Overall and cause-specific mortality in systemic lupus erythematosus: An updated meta-analysis

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Abstract

Aims This study aimed to assess all-cause and cause-specific standardized mortality ratios (SMRs) in patients with systemic lupus erythematosus (SLE). Methods We surveyed studies examining all-cause and/or cause-specific SMR in patients with SLE compared to the general population using PUBMED, EMBASE and Cochrane databases and manual searches. We performed a meta-analysis of all-cause, sex-specific, ethnicity-specific, and cause-specific SMRs in SLE patients. Results Fifteen reports including 26,101 patients with SLE with 4640 deaths met the inclusion criteria. Compared to the general population, all-cause SMR was significantly increased 2.6-fold in patients with SLE (SMR 2.663, 95% CI 2.090-3.393, p < 1.0 × 10-8). Stratification by ethnicity showed that all-cause SMR was 2.721 (95% CI 1.867-3.966, p = 1.9 × 10-6) in Caucasians and 2.587 (95% CI 1.475-4.535, p = 0.001) in Asians. Sex-specific meta-analysis revealed that all-cause SMR was 3.141 (95% CI 2.351-4.198, p < 1.0 × 10-8) for women and 3.516 (95% CI 2.928-4.221, p < 1.0 × 10-8) for men. The risk of mortality was significantly increased for mortality due to renal disease (SMR 4.689, 95% CI 2.357-9.330, p = 1.10 × 10-5), cardiovascular disease (CVD) (SMR 2.253, 95% CI 1.304-3.892, p = 0.004), and infection (SMR 4.980, 95% CI 3.876-6.398, p < 1.0 × 10-8), although there was no significant increase in SMR for mortality due to cancer (SMR 1.163, 95% CI 0.572-2.363, p = 0.676). Conclusions Patients with SLE had higher rates of death from all causes, regardless of sex, ethnicity, renal disease, CVD or infection. However, the risk of death due to malignancy was not increased.

Original languageEnglish
Pages (from-to)727-734
Number of pages8
JournalLupus
Volume25
Issue number7
DOIs
Publication statusPublished - 2015 Jan 1

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Systemic Lupus Erythematosus
Meta-Analysis
Mortality
Cardiovascular Diseases
Cardiovascular Infections
Kidney
Population
Cause of Death
Neoplasms

Keywords

  • meta-analysis
  • mortality
  • SLE

ASJC Scopus subject areas

  • Rheumatology

Cite this

@article{970f2519b6dd4877a44228c69431a37c,
title = "Overall and cause-specific mortality in systemic lupus erythematosus: An updated meta-analysis",
abstract = "Aims This study aimed to assess all-cause and cause-specific standardized mortality ratios (SMRs) in patients with systemic lupus erythematosus (SLE). Methods We surveyed studies examining all-cause and/or cause-specific SMR in patients with SLE compared to the general population using PUBMED, EMBASE and Cochrane databases and manual searches. We performed a meta-analysis of all-cause, sex-specific, ethnicity-specific, and cause-specific SMRs in SLE patients. Results Fifteen reports including 26,101 patients with SLE with 4640 deaths met the inclusion criteria. Compared to the general population, all-cause SMR was significantly increased 2.6-fold in patients with SLE (SMR 2.663, 95{\%} CI 2.090-3.393, p < 1.0 × 10-8). Stratification by ethnicity showed that all-cause SMR was 2.721 (95{\%} CI 1.867-3.966, p = 1.9 × 10-6) in Caucasians and 2.587 (95{\%} CI 1.475-4.535, p = 0.001) in Asians. Sex-specific meta-analysis revealed that all-cause SMR was 3.141 (95{\%} CI 2.351-4.198, p < 1.0 × 10-8) for women and 3.516 (95{\%} CI 2.928-4.221, p < 1.0 × 10-8) for men. The risk of mortality was significantly increased for mortality due to renal disease (SMR 4.689, 95{\%} CI 2.357-9.330, p = 1.10 × 10-5), cardiovascular disease (CVD) (SMR 2.253, 95{\%} CI 1.304-3.892, p = 0.004), and infection (SMR 4.980, 95{\%} CI 3.876-6.398, p < 1.0 × 10-8), although there was no significant increase in SMR for mortality due to cancer (SMR 1.163, 95{\%} CI 0.572-2.363, p = 0.676). Conclusions Patients with SLE had higher rates of death from all causes, regardless of sex, ethnicity, renal disease, CVD or infection. However, the risk of death due to malignancy was not increased.",
keywords = "meta-analysis, mortality, SLE",
author = "Lee, {Young Ho} and Sungjae Choi and Ji, {Jong Dae} and Song, {Gwan Gyu}",
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T1 - Overall and cause-specific mortality in systemic lupus erythematosus

T2 - An updated meta-analysis

AU - Lee, Young Ho

AU - Choi, Sungjae

AU - Ji, Jong Dae

AU - Song, Gwan Gyu

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Aims This study aimed to assess all-cause and cause-specific standardized mortality ratios (SMRs) in patients with systemic lupus erythematosus (SLE). Methods We surveyed studies examining all-cause and/or cause-specific SMR in patients with SLE compared to the general population using PUBMED, EMBASE and Cochrane databases and manual searches. We performed a meta-analysis of all-cause, sex-specific, ethnicity-specific, and cause-specific SMRs in SLE patients. Results Fifteen reports including 26,101 patients with SLE with 4640 deaths met the inclusion criteria. Compared to the general population, all-cause SMR was significantly increased 2.6-fold in patients with SLE (SMR 2.663, 95% CI 2.090-3.393, p < 1.0 × 10-8). Stratification by ethnicity showed that all-cause SMR was 2.721 (95% CI 1.867-3.966, p = 1.9 × 10-6) in Caucasians and 2.587 (95% CI 1.475-4.535, p = 0.001) in Asians. Sex-specific meta-analysis revealed that all-cause SMR was 3.141 (95% CI 2.351-4.198, p < 1.0 × 10-8) for women and 3.516 (95% CI 2.928-4.221, p < 1.0 × 10-8) for men. The risk of mortality was significantly increased for mortality due to renal disease (SMR 4.689, 95% CI 2.357-9.330, p = 1.10 × 10-5), cardiovascular disease (CVD) (SMR 2.253, 95% CI 1.304-3.892, p = 0.004), and infection (SMR 4.980, 95% CI 3.876-6.398, p < 1.0 × 10-8), although there was no significant increase in SMR for mortality due to cancer (SMR 1.163, 95% CI 0.572-2.363, p = 0.676). Conclusions Patients with SLE had higher rates of death from all causes, regardless of sex, ethnicity, renal disease, CVD or infection. However, the risk of death due to malignancy was not increased.

AB - Aims This study aimed to assess all-cause and cause-specific standardized mortality ratios (SMRs) in patients with systemic lupus erythematosus (SLE). Methods We surveyed studies examining all-cause and/or cause-specific SMR in patients with SLE compared to the general population using PUBMED, EMBASE and Cochrane databases and manual searches. We performed a meta-analysis of all-cause, sex-specific, ethnicity-specific, and cause-specific SMRs in SLE patients. Results Fifteen reports including 26,101 patients with SLE with 4640 deaths met the inclusion criteria. Compared to the general population, all-cause SMR was significantly increased 2.6-fold in patients with SLE (SMR 2.663, 95% CI 2.090-3.393, p < 1.0 × 10-8). Stratification by ethnicity showed that all-cause SMR was 2.721 (95% CI 1.867-3.966, p = 1.9 × 10-6) in Caucasians and 2.587 (95% CI 1.475-4.535, p = 0.001) in Asians. Sex-specific meta-analysis revealed that all-cause SMR was 3.141 (95% CI 2.351-4.198, p < 1.0 × 10-8) for women and 3.516 (95% CI 2.928-4.221, p < 1.0 × 10-8) for men. The risk of mortality was significantly increased for mortality due to renal disease (SMR 4.689, 95% CI 2.357-9.330, p = 1.10 × 10-5), cardiovascular disease (CVD) (SMR 2.253, 95% CI 1.304-3.892, p = 0.004), and infection (SMR 4.980, 95% CI 3.876-6.398, p < 1.0 × 10-8), although there was no significant increase in SMR for mortality due to cancer (SMR 1.163, 95% CI 0.572-2.363, p = 0.676). Conclusions Patients with SLE had higher rates of death from all causes, regardless of sex, ethnicity, renal disease, CVD or infection. However, the risk of death due to malignancy was not increased.

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