Mortality in systemic lupus erythematosus: causes, predictors and interventions

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by organ damage, flare-remission pattern, and increased mortality when compared with the general population. SLE mortality depends on epidemiological, sociodemographic, genetic, and clinical factors. Mortality causes have been mainly grouped in disease activity, infections, and cardiovascular complications. Lupus nephritis and neuropsychiatric lupus are the main manifestations associated to mortality. Bacterial infection remains an important cause of death, and cardiovascular mortality is almost double when compared to age - and sex-matched comparisons. Characteristics such as time from onset to diagnosis > 1-year, renal involvement, high SLEDAI and severe organ involvement, may be predictors of mortality. Interventions including steroids, immunosuppressants, plasmapheresis, some biologics, and vaccination have shown efficacy in reducing mortality rates. Areas covered: In this narrative review the epidemiology, main causes of mortality, potential predictors, and interventions are described. Expert commentary: Despite early diagnosis and immunosuppressive treatment, SLE mortality remains high. African-American, Hispanic-American origin, low socioeconomic status and male sex are associated with increased mortality. Currently, there is no unique, precise prediction model for mortality; however, predictors for increased activity such as infections and cardiovascular events, lead to increased mortality. New prediction models may indicate early interventions in order to improve mortality rates.

Keywords: SLE; cardiovascular events; causes; flares; infections; lupus nephritis; mortality; predictors; standardized mortality ratio.