Mortality and Morbidity in Systemic Lupus Erythematosus (SLE)

Introduction to SLE Mortality

Infections, cardiovascular complications, and chronic kidney disease are the major causes of death in SLE patients, with early deaths primarily related to infections or lupus activity, while cardiovascular complications, malignancies, and kidney failure account for late mortalities 1
Patients with SLE show increased mortality rates compared to age- and sex-matched controls in the general population 1

Infections account for 25-50% of overall mortality in SLE patients 2
Half of SLE patients may experience severe infection, with more than 20% of hospitalizations being due to infections 2
Risk factors for infection include disease-related immune dysregulation and immunosuppressive therapy 2
Cardiovascular disease is a major cause of late mortality in SLE patients 1
SLE patients have both traditional risk factors (dyslipidemia, smoking, obesity) and non-traditional risk factors (proteinuria, inflammation) for cardiovascular disease 1
Risk attenuation strategies include dyslipidemia management, blood pressure control, and low-dose aspirin during pregnancy 1
Kidney involvement in SLE has been associated with higher mortality, especially for patients progressing to kidney failure 3
Lupus nephritis occurs in 20-60% of SLE patients and is a major determinant of overall morbidity and mortality 3

Childhood-onset SLE is associated with a higher incidence of lupus nephritis and more severe disease than adult-onset SLE 3
The incidence of lupus nephritis varies by race/ethnicity and age 3
Higher index of suspicion should be maintained for patients of Asian, African/Caribbean, and Hispanic descent 3

Pneumococcal vaccination is recommended due to the high risk of pneumococcal infection in SLE patients 2
Hydroxychloroquine treatment reduces flares and organ damage accrual 4

Regular assessment of kidney function with serum creatinine, urinalysis, proteinuria, and blood pressure measurements 5
Monitoring of anti-dsDNA antibody titers and complement levels as they may correlate with disease activity 5
Vigilance for symptoms and signs suggestive of kidney involvement 6
Regular screening for co-morbidities including infections, atherosclerosis, hypertension, dyslipidemia, diabetes, and osteoporosis 7