Analiza uzroka smrti u bolesnika sa sistemskim eritemskim lupusom praćenih u tercijarnom bolničkom centru tijekom desetogodišnjega razdoblja od 2002. - 2011. [Analysis of cause of death of patients with systemic lupus erythematosus followed-up in a tertiary hospital center during a ten-year period (2002-2011)]

Padjen, Ivan (2016) Analiza uzroka smrti u bolesnika sa sistemskim eritemskim lupusom praćenih u tercijarnom bolničkom centru tijekom desetogodišnjega razdoblja od 2002. - 2011. [Analysis of cause of death of patients with systemic lupus erythematosus followed-up in a tertiary hospital center during a ten-year period (2002-2011)]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Introduction: Five- and ten-year survival of patients with systemic lupus erythematosus (SLE) increased to ˃90% within the last 50 years. Causes of death and survival are important indicators of treatment efficacy in SLE patients. No data are available on causes of death and survival of SLE patients in Croatia and neighboring countries. Hypothesis: Frequencies of categories of causes of death differ between early and late death. Aim: Analysis of disease characteristics and causes of death of patients deceased within the 2002-2011 period, and analysis of survival of patients diagnosed over the same period. Patients and methods: Characteristics of deceased patients fulfilling ≥4 classification criteria of the American Colege of Rheumatology (ACR) were analyzed. Demographics, classification criteria, damage and causes of death were compared between patients deceased early and late in their disease course. Survival analysis was performed in an inception cohort of patients diagnosed within 2002-2011. Results: 90 deceased patients were identified. Patients deceased earlier were diagnosed at a later age. The most frequent classification criteria were antinuclear antibodies, immunological and hematological disorder, with no difference between patients deceased early and late. At time of death the damage index was 4.9±3.2. The most frequent damage categories were musculoskeletal, cardiovascular and neuropsychiatric damage. Causes of death were: cardiovascular diseases (40%), infections (33%), active SLE (29%), malignant disease (17%) and other causes (11%). There was no difference between the frequencies of causes of early and late death, except for stroke, which caused only late death. Five- and ten-year survival in the inception cohort (185 non-deceased, 28 deceased patients) was 91% and 80.5%, respectively. Diagnosis at a later age, neuropsychiatric and renal disorder, as well as serositis were identified as predictors of death. Conclusion: No difference was observed in the frequencies of causes of early and late death, with the exception of stroke which only caused late death. The five-year survival is similar to survival observed in developed countries, while ten-year survival is unexpectedly lower.

Abstract in Croatian

Uvod: Petogodišnje i desetogodišnje preživljenje bolesnika sa sistemskim eritemskim lupusom (SLE) povisilo se na ˃90% unatrag 50-ak godina. Uzroci smrti i preživljenje važan su pokazatelj uspjeha liječenja bolesnika sa SLE-om. Nema dostupnih podataka o uzrocima smrti i preživljenju bolesnika sa SLE-om u Hrvatskoj i susjednim zemljama. Hipoteza: Frekvencije kategorija uzroka smrti razlikuju se između rane i kasne smrti. Cilj: Analiza obilježja bolesti i uzroka smrti bolesnika umrlih u razdoblju 2002.-2011. te analiza preživljenja bolesnika kojima je dijagnoza postavljena u tom razdoblju. Ispitanici i metode: Analizirana su obilježja umrlih bolesnika koji ispunjavaju ≥4 klasifikacijska kriterija Američkog društva za reumatologiju (ACR). Demografska obilježja, klasifikacijski kriteriji, oštećenje i uzroci smrti uspoređeni su između bolesnika umrlih ranom i kasnom smrću. Provedena je analiza preživljenja u incepcijskoj kohorti bolesnika kojima je dijagnoza postavljena u razdoblju 2002.-2011. Rezultati: Utvrđeno je 90 umrlih bolesnika. Bolesnici umrli ranije dijagnosticirani su u kasnijoj životnoj dobi. Najčešći klasifikacijski kriteriji su antinuklearna protutijela, imunološki i hematološki poremećaj, bez razlike između bolesnika umrlih ranom i kasnom smrću. Indeks oštećenja u trenutku smrti iznosi 4,9±3,2. Najčešće zabilježene kategorije oštećenja su: muskuloskeletno, kardiovaskularno i neuropsihijatrijsko oštećenje. Uzroci smrti su: kardiovaskularne bolesti (40%), infekcije (33%), aktivni SLE (29%), maligne bolesti (17%), ostali uzroci (11%). Nije zabilježena razlika u učestalosti uzroka rane i kasne smrti osim u slučaju moždanog udara koji je uzrokovao isključivo kasnu smrt. Petogodišnje preživljenje u incepcijskoj kohorti (185 živih, 28 umrlih bolesnika) iznosi 91%, a desetogodišnje 80,5%. Dijagnoza u starijoj dobi, neuropsihijatrijski i bubrežni poremećaj te serozitis utvrđeni su kao prediktori smrti. Zaključak: Nije zabilježena razlika u učestalosti uzroka rane i kasne smrti osim u slučaju moždanog udara koji je isključivo uzrok kasne smrti. Petogodišnje preživljenje slično je vrijednostima u razvijenim zemljama, dok je desetogodišnje neočekivano niže.

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