Two aspects of the clinical and humanistic burden of systemic lupus erythematosus: Mortality risk and quality of life early in the course of disease
Two aspects of the clinical and humanistic burden of systemic lupus erythematosus: Mortality risk and quality of life early in the course of disease
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DOI：
10.1002/art.23539
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发表时间：
2008-04-15
期刊：
影响因子：
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通讯作者：
Gilkeson, Gary S.
中科院分区：
文献类型：
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作者：
Camtbell, Robert, Jr.;Cooper, Glinda S.;Gilkeson, Gary S.
目标。评价新近诊断的系统性红斑狼疮（SLE）患者的死亡风险及其预测因素。在卡罗莱纳狼疮研究中，265名SLE患者和355名对照者（自诊断以来的中位时间为13个月）的生命状态与入组后5年相似。我们还评估了8项生活质量工具的效用，该工具来自标准的36项医疗结果研究简表36，作为疾病影响的附加测量。确诊5年后，9.7%的患者和0.3%的对照组死亡（P < 0.0001）。老年患者的死亡风险增加（调整后的风险比[HR] 1.03, 95%可信区间[95% CI] 1.01-1.06），男性、非裔美国人、狼疮性肾炎患者和抗双链DNA抗体患者（调整后的风险比类似于2.0）。此外，在研究入组时未提供血液样本的患者死亡风险增加（年龄、性别和种族调整后的HR 3.7, 95% CI 1.5-9.1）。在限于研究入组时间的分析中也看到了类似的结果。与对照组相比，两组患者生活质量指标生理成分得分分别降低了7.7分（P < 0.0001）和1.8分（P = 0.07）。SLE患者的死亡风险是显著的，特别是在非裔美国人中，即使在疾病早期和目前可用的治疗中也是如此。使用短表8的病例和对照组在健康相关生活质量方面的差异也表明SLE的多维负担。
Objective. To evaluate mortality risk and predictors among recently diagnosed systemic lupus erythematosus (SLE) patients.Methods. The vital status of 265 SLE patients and 355 controls enrolled in the Carolina Lupus Study (median time since diagnosis 13 months) was determined similar to 5 years after enrollment. We also assessed the utility of an 8-item quality of life instrument, derived from the standard 36-item Medical Outcomes Study Short Form 36, as an additional measure of disease impact.Results. Five years after diagnosis, 9.7% of patients compared with 0.3% of controls had died (P < 0.0001). Increased mortality risk was seen among older patients (adjusted hazard ratio [HR] 1.03, 95% confidence interval [95% CI] 1.01-1.06 per 1-year increment in age) and among men, African Americans, patients with lupus nephritis, and patients with anti-double-stranded DNA antibodies (adjusted HR similar to 2.0 for each of these factors). In addition, patients who did not provide a blood sample at study enrollment experienced increased mortality risk (age-, sex-, and race-adjusted HR 3.7, 95% CI 1.5-9.1). Similar results were seen in analyses limited to time from study enrollment. Physical component scores of the quality of life measure were 7.7 points lower (P < 0.0001) and mental component scores were 1.8 points lower (P = 0.07) in patients compared with controls.Conclusion. The mortality risk among SLE patients is significant, particularly among African Americans, even early in the disease process and even with currently available treatments. Differences between cases and controls in health-related quality of life using the Short Form 8 also demonstrate the multidimensional burden of SLE.