A prospective study of survival and prognostic indicators of systemic lupus erythematosus in a southern Chinese population

Objectives. To study the survival rate and prognostic indicators of systemi c lupus erythematosus (SLE) in a southern Chinese population. Methods. One hundred and eighty-six patients with SLE diagnosed between 199 2 and 1999 were prospectively followed. Clinical features at presentation, subsequent evolving features, autoantibody profile, damage scores and morta lity data were obtained. Prognostic factors for survival were studied by st atistical analysis. Results. One hundred and sixty-three female and 23 male SLE patients were s tudied. The female to male ratio was 7.1 to 1 and the mean age at presentat ion was 33.6 yr (range 12-75). The mean disease duration was 45.2 months. A t diagnosis, arthritis, malar rash and alopecia were the commonest features . During follow-up, the prevalence of nephritis, arthritis, photosensitivit y and haematological disease increased significantly. Thirty-one per cent o f the patients had organ damage at the time of data analysis and renal dise ase was the commonest cause. Logistic regression revealed that central nerv ous system disease, discoid lesions and treatment with high-dose steroid we re independent predictors for damage. Nine patients died during the study p eriod (three of disease-related complications and six of infections). The 3 -, 5-, and 7-yr survival rates of our cohort were 97, 93 and 93%, respectiv ely. Cox regression analysis revealed that thrombocytopenia and high-dose s teroid treatment were independent risk factors for mortality. Conclusions. The survival of SLE in our southern Chinese patients is simila r to that of the Caucasian series reported in the 1990s. Although nephritis contributes to organ damage, it is not a major determinant for survival. I nfection remains the commonest cause of death. High-dose steroid treatment and thrombocytopenia are independent risk factors for mortality. Judicious use of immunosuppressive agents is necessary to improve the short-term surv ival of SLE.