Journal Article

POS1105 MORTALITY PATTERNS AND RISK FACTORS IN KOREAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A POPULATION-BASED COHORT STUDY

Kang, G., Jung, S. Y., Han, J. Y., Cho, S. K., Jang, E. J., Jeon, Y., Sung, Y. K.

2024

Overview

Background:Systemic Lupus Erythematosus (SLE) is a multifaceted autoimmune disorder characterized by diverse clinical manifestations. Despite improved survival rates, the mortality risk in SLE patients remains elevated compared to the general population.Objectives:To evaluate the patterns of mortality and associated risk factors in Korean patients with SLE.Methods:Using data from the National Health Insurance database spanning 2008 to 2018, incident SLE patients aged 10-79 years were included. The primary endpoint was all-cause death and cause-specific death, with secondary outcomes focusing on cause-specific death stratified by age group. The main causes of death were identified using the ICD-10 code of the primary diagnosis within six months prior to death. The mortality rate (MR) was calculated as the number of deaths per 100,000 person-years (PYs). A generalized estimating equations model was employed for risk factor analysis.Results:A total of 11,375 incident SLE patients were recruited, with an average age of 42.3 ± 16.7 years and 86.1% female. During 57,658 PYs of observation, 728 deaths occurred, resulting in an MR of 1,262.62 per 100,000 PYs. The MR for males (2,718.86/100,000 PYs) exceeded that for females (1,060.57/100,000 PYs). SLE itself (381.56/100,000 PYs) was the leading cause of death, followed by cardiovascular disease (202.92/100,000 PYs), cancer (175.17/100,000 PYs), infection (143.95/100,000 PYs), and renal disease (57.23/100,000 PYs). Age-specific mortality risk increased proportionally with both age and mortality risk. Among adolescents (10-19 years), all-cause MR was 520.47 per 100,000 PYs, with SLE itself accounting for over half of the cause of deaths. In elderly patients (70-79 years), all-cause mortality peaked at 7,252.06 per 100,000 PYs, emphasizing the impact of infection and cancer. Risk factor analysis for SLE-related mortality revealed significant associations with comorbidities (Table 1). Pulmonary alveolar hemorrhage (Hazard Ratio [HR] 9.93, 95% CI 3.81-25.89), pulmonary arterial hypertension (HR 3.77, 95% CI 1.54-9.21), and interstitial lung disease (HR 3.27, 95% CI 1.87-5.72) were identified as associated factors for mortality in Korean SLE patients. Medications were also associated with increased mortality risk; intravenous glucocorticoids (HR 16.38, 95% CI 10.06-26.66) and cyclophosphamide (HR 5.51, 95% CI 3.38-8.97) were linked to mortality risk in SLE.Conclusion:This study offers a comprehensive analysis of the mortality patterns in Korean SLE patients. SLE itself, cardiovascular disease, cancer, and infection emerged as the primary causes of death, with age at onset influencing mortality patterns. Pulmonary manifestations, intravenous glucocorticoids, and cyclophosphamide were significantly associated with an increased risk of mortality.Figure 1.All-cause and cause-specific mortality rate stratified by age groupTable 1.Risk factors for SLE-related mortalityVariablesUnivariable HR(95% CI)PMultivariable HR*(95% CI)PSLE-related comorbidities† Opportunistic infection4.41 (3.11, 6.27)< 0.0012.10 (1.37, 3.24)< 0.001 Antiphospholipid antibody syndrome0.71 (0.26, 1.91)0.5000.54 (0.20, 1.44)0.218Avascular necrosis1.00 (0.37, 2.69)0.9971.27 (0.46, 3.47)0.643Interstitial lung disease5.34 (3.51, 8.14)< 0.0013.27 (1.87, 5.72)< 0.001Pulmonary artery hypertension8.87 (4.70, 16.76)< 0.0013.77 (1.54, 9.21)0.004Pulmonary alveolar hemorrhage54.86 (29.49, 102.04)< 0.0019.93 (3.81, 25.89)< 0.001Congestive heart failure7.79 (5.69, 10.65)< 0.0013.06 (1.83, 5.14)< 0.001Lupus nephritis4.58 (3.44, 6.10)< 0.0012.15 (1.46, 3.18)< 0.001Medication††Oral glucocorticoid0.88 (0.68, 1.15)0.3560.64 (0.44, 0.93)0.018IV glucocorticoid19.34 (12.13, 30.85)< 0.00116.38 (10.06, 26.66)< 0.001Hydroxychloroquine0.39 (0.30, 0.51)< 0.0010.39 (0.28, 0.56)< 0.001Nonsteroidal anti-inflammatory drug0.36 (0.25, 0.52)< 0.0010.32 (0.22, 0.49)< 0.001Oral immunosuppressive agents0.64 (0.46, 0.87)0.0050.35 (0.23, 0.54)< 0.001IV cyclophosphamide14.32 (10.58, 19.39)< 0.0015.51 (3.38, 8.97)< 0.001*Adjusted for age, gender, payer type and comorbidities.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier B.V,Elsevier Limited
• Subject: Age groups / Alveoli / Anti-inflammatory agents / Antiphospholipid antibodies / Avascular necrosis / Cancer / Cardiovascular disease / Cardiovascular diseases / Comorbidity / Congestive heart failure / Cyclophosphamide / Death / Discriminant analysis / Epidemiology / Factor analysis / Glucocorticoids / Hemorrhage / Hydroxychloroquine / Hypertension / Immunosuppressive agents / Infections / Intravenous administration / Lung cancer / Lung diseases / Lupus / Lupus nephritis / Mortality / Opportunist infection / Population studies / Pulmonary arteries / Pulmonary artery / Risk factors / Scientific Abstracts / Sex/gender/diversity / Systemic lupus erythematosus