MORTALITY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A META-ANALYSIS OF OVERALL AND CAUSE-SPECIFIC EFFECTS

초록

Background/Purpose While therapeutic advancements have markedly refined the management of systemic lupus erythematosus (SLE), SLE patients persistently face mortality rates significantly higher—by 2 to 5-fold—than the general population. Persistent concerns about mortality rates necessitate a thorough appraisal of mortality trends within this complex patient cohort. The objective of this study was to assess the overall and cause-specific standardized mortality ratios (SMRs) among patients with SLE. Methods An exhaustive systematic review was undertaken, encompassing studies that scrutinized SMRs, both overall and for specific causes, in patients diagnosed with SLE compared to the general populace. The databases of PUBMED, EMBASE, and Cochrane were meticulously searched to collate relevant literature. Following this comprehensive search, a meta-analysis was executed to methodically assess all-cause, sex-specific, ethnicity-specific, and cause-specific SMRs in patients with SLE. Results The inclusion criteria were met by 29 studies encompassing 72,342 patients with SLE and documenting 7,352 deaths. The meta-analysis disclosed a pronounced 2.87-fold elevation in the SMR for all-cause mortality in SLE patients relative to the general population (SMR, 2.866; 95% confidence interval [CI], 2.490-3.242; p < 0.001). Region-specific assessments showed variable all-cause SMRs, with Europe reporting 2.607 (95% CI, 1.939-3.275; p < 0.001), Asia revealing 3.043 (95% CI, 2.082-4.004; p < 0.001), and particularly high SMRs noted in North America and Oceania. Gender-focused analyses presented a pooled SMR of 3.261 (95% CI, 2.674-3.848; p < 0.001) for females, and 2.747 (95% CI, 2.190-3.304; p < 0.001) for males. Evaluations specific to cause of death illustrated notably elevated SMRs for renal disease (SMR, 4.486; 95% CI, 3.024-5.948; p < 0.001), infections (SMR, 4.946; 95% CI, 4.253-5.639; p < 0.001), cardiovascular diseases (CVD) (SMR, 2.931; 95% CI, 1.802-4.061; p < 0.001), cerebrovascular accidents (CVA) (SMR, 1.588; 95% CI, 0.647-2.528; p = 0.001), and cancer (SMR, 1.698; 95% CI, 0.871-2.525; p < 0.001). Conclusions This meta-analysis shows a significant 2.87-fold elevation in the SMR among patients with SLE compared to the general population, transcending differences in sex or geographical regions. Moreover, an appreciable increase in mortality due to specific causes, including renal disease, infection, CVD, CVA, malignancy, and neuropsychiatric SLE, accentuates the imperative for targeted interventions to mitigate these elevated risks in SLE patients.