RESEARCH - In SLE, renal damage is the most important predictor of mortality within the damage index: LUMINA LXIV

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Rheumatology Advance Access published online on February 20, 2009

Rheumatology, doi:10.1093/rheumatology/kep012

Renal damage is the most important predictor of mortality within the

damage index: data from LUMINA LXIV, a multiethnic US cohort

I. Danila1,*, Guillermo J. Pons-Estel1,*, Jie Zhang1, M.

Vilá2, D. Reveille3 and Graciela S. Alarcón1,4

1Department of Medicine, Division of Clinical Immunology and

Rheumatology, Schools of Medicine and Public Health, The University of

Alabama at Birmingham, Birmingham, AL, USA, 2Department of Medicine,

Division of Rheumatology, The University of Puerto Rico Medical

Sciences Campus, San , Puerto Rico, 3Department of Medicine,

Division of Rheumatology, The University of Texas Health Science

Center at Houston, Houston, TX and 4Department of Epidemiology,

Schools of Medicine and Public Health, The University of Alabama at

Birmingham, Birmingham, AL, USA.

Abstract

Objective. Damage accrual in SLE has been previously shown to be an

independent predictor of mortality. We sought to discern which SLICC

Damage Index (SDI) domains are the most important predictors of

survival in SLE.

Methods. SLE patients (ACR criteria), age 16 years, disease duration 5

years at enrolment, of African–American, Hispanic or Caucasian

ethnicity were studied. Disease activity was assessed using the

SLAM-Revised (SLAM-R) at diagnosis. Damage was ascertained using the

SDI at the last visit. The SDI domains associated with time to death

(and interaction terms) were examined by univariable and multivariable

proportional hazards regression analyses; those significant in the

multivariable analyses were added to the final two models (with and

without poverty) that included other variables known to be associated

with shorter survival.

Results. A total of 635 SLE patients were studied of whom 97 (15.3%)

have died over a mean (S.D.) total disease duration of 5.7 (3.7)

years. Patients were predominantly women [570 (89.8%)]; their mean

(S.D.) age was 36.5 (12.6) years; 126 (19.8%) had developed renal

damage, 62 (9.3%) cardiovascular, 48 (7.8%) pulmonary and 34 (5.4%)

peripheral vascular damage. When excluding poverty from the

multivariable model, the renal domain of the SDI was independently

associated with a shorter time to death (hazard ratio = 1.65; 95% CI

1.03, 2.66).

Conclusions. The renal domain of the damage index is associated with a

shorter time to death when poverty, a strong predictor of this

outcome, is removed from the model. Preventing renal damage in lupus

patients has long-term prognostic implications.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kep012v1?papetoc

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