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Michael M. Ward, MD, MPH; Elise Pyun, MD; Stephanie Studenski, MD, MPH

Arch Intern Med. 1996;156(12):1337-1344.

Abstract
Background
Mortality in patients with systemic lupus erythematosus (SLE) is often related to disease in particular organ systems. We examined the risks of mortality associated with 8 clinical manifestations of SLE and determined whether these risks differed among patients with different sociodemographic characteristics.

Methods
Using life table analysis, we determined the associations of hemolytic anemia, leukopenia, thrombocytopenia, arthritis, serositis, nephritis, psychosis, and seizures with both all-cause mortality and SLE-related mortality in a cohort of 408 patients.

Results
Over a median duration of follow-up of 11 years, 144 patients died; 78 deaths (54%) were SLE related. In univariate analyses, the presence of hemolytic anemia, serositis, nephritis, psychosis, and seizures was associated with greater all-cause mortality, while the presence of arthritis was protective. In multivariate analyses that controlled for patient demographic characteristics, nephritis (relative risk, 2.34) and seizures (relative risk, 1.77) were associated with poorer overall survival. Nephritis and seizures, along with thrombocytopenia, were also associated with greater SLE-related mortality, while leukopenia was protective. The risk of death in association with these clinical manifestations did not differ among patient age, sex, race, or socioeconomic subgroups.

Conclusions
The presence of nephritis and seizures each increased the risk of death in patients with SLE approximately 2-fold. Thrombocytopenia also increased the risk of SLE-related mortality, while leukopenia was protective.

(Arch Intern Med. 1996;156:1337-1344)

Author Affiliations
From the Medical Service, Palo Alto Veterans Affairs Medical Center, Palo Alto, Calif, and the Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, Calif (Dr Ward); the Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC (Dr Pyun); and the Center on Aging, University of Kansas Medical Center, Kansas City (Dr Studenski). Dr Pyun is now with Fallon Clinic, Worcester, Mass.

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