| ObjectiveThis study aims to exhibit the prognosis, both mortality and morbidity, for patients with Systemic Lupus Erythematosus (SLE) in a large single-center and multi-center cohort in China.MethodsA large multi-center cohort of Chinese SLE patients were recruited from April 2009 to February 2010, and followed up regularly in clinic. Data for baseline, follow-up and survival were collected, including demography, manifestations, activity (SLEDAI-2K), SLE International Collaborating Clinics Damage Index (SDI), and medications. Data from the largest single-center was collected and analyzed first, and then the multic-center. Kaplan-Meier method was adopted for survival analysis. Predicting and risk factors for both mortality and morbidity were evaluated by COX proportional hazard model. Associated factors were analyzed by Logistic Regression model.ResultsA total of 260 patients (female:male=237:23) were included in single-center cohort study. The 1,3 and 5 year survival rates were 99.2%,95.9% and 94.3%, respectively. Multivariate Cox regression analysis indicated that time from onset to diagnosis>1 year[HR 3.096,95%CI 1.109-8.643, p=0.031], organ damage[HR 6.841,95%CI 1.890-24.752, p=0.003] and severe organ involvement[HR 5.233,95%CI 1.466-18.682, p=0.011] are independent predictors for all-cause mortality. The proporation of patients with organ damage increased from 12.8% at baseline to 27.5% at year 6. The top 3 organ damages were musculoskeletal 32.1%, neuropsychiatric 17.9% and pulmonary 10.7%. Cox regression analysis indicated that onset age>50[RR 3.538,95%CI 1.602-7.816, p=0.002], previous organ damage[RR 2.670,95%CI 1.106-6.449,p=0.029] and organ involved flare[RR 3.167,95%CI 1.609-6.232, p=0.001] are risk factors for new damage, and among them late-onset age and organ involved flare are independent risk factors for new damage. At entry, the top 2 involved organs were HEMA 54.6% and LN 49.0%. For new developed organ involvement, LN (43.3%) and NPSLE (23.3%) took the most part. The yearly flare rate for consecutively followed up patients was 14.7-20.6%. The rate with no flare at year 1,3 and 5 were 79.3%,59.8%,47.2%. Finally,17.1% of the consecutively followed patients developed prolonged clinical remission (remission for 5 years). At entry, a total of 2104 SLE patients were recruited for multi-center cohort study and 1542 patients were followed up. The 1,3 and 5 year survival rates were 99.3%,98.2%,97.2%. Multivariate Cox regression analysis indicated that male[HR 2.021,95%CI 1.053-3.881, p=0.034], age at onset>50[HR 3.482,95%CI 1.762-6.878, p<0.001], time from onset to diagnosis>1 year[HR 1.771,95%CI 1.070-2.930, p=0.026] and organ damage[HR 2.968, 95%CI 1.693-5.202, p<0.001], serositis[HR 2.247,95%CI 1.083-4.665, p=0.030] and severe organ involvement[HR 2.326,95%CI 1.191-4.543, p=0.013] are independent predictors for all-cause mortality.ConclusionLong-term survival rates in our cohort are comparable to previous reported ones for both Chinese and Caucasians. For Chinese SLE patients, gender, late-onset age, time from onset to diagnosis, organ damage, serositis and severe organ involvement are prognostic factors and deserve more attention in the future. Late-onset age, previous Damage and organ involved flare may lead to more damage accrual afterwards for Chinese SLE patients. |
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