE患者的死亡率，描述死亡原因，并确定与死亡率相关的因素。该研究于2009年至2021年在一家转诊医院进行，采用巢式病例对照设计。对在风湿病科住院的SLE患者的记录进行了回顾。病例被确定为在住院期间死亡的个体，而对照则是同期存活出院的个体。择期住院患者不包括在研究范围内。记录主要死亡原因，并分析人口统计学、临床、实验室和免疫学变量作为与住院死亡率相关的潜在风险因素。该研究包括105例住院期间死亡的患者和336例存活出院的患者。估计死亡率为每年每1000例住院患者中有10.93例死亡。主要死亡原因是SLE活动（20%）、感染（34.2%）或两者兼而有之（24.8%）。与住院死亡率相关的风险因素包括任何感染（比值比2.5，95%置信区间1.2 - 5.2）、医院感染（比值比5.0，95%置信区间1.8 - 13.7）、SLEDAI - 2K＞2（比值比2.0，95%置信区间1.02 - 3.8）、淋巴细胞减少（比值比2.1，95%置信区间1.01 - 4.6）、贫血（比值比2.9，95%置信区间1.4 - 5.7）和血小板减少（比值比3.3，95%置信区间1.7 - 6.4）。疾病活动和感染，尤其是医院感染，是住院SLE患者死亡的重要原因。此外，血液学表现对这些患者的住院死亡率起着重要作用。
