Mortality in systemic lupus erythematosus
Mortality in systemic lupus erythematosus
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DOI：
10.1002/art.21955
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发表时间：
2006-08-01
影响因子：
--
通讯作者：
Ramsey-Goldman, R.
中科院分区：
文献类型：
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作者：
Bernatsky, S.;Boivin, J. -F.;Ramsey-Goldman, R.
Objective.研究有史以来最大的系统性红斑狼疮（SLE）队列的死亡率。我们的样本是一个多中心的国际SLE队列（23个中心，9,547例患者）。死亡是通过生命统计登记联系确定的。标准化死亡率比（SMR;观察到的死亡与预期死亡的比率）估计值计算所有死亡和原因。性别、年龄、SLE病程、种族和病程的影响被确定。总体SMR为2.4（95%置信区间2.3-2.5）。循环系统疾病、感染、肾脏疾病、非霍奇金淋巴瘤和肺癌的死亡率特别高。最高SMR估计值见于女性、年龄较小、SLE病程< 1年或黑人/非裔美国人种族的患者组。在过去的几年中，SMR估计值大幅下降，这在特定原因中得到证实，包括感染导致的死亡和肾脏疾病导致的死亡。但循环系统疾病的SMR从70年代到2001年有小幅上升的趋势。我们来自一个非常大的多中心国际队列的数据强调了以前在较小样本中已经证明的内容。这些结果强调了与一般人群相比，系统性红斑狼疮患者的死亡率增加，并且表明与女性、年龄较小、系统性红斑狼疮持续时间较短和黑人/非裔美国人种族相关的特定风险。某些类型的死亡风险，主要与狼疮活动（如肾脏疾病）有关，随着时间的推移而下降，而由于循环系统疾病导致的死亡风险似乎没有减少。
Objective. To examine mortality rates in the largest systemic lupus erythematosus (SLE) cohort ever assembled.Methods. Our sample was a multisite international SLE cohort (23 centers, 9,547 patients). Deaths were ascertained by vital statistics registry linkage. Standardized mortality ratio (SMR; ratio of deaths observed to deaths expected) estimates were calculated for-all deaths and by cause. The effects of sex, age, SLE duration, race, and calendar-year periods were determined.Results. The overall SMR was 2.4 (95% confidence interval 2.3-2.5). Particularly high mortality was seen for circulatory disease, infections, renal disease, non-Hodgkin's lymphoma, and lung cancer. The highest SMR estimates were seen in patient groups characterized by female sex, younger age, SLE duration < 1 year, or black/African American race. There was a dramatic decrease in total SMR estimates across calendar-year periods, which was demonstrable for specific causes including death due to infections and death due to renal disorders. However, the SMR due to circulatory diseases tended to increase slightly from the 1970s to the year 2001.Conclusion. Our data from a very large multicenter international cohort emphasize what has been demonstrated previously in smaller samples. These results highlight the increased mortality rate in SLE patients compared with the general population, and they suggest particular risk associated with female sex, younger age, shorter SLE duration, and black/African American race. The risk for certain types of deaths, primarily related to lupus activity (such as renal disease), has decreased over time, while the risk for deaths due to circulatory disease does not appear to have diminished.