Risk of mortality in systemic lupus erythematosus patients in Indonesia: A retrospective cohort study

Abstract

Purpose

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that associated with great mortality. However, studies on survival & predictors mortality in SLE are lacking in developing countries in Asia region. To calculate survival rates and to determine the cause and suggestive risk factors of mortality in SLE patients.

Patients and methods

This study included all SLE patients in Hasan Sadikin Lupus Registry (HSLR) cohort in Hasan Sadikin Hospital Bandung between September 2001 to December 2020. Cox-regression model was used to determine the risk factors of mortality, whereas Kaplan-Meier method used to estimate survival probabilities since diagnosis.

Results

There were 1263 patients included in this study and 125 of them were deceased. Infection (40.8%) was the most common cause of death. The 1, 5 and 10-year survival rate among our patients were 95.6%, 89.7% and 82.1%, respectively. Male sex (HR 1.89), active SLE (HR 6.06), hemolytic anemia (HR 1.62) and serositis (HR 1.74) involvement throughout the disease, and use of methylprednisolone pulse (HR 1.75) due to high disease activity significantly affect mortality. On the other hand, the use of azathioprine (HR 0.61), mycophenolic mofetil/ mycophenolic acid (MMF/MPA, HR 0.43), and anti-malaria (chloroquine/hydroxychloroquine (CQ/HCQ)) (HR 0.5) had protective effect towards mortality.

Conclusion

Survival rates of SLE patients was still low in Indonesia. Hemolytic anemia and serositis involvement throughout the disease, male sex, and active SLE, along with the use of methylprednisolone pulse were significantly affect mortality of SLE in this study. Meanwhile the use of azathioprine, MMF/MPA, and anti-malaria therapy had protective effect on SLE mortality.