Causes of death of systemic lupus erythematosus patients in the past twenty-five years / 中华风湿病学杂志

ObjectiveTo investigate the changes of major causes of death of patients with systemic lupus erythematosus(SLE).MethodsDeath cases with SLE from January 1986 to May 2011 in Peking Union Medical College Hospital were retrospectively analyzed.ResultsOut of 3554 patients with SLE,252 patients died,including 223 women and 29 men.The mortality rate was 7.2％ among female and 6.2％ among male,the overall mortality rate was 7.1％.The mortality rate in SLE patients had dropped steadily in the past 25 years,but there was a mild increase of mortality in 2006-2011 compared with that in 2001-2005 (5.7％vs 5.3％ ).In addition to infection,neuropsychiatric lupus and lupus nephritis had become the most common causes of death in SLE patients during the past 25 years.Furthermore,diffuse alveolar hemorrhage,severe pulmonary hypertension,coronary heart disease,thrombocytopenia,interstitial lung disease,lupus pneumonia,gastrointestinal hemorrhage, intestinal obstruction and multiple organ failure were the common causes of death,accounting for 4.4％,4.4％,3.2％,2.8％,2.4％,2.0％,2.0％,1.2％ and 1.2％ of all the death cases respectively.From 1986 to 2005,infection,neuropsychiatric lupus and lupus nephritis were the most common causes of death in patients with SLE,whereas the cases dying from lupus nephritis had decreased obviously and severe pulmonary hypertension had become the third most frequent causes of death during the past 5years.From 1986 to 1990,lupus nephritis,infection and neuropsychiatric lupus accounted for 31.4％,25.7％and 25.7％ of death cases respectively.From 1991 to 1995,lupus nephritis,infection and neuropsychiatric lupus accounted for 27.6％,24.1％ and 24.1％ respectively.From 1996 to 2000,infection,neuropsychiatric lupus and lupus nephritis took up 31.6％,21.1％ and 15.8％ respectively.From 2001 to 2005,infection,neuropsychiatric lupus and lupus nephritis took up 34.9％,20.6％ and 7.9％ respectively.From 2006 to 2011,infection, neuropsychiatric lupus and pulmonary hypertension accounted for 60.3％, 11.8％ and 7.4％ respectively.The mortality in the first year was the highest in the whole disease course,accounting for 32.5％ of patients.Deaths caused by neuropsychiatric lupus and infection happened most frequently during the first year,accounting for 41.9％ and 32.9％,whereas deaths caused by lupus nephritis occurred most frequently 10 years later,accounting for 32.3％.Age and gender had significant association with the major causes of death.The male patients took up 50.0％ of the total patients dying from coronary heart disease,in which 75.0％ of patients were older than 50 years.ConclusionInfection,neuropsychiatric lupus and lupus nephritis are the three most common causes of death in SLE patients fron 1986 to 2005.Severe pulmonary hypertension has become the third most frequent causes of death during the past 5 years instead of lupus nephritis.Severe infection has increased significantly and has been the leading cause of death in SLE patients in recent 5 years.

Analysis of locations and pathogens of systemic lupus erythematosus cases died from infection / 中华风湿病学杂志

Objective To investigate the location and the pathogens of systemic lupus erythematosus (SLE) patients who died from infection.Methods Dead cases of hospitalized SLE patients in Peking Union Medical Hospital from January 1986 to May 2011were retrospectively analyzed.Results Severe infection was an important cause of mortality in patients with SLE.There were 252 dead cases of SLE in total from 1986 to 2011,in which 97 cases died from severe infection.The proportion of patients died from infection was gradually increased during the past 26 years,which was 25.7％,24.1％,31.6％,34.9％ and 60.3％ in 1986-1990,1991-1995,1996-2000,2001-2005 and 2006-2011respectively.Lung was the most common site of infec-t ion,accounting for 65％ of all dead cases.Among the 31cases with identified microorganism,14 patients had single microorganism infection and 17 patients had mixed infections.In the single microorganism infection patients,fungal infection contributed to the cause of death in 9 out of 14 (64％) patients,of which 4,2,1,1,and 1 cases were infected with Pneumocystis carinii, Aspergillus fumigates,Fusarium,Candida tropicalis and Cryptococcus respectively.There were 3 cases of bacteria infection,including 2 cases with Methicillinresistant staphylococcus,aureus and 1case with Klebsiella pneumoniae infection.Two patients died from pulmonary tuberculosis.In 17 patients with mixed infection cases, 14 deaths were caused by bacteria infection,including Acinetobacter baumannii, Eschefichia coli, Enterococcus, Klebsiella pneumoniae,Pseudomonas aeruginosa and Enterobacter cloacae.Eleven patients died from mixed fungus infection,including 6 cases of Aspergillus fumigates,3 cases of Candida tropicalis,3 cases of Pneumocystis carinii,2 cases of Aspergillus flavus,1 case of Soil Aspergillus,2 cases of Candida albicans,1 case of Candida glabrata and Candida Krusei.In addition to bacteria and fungi infection,cytomegalovirus infection occurred frequently in SLE death cases.Conclusions Severe infection has been the most frequent cause of death in SLE patients,in which lung infection is the leading cause.Pneumocystis carinii,Aspergillus fumigates,Acinetobacter baumannii and cytomegalovirus are the major pathogens that cause death in SLE patients.